Ala. Admin. Code ch. 420-5-4

Assisted Living Facilities

This chapter establishes the licensing and operating standards for assisted living facilities in Alabama, covering all facility classifications (group, congregate, specialty care, and family). Operators must obtain and maintain a license from the Alabama State Board of Health, comply with requirements for administration, personnel, resident care, physical environment, and safety, and adhere to procedures for license renewal, change of ownership, and revocation. The rules govern the full lifecycle of facility licensure, including application, inspection, enforcement, and appeal rights.

ALABAMA STATE COMMITTEE OF PUBLIC HEALTHALABAMA DEPARTMENT OF PUBLIC HEALTHDIVISION OF LICENSURE AND CERTIFICATIONADMINISTRATIVE CODE 
CHAPTER 420-5-4ASSISTED LIVING FACILITIES
TABLE OF CONTENTS
420-5-4-.01 General420-5-4-.02 The License420-5-4-.03 Administration420-5-4-.04 Personnel420-5-4-.05 Records And Reports420-5-4-.06 Care Of Residents420-5-4-.07 Food Service420-5-4-.08 Physical Facilities420-5-4-.09 Laundry420-5-4-.10 Sanitation And Housekeeping420-5-4-.11 Fire And Safety420-5-4-.12 Physical Environment420-5-4-.03 (Repealed)Classification Of AssistedLiving Facilities420-5-4-.07 (Repealed)Storage of Drugs and Medicines420-5-4-A Appendix A Code of Ala. 1975,Sections 22-21-20, et seq.
420-5-4-.01 General.
(1) Legal Authorityfor Adoption of Rules. Under and by virtue ofthe authority vested in it by the Legislature of Alabama, Code ofAla. 1975, Sections 22-21-20, et seq., the Alabama State Board ofHealth does hereby adopt and promulgate the following Rulesgoverning all assisted living facilities.
(2) Definitions.
(a) "Advisory Board" means the Licensure Advisory Boardestablished by law to serve as consultants to the State HealthOfficer and to assist in rule making necessary to carry outthe provisions of Code of Ala. 1975, Section 22-21-20, et seq.
(b) “Assisted Living Facility” means an individual,individuals, corporation, partnership, limited partnership,limited liability company or any other entity that provides,or offers to provide, any combination of residence, healthsupervision, and personal care to three or more individualswho are in need of assistance with activities of daily living
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which include bathing, dressing, ambulation, feeding,toileting, grooming, medication assistance, diet, and personalsafety. Exceptions to this definition are:
1. Individuals who provide residential and personal careservices solely to persons to whom they are personallyrelated, shall not be deemed to be an assisted livingfacility. “Personally related” means that the personreceiving the residential and personal care services isthe spouse, parent, sibling, adult child, adultgrandchild, grandparent, great-grandparent, adult niece,adult nephew, aunt, uncle, or first cousin of the personproviding such services, or stands in that relation tothe current spouse of the person providing the services.This exception is only for individuals, and does notapply to corporations, partnerships, limitedpartnerships, limited liability companies, or any otherorganized entity or business.
2. Facilities whose residents are under the care,oversight or protection of another governmental agencyshall not be deemed to be assisted living facilities andshall not be subject to these rules, if both of thefollowing conditions are satisfied:
(i) A federal, state, or other governmental body,agency, or authority has a fiduciary relationship orsome other legally recognized and enforceablerelationship to the residents of the facility whichcarries an obligation to oversee the health, safety,and welfare of the residents; and
(ii) The federal, state, or other governmental body,agency, or authority licenses, certifies, orotherwise legally authorizes the facility to provideaccommodations and care for the residents.
(c) “Abuse” means the willful infliction of injury,unreasonable confinement, intimidation, or punishment withresulting physical harm, pain, or mental anguish. Abuse shallalso include mental abuse, physical abuse, sexual abuse, andverbal abuse, as defined below.
(1) “Mental Abuse” means any willful act directed at aresident that is intended to result in or that is likelyto result in mental distress or mental anguish. Itincludes humiliation, harassment, threats of punishment,and threats of deprivation.
(2) “Physical Abuse” means any willful act directed at aresident that is intended to result in or that is likelyto result in injury or pain. Physical abuse includes
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slapping, pinching, kicking, shoving, and corporalpunishment of any kind.
(3) “Sexual Abuse” means any sexually oriented behaviordirected at a resident by a staff member, any sexuallyoriented behavior between residents that is not fully andfreely consented to by both residents involved, anysexually oriented behavior between residents when eitheror both residents are incapable of consenting to thebehavior, or any sexually oriented behavior by a visitordirected at a resident incapable of consenting to thebehavior.
(4) “Verbal Abuse” means the use of oral, written, orgestured language that willfully includes disparaging orderogatory terms to residents or their families, or thatis used or uttered within the hearing distance ofresidents or their families, regardless of their age,ability to comprehend, or disability. Examples of verbalabuse include threats of harm, or saying things tofrighten a resident; such as telling a resident that theresident will never see his or her family again.
(d) "Bed Capacity" means the maximum number of beds which canbe installed or set up in an assisted living facility at anygiven time for use of residents. The bed capacity shall bebased upon space designed or specifically intended for suchuse, whether or not the beds are actually installed.
(e) "Bed Complement" means the number of beds normallyinstalled in an assisted living facility for use of theresidents.
(f) "Board,” or “State Board of Health," means the AlabamaState Board of Health.
(g) “Bureau” means the Bureau of Health Provider Standards,Alabama Department of Public Health.
(h) “Closure” means that the facility has no current occupantswhich are classified as residents of the facility and is notaccepting and admitting new residents.
(i) “Congregate Assisted Living Facility" means an assistedliving facility authorized to care for 17 or more adults.
(j) "Department" means the Alabama Department of PublicHealth.
(k) “Elopement” means a resident who is incapable ofprotecting himself or herself from harm is able tosuccessfully leave a safe area or safe premises.
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(l) “Exploitation” means the deliberate misplacement orwrongful temporary or permanent use of a resident’sbelongings, money, or property without the resident’s consent.
(m) "Family Assisted Living Facility" means an assisted livingfacility authorized to care for two or three adults, which waslicensed prior to October 1, 2015. Family assisted livingfacilities currently licensed may renew their license yearlybut if closed for any reason, may not be relicensed as afamily assisted living facility. No new license will begranted for assisted living facilities of fewer than threebeds.
(n) "Group Assisted Living Facility" means an assisted livingfacility authorized to care for 3 to 16 adults.
(o) "License" means the legal authority granted by the StateBoard of Health to operate a facility.
(p) "License Certificate" means the document issued by theState Board of Health and signed by the State Health Officerthat constitutes rebuttable evidence of the facility's legalauthority to operate.
(q) “Licensed Bed Capacity” means the number of beds for whichthe facility has been issued a certificate of licensure by theDepartment. The Licensed Bed Capacity is also the maximumdaily census that an assisted living facility may have in itscapacity.
(r) "Licensed Practical Nurse" (LPN) means a person currentlylicensed as a Licensed Practical Nurse by the State of AlabamaBoard of Nursing in accordance with Code of Ala. 1975,Sections 34-21-1, et seq.
(s) “Mechanical Restraint” means any manual method or physicalor mechanical device, material, or equipment that the residentcannot remove which restricts freedom of movement or normalaccess to one’s body (e.g. leg restraints, arm restraints,hand mitts, soft ties or vests, lap cushions, and lap trays).Facility practices that meet the definition of a restraintinclude, but are not limited to: using side rails that keep aresident from voluntarily getting out of bed; tucking in,tying, or using devices or materials to hold a sheet, fabric,or clothing tightly so that a resident’s movement isrestricted; using devices in conjunction with a chair, such astrays, tables, bars, or belts that the resident cannot remove,that prevent the resident from rising; placing a resident in achair that prevents the resident from rising; and placing achair or bed so close to a structure that the structureprevents the resident from rising out of the chair orvoluntarily getting out of bed.
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(t) “Medication" means all substances having medicinalproperties intended for external and/or internal use for thetreatment, prevention, diagnosing, or curing of any disease,illness, malady, etc., in humans. The term "medication" asdefined in the Pharmacological Basis of Therapeutics shallencompass all other synonymous terms such as drugs,biologicals, chemicals, potions, remedies, or poisons.
(u) “Medication Administration” means the act of givingmedications to residents by a nurse or physician as defined inthese rules.
(v) “Medication Error” means any preventable event that causesor leads to inappropriate medication use or harm whilemedication is in the control of the assisted living facilitystaff or resident.”
(w) “Neglect” means the failure to provide goods and servicesnecessary to avoid physical harm or mental distress oranguish.
(x) "Pharmacist" means a person currently licensed to practicepharmacy in Alabama under the provisions of Code of Ala. 1975,Sections 34-23-1, et seq.
(y) "Physician" means a person currently licensed by theMedical Licensure Commission of Alabama to practice medicineand surgery in Alabama. The use of the word, “physician” inthese rules shall not be deemed to preclude a properlylicensed nurse practitioner or a physician assistant fromperforming any function in an assisted living facility that iswithin that individual’s scope of practice.
(z) “Qualified Dietitian” means a person who is currentlylicensed in the State of Alabama in accordance with theprovisions contained in current state statutes as governed bythe Board of Examiners for Dietetic/Nutrition Practice.
(aa) "Registered Professional Nurse” (RN) means a personcurrently licensed as a Registered Professional Nurse by theState of Alabama Board of Nursing in accordance with Code ofAla. 1975, Section 34-21-21.
(bb) “Resident” means any individual in need of assistancewith activities of daily living that receives residence,health supervision, or personal care in an assisted livingfacility.
(cc) "Specialty Care Assisted Living Facility" means afacility that meets the definition of an assisted livingfacility but which is specially licensed and staffed to permitit to care for residents with a degree of cognitive impairment
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that would ordinarily make them ineligible for admission orcontinued stay in an assisted living facility.
(3) Procedure Governing Adoption, Amendment, and Rescission ofRules.
(a) Authority. The State Board of Health, with the advice andapproval of the Advisory Board defined in Code of Ala. 1975,Section 22-21-27, has the legal authority to adopt, reasonablerules governing the operation and conduct of assisted livingfacilities, and it may amend or rescind any rules previouslyadopted.
(b) Procedure. In adopting, amending, or rescinding rules, theBoard shall follow the provisions of the AlabamaAdministrative Procedure Act. The effective date of any rulesadopted, amended, or rescinded shall likewise be governed bythe Administrative Procedure Act.
(c) Joint Hearings. All hearings shall be joint hearings setby the State Board of Health and the Advisory Board, at whichtime any interested member of the public may be heard.
(4) Inspections.
(a) Inspections Required. Each assisted living facility forwhich a license has been granted may be inspected by the StateBoard of Health, or by its authorized representatives at suchintervals as the Board may direct. The State Board of Healthand its authorized representatives may inspect constructionwork including new facilities, additions, and alterations atany time the construction work is in progress or after it hasbeen completed.
(b) Information Disclosure. Official reports, such asstatements of deficiencies generated by the State Board ofHealth as a result of on-site inspections, and plans ofcorrection submitted in response to those statements ofdeficiencies, are subject to public disclosure. Informationreceived through other means and reports other than statementsof deficiencies shall be deemed to be confidential and shallnot be publicly disclosed except in response to a validsubpoena or court order or in proceedings involving theaffected facility's license or proceedings involving thelicense of another facility operated by the same governingauthority. Confidential records in the possession of theDepartment are deemed to be records in the possession of theState of Alabama, and shall be freely shared with any otherState of Alabama agency that presents a good reason for accessto the records.
(5) Closures.
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(a) Facility closures which are temporary or less than 30 daysin length must be reported to the Department in advance andauthorized. Such closures do not result in automatictermination of the facility license.
(b) Facility closures of greater than 30 days, unlessauthorized by the Department, will result in the licensebecoming null and void. Any owner or operator wishing toreopen the facility as an assisted living facility shall berequired to file an initial licensure application to includeplan review and building inspection and obtain a certificateof completion before processing of the application by theDepartment.Author: Rick Harris, Kelley Mitchell, Walter GearyStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History: Filed November 20, 1991. Repealed and New Rule: FiledOctober 18, 2001; effective November 22, 2001. Amended: FiledJune 21, 2006; effective July 26, 2006. Amended: Filed March 21,2007; effective April 25, 2007. Amended: Filed August 20, 2015;effective September 24, 2015; operative October 1, 2015. Repealedand New Rule: Filed February 20, 2019; effective April 7, 2019.
420-5-4-.02 The License.
(1) Classifications of Licenses. All licenses are granted for thecalendar year and shall expire on December 31 unless renewed bythe owner for the succeeding year.
(a) Regular License. A regular license shall be granted by theState Board of Health upon a determination by the Board or itsauthorized agents that the operator or operators of theassisted living facility are willing and capable of achievingand maintaining substantial compliance with the rules hereinadopted.
(b) Probational License. At its discretion, the Board maygrant a probational license when it determines that thefollowing conditions exist:
1. The facility has engaged in one or more deficientpractices which are serious in nature, chronic in nature,or which the facility has failed to correct.
2. The facility’s current governing authority hasdemonstrated the capability and willingness to correctcited problems and to maintain compliance.
3. This license shall be granted when the Board issatisfied that the health and safety of residents willnot be endangered during this period. Maximum length oftime for probationary status is one year.
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(c) A facility on probation may not add additional beds duringthe probational period.
(2) Application.
(a) An applicant for initial licensure shall provide allinformation on the application form prescribed by theDepartment, including all information required by law, theserules, and the policies and procedures of the Department, andshall submit such additional information as shall be requiredby the Department in its discretion to demonstrate that theapplicant has the ability and the willingness to comply withthese rules. Each application shall be signed by theapplicant, if the applicant is a natural person, or if theapplicant is not a natural person, shall be signed by anatural person who is authorized to bind the applicant to therepresentations in the application and any supportingdocumentation.
(b) Fee. An initial license application, an application forlicense renewal, an application for an increase in the numberof licensed beds, or an application for a change in ownership,shall be accompanied by the application fee as specified in§22-21-24, Code of Ala. 1975. Fees shall be paid by cash,check, or money order made payable to the Alabama Departmentof Public Health. An application for a name change, anapplication for a decrease in licensed bed capacity, or anapplication for a relocation is not subject to a licenseapplication fee. An application fee is non-refundable. Anyapplication fee submitted in the incorrect amount shallnevertheless be deposited. If the fee submitted is too large,a refund for the difference shall be processed using theDepartment’s usual procedures. If the fee submitted is toosmall, the applicant shall be notified and the applicationshall not be considered until the difference is received. Anyapplication submitted without any fee shall be returned to theapplicant. If an incomplete application is submitted, theapplication fee shall be deposited, and the applicant shall benotified in writing of the defects in the application. If theapplicant fails to submit all required additional informationwithin 10 working days of the date of the notice, theapplication shall be denied. The Department may in itsdiscretion extend the deadline for submitting additionalinformation. Denial of an application as incomplete shall notprejudice the applicant from submitting a new application,accompanied by the requisite fee, at a future date.
(c) Name of Assisted Living Facility. Each assisted livingfacility shall be designated by a permanent, distinctive, andunique name which shall be used in applying for a license andwhich shall not be changed without first notifying the Boardin writing. A notice of name change shall specify the name tobe discontinued as well as the new name. The words "hospital,"
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"nursing home," “clinic,” “sanatorium,” “specialty carefacility,” “dementia care facility,” “impaired memory unit,”“Alzheimer's care facility,” or any other term which wouldindicate that the facility is a different type of facilityshall not be used as the name of an assisted living facility.An assisted living facility shall use its licensed name on allstationary, all signage, and on all other material that may bevisible to the public, to residents of the facility, or tofamilies of residents. An assisted living facility shall nothold itself out to the public as having a name other than itslicensed name. No facility shall hold itself out to the publicas an assisted living facility unless the facility has acurrent, valid license as an assisted living facility.
(d) Number of Beds. Each application for license and licenserenewal shall specify the bed capacity of the assisted livingfacility. In the event of a natural disaster or othercatastrophic emergency, the Department may grant a temporarybed increase to any facility for reasons of public health orpublic safety. A temporary bed increase may be granted onlyfor a specified number and shall expire by its terms after aspecific, finite period of time.
(3) License. If an applicant submits a timely and completeapplication accompanied by the appropriate license fee and anysupporting documentation that may be required by the Department,and if the Department is satisfied that the applicant is likelywilling and capable of compliance with these rules, and ifgranting such a license would not violate any other state orfederal law or regulation, then the Department, as agent for theBoard, may grant a license to the applicant. All licenses grantedshall expire at midnight on December 31 of the year in which thelicense is granted. The Department, as agent for the Board, maydeny a license. A license shall only be valid at the licensedpremises and for the individual or business entity licensed. It isa condition of licensure that the licensee must continuouslyoccupy the licensed premises and remain open as an assisted livingfacility, fully staffed and otherwise capable of admitting andproviding assisted living services. If a facility fails to remainopen and staffed as required for a period of 30 days, its licenseshall become void unless the Department has been notified thatservices are temporarily suspended for remodeling or minoralterations. If a licensee abandons the licensed premises, thelicense shall immediately become void.
(a) Issuance of License Certificate. The license certificateissued by the State Board of Health shall set forth the nameand location of the assisted living facility, theclassification of the assisted living facility, and thefacility's bed capacity.
(b) Separate Licenses. Each assisted living facility shall beseparately licensed, regardless of whether it is owned or
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managed by the same entity as another assisted livingfacility.
(c) Posting of License Certificate. The license certificateshall be posted in a conspicuous place on the licensedpremises.
(d) License Renewal. Licenses may be renewed by the applicantas a matter of course upon submission of a completed renewalapplication and payment of the required fee. When theDepartment has served written notice on the facility of itsintent to revoke or downgrade the license, a renewalapplication shall be filed but does not affect the proposedadverse licensure action.
(e) Failure to Renew a License. Any licensee who fails torenew a license on or before the close of business on the lastbusiness day in December shall be assessed a late fee equal tothe amount of the original license fee. A license may only berenewed with the payment of a late fee before the close ofbusiness on the last business day in January of the succeedingcalendar year. A license which has not been renewed by the endof January has expired and shall be void.
(f) Change of Ownership. An assisted living facility licenseis not transferrable. In the event that the legal ownership ofthe right to occupy a facility’s premises is withdrawn ortransferred to an individual or entity other than thelicensee, the facility license shall become void and continuedoperation of the facility shall be unlawful pursuant to§22-21-22, Code of Ala. 1975, and subject to penalties asprovided in §22-21-33, Code of Ala. 1975, unless anapplication for a change of ownership has been submitted toand approved by the Department prior to the transfer of legalownership. At least 30 days prior to any proposed change inownership, the new prospective licensee of an assisted livingfacility shall file a change of ownership application with theState Board of Health. An application for change of ownershipshall be submitted on the form prescribed by the Department,shall be accompanied by the requisite application fee setforth in §22-21-24, Code of Ala. 1975, and shall be subject tothe same requirements and considerations as are set forthabove for initial license applications. An application for achange of ownership shall be submitted and signed by theprospective new licensee, or its agent, and also either signedby the current licensee or its agent, or accompanied by acourt order demonstrating that the current licensee has beendispossessed of the legal right to occupy the premises andthat the prospective new licensee has been awarded the legalright to occupy the premises. Upon approval of a change ofownership, the Department shall notify the current licenseeand the new license applicant, and shall issue a licensecertificate to the new licensee.
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Indicia of ownership of a facility include the right to hire,terminate, and to determine the compensation and benefits paidto the facility’s administrator and other staff; the right toreceive payment from residents and third parties for servicesprovided by the facility; the right to establish and to changethe policies, procedures, and protocols under which thefacility operates; and the right to overrule operationaldecisions made by the facility administrator and other staff.
(g) Change in Bed Capacity. A facility may apply for a changein licensed bed capacity by submitting a completed applicationon a form prescribed by the Department and accompanied by thefee prescribed in §22-21-24, Code of Ala. 1975, together withsuch other documentation as the Department may require. Uponapproval of a change of bed capacity, the Department shallnotify the licensee and shall issue a revised licensecertificate to the licensee, which may be predicated on thereturn of the old license certificate.
(h) Change of Name. A facility may apply for a change of nameby submitting a completed application on a form prescribed bythe Department. There is no application fee for a change ofname application. The Department may in its discretion deny anapplication for a change of name if the Department determinesthat the proposed name is misleading to the public or that thename is overly similar to the name of an already licensedfacility. Separately licensed facilities owned by the samegoverning authority may have names that are similar to oneanother and distinguished from one another in some othermanner, such as a geographic description. Upon approval of achange of name, the Department shall notify the licensee andshall issue a revised license certificate to the licensee,which may be predicated on the return of the old licensecertificate.
(i) Denial of a License. The Board may deny a license to anyapplicant on grounds of insufficient evidence of thewillingness or ability to comply with §§22-21-20 through22-21-34, Code of Ala. 1975, or these rules, including thefollowing reasons:
1. The applicant or any principal associated with theapplicant has violated any provision of §§22-21-20through 22-21-34, Code of Ala. 1975.
2. The applicant or any principal associated with theapplicant has been convicted of engaging in, permitting,aiding, or abetting the commission of an illegal act inany licensed health care facility.
3. The applicant or any principal associated with theapplicant has engaged in conduct or practices deemed by
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the Board to be detrimental to the welfare of theresidents of the health care facility.
4. Conduct and practices deemed detrimental to thewelfare of residents of a facility or provide groundspursuant to this subsection for denial of a licenseinclude:
(i) The applicant or an agent authorized by theapplicant has deliberately falsified any materialinformation or record submitted as part of theapplication for licensure.
(ii) The applicant has changed its corporate name,charter, entity, or its partnership name orcomposition to avoid the imposition of liens or courtaction.
(iii) The applicant or any principal associated withthe applicant has been convicted of engaging in thephysical, mental, or sexual abuse or in the financialexploitation of a patient or patients.
(iv) The applicant or any principal associated withthe applicant has operated a health care facility inAlabama or in any other jurisdiction in a manner thatresulted in one or more violations of applicable lawsor other requirements and as a result caused death,injury, disability, or serious risk of death, injury,or disability to any resident or patient of thefacility and such past conduct causes the Departmentto reasonably believe that granting a license to theapplicant would likely be detrimental to the life,health, or safety of prospective residents of thefacility for which licensure is sought.
(v) The applicant or any principal associated withthe applicant has been convicted of fraud in this orany other jurisdiction.
(vi) The applicant or any principal associated withthe applicant has in the past deliberately falsifiedrecords or has otherwise made a deliberate andmaterial misrepresentation of facts to an employee ofthe Department in an attempt to influence the outcomeof a survey or some other regulatory compliancedetermination by the Department.
(vii) The applicant or any principal associated withthe applicant has in the past induced or attempted toinduce a subordinate employee to falsify records orto otherwise make a deliberate and materialmisrepresentation of facts to an employee of the
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Department in an attempt to influence the outcome ofa survey or some other regulatory compliancedetermination by the Department.
(viii) The applicant or any principal associated withthe applicant is operating, or has in the pastoperated, an unlicensed health care facility.
(ix) The applicant or any principal associated withthe applicant has at any time been debarred fromparticipation in the Medicare or Medicaid programs.
(x) Other serious misconduct which, in the judgmentof the Board, poses a serious risk to patient healthor safety.
5. An applicant may appeal the denial of a licensepursuant to the provisions of the Alabama AdministrativeProcedure Act, §41-22-1, et seq., Code of Ala. 1975, andthe Board’s Rules for Hearing of Contested Cases, Chapter420-1-3, Ala. Admin. Code.
(4) Revocation of License.
(a) The State Board of Health may revoke or downgrade thelicense of an assisted living facility for any of thefollowing reasons:
1. Violation of any of the provisions of these rules.
2. Permitting, aiding, or abetting the commission of anyunlawful act in the assisted living facility.
3. Conduct or practices deemed by the State Board ofHealth to be detrimental to the lives, health, safety, orwelfare of the residents of the assisted living facility.Conduct and practices deemed detrimental to the welfareof residents of a facility include:
(i) The administrator of the facility, the governingauthority of a facility, or an agent authorized bythe governing authority of the facility hasdeliberately falsified any material information orrecord submitted as part of the application forlicensure or on a Department survey.
(ii) The facility or its governing authority haschanged its corporate name, charter, entity, or itspartnership name or composition to avoid theimposition of liens or court action.
(iii) The governing authority, any principalassociated with the governing authority, or the
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administrator has been found to have engaged in thephysical, mental, sexual, or verbal abuse or in thefinancial exploitation of a resident or residents ofthis facility or any other licensed health carefacility.
(iv) The facility has been operated in a manner thatresulted in one or more violations of applicable lawsor other requirements and as a result caused death,injury, disability, or serious risk of death, injury,or disability to any resident or residents of thefacility and such conduct causes the Department toreasonably believe that continued licensure of thefacility to its current governing authority wouldlikely be detrimental to the life, health, or safetyof residents of the facility.
(v) The facility is unable to meet its financialobligations and, as a result, its residents are atrisk, as evidenced by more than one utility cut-offnotice for non-payment, inadequate amounts food orsupplies, vendors placing the facility on cash ondelivery only status due to non-payment of priorinvoices, or the failure of banks to honor employeepayroll checks due to insufficient funds on deposit.
(vi) The governing authority or any principalassociated with the governing authority has beenfound to have committed fraud in this or any otherjurisdiction.
(vii) The governing authority or any principalassociated with the governing authority has falsifiedrecords or otherwise made a deliberate and materialmisrepresentation of facts to an employee of theDepartment in an attempt to influence the outcome ofa survey or some other regulatory compliancedetermination by the Department.
(viii) The governing authority or any principalassociated with the governing authority has inducedor attempted to induce a subordinate employee tofalsify records or to otherwise make a deliberate andmaterial misrepresentation of facts to an employee ofthe Department in an attempt to influence the outcomeof a survey or some other regulatory compliancedetermination by the Department.
(ix) The governing authority or any principalassociated with the governing authority is operating,or has in the past operated, an unlicensed healthcare facility.
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(x) Other serious misconduct or failure which, in thejudgment of the Board, poses a serious risk topatient health or safety.
4. Refusal by the owner or administrator to permit fullinspection or survey of the facility, to permit anyresident assessment or interview, or to permit a reviewof any records deemed necessary by the Department tofulfill a survey.
5. Failure by the facility to submit an acceptable planof correction for deficiencies cited by the Department.
(b) The proposed revocation of a license and downgrade oflicense shall be governed by the provisions of the AlabamaAdministrative Procedure Act, §41-22-1, et seq., Code of Ala.1975, and the Board’s Rules for Hearing of Contested Cases,Chapter 420-1-3, Ala. Admin. Code.
(i) Before any license to operate an assisted livingfacility is revoked or downgraded to probational status,written notice shall be given to the administrator of theassisted living facility, and may also be given to thegoverning authority, giving a brief explanation of thereason or reasons that the Board proposes to revoke ordowngrade the license. The written notice shall alsostate a time and place at which a hearing or other lawfuladministrative proceeding shall occur to determinewhether the license will be revoked or downgraded. Thedate of the hearing shall be not less than 30 days fromthe date of the notice. The notice shall be sent byregistered or certified mail to the administrator of thefacility as shown on the records of the Department, andshall be mailed to the address of the assisted livingfacility. The hearing or other administrative proceedingshall comply in all respects with the AlabamaAdministrative Procedure Act and the State Board ofHealth rules for contested case proceedings. The licenseemay be represented by legal counsel at the hearing attheir own expense.
(ii) If a license is revoked, a new license may beconsidered by the State Board of Health only after theconditions which resulted in the revocation have beencorrected to the satisfaction of the Board.
(iii) Violations of these rules may result in a penaltyunder Code of Ala. 1975, Section 22-21-33.
(iv) Return of License Certificate. Each licensecertificate shall be returned to the Board immediatelyupon its revocation or after the facility voluntarilyceases operation.
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(5) Right of Appeal. Any licensee dissatisfied with administrativedecisions made in the application of these rules may appeal underthe procedures of the Alabama Administrative Procedures Act, Codeof Ala. 1975, Section 41-22-1 et seq.
(6) Dispensations for Research. Any licensee who is, orcontemplates being, engaged in a bona fide scientific researchprogram which may be in conflict with one or more specificprovisions of these rules may make application for dispensation ofthe specific provisions in conflict. Application for dispensationshall be made in writing to the Licensure Advisory Board whichshall, upon completion of its investigation, send its findings,conclusions, and recommendations to the State Board of Health forfinal action.Author: Rick Harris, Kelley Mitchell, Walter GearyStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History: Filed November 20, 1991. Repealed and New Rule: FiledOctober 18, 2001; effective November 22, 2001. Amended: FiledAugust 20, 2015; effective September 24, 2015; operative October1, 2015. Repealed and New Rule: Filed February 20, 2019;effective April 7, 2019.
420-5-4-.03 Administration.
(1) The Assisted Living Facility Governing Authority.
(a) An assisted living facility shall have an identified soleproprietorship, corporation, partnership, limited partnership,or other business entity that is its governing authority, orit shall have a designated individual or group of designatedindividuals who serve as its governing authority. A facilitymust give complete information to the Department identifying:
1. Each person who has an ownership interest of 10percent or more of the governing authority.
2. Each person or entity who has an ownership interest of10 percent or more in the real property or building usedby the assisted living facility to offer its services.
3. Each officer and each director of the corporation ifthe governing authority is a corporation.
4. Each partner, including any limited partners, if thegoverning authority is a partnership.
(b) The governing authority shall submit any changes to theinformation listed above to the Department within 15 days ofthe change.
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(c) Responsibility of Staff to Governing Authority. Theadministrator, medical staff, facility personnel, and allauxiliary organizations shall be directly or indirectlyresponsible to the governing authority. For the purposes ofthese rules, auxiliary organizations include but are notlimited to licensed or certified outside providers,consultants, management companies that are not the facilitylicense holder.
(d) The governing authority is responsible for appointing andsupervising the administrator who is responsible for overallmanagement and the day-to-day operation of the facility. Underno circumstances shall the facility operate without a licensedadministrator for greater than 45 days.
(e) Policies. The governing authority shall be responsible forestablishing and implementing written policies for themanagement and operation of the facility and shall beresponsible for development of, and adherence to, proceduresimplementing those policies. The policies and procedures shallbe made available to residents, any guardians, next of kin,sponsoring agency(ies), or representative payee(s). Allresidents shall be informed of new policies or changes inexisting policies that may have bearing on the residents. Allresidents shall be provided a copy of such policies at least30 days prior to the policies taking effect. Policies shallcover the following:
(i) Facility responsibility to protect all residents fromabuse, neglect, and exploitation.
(ii) How allegations of abuse, neglect, and exploitationwill be handled by the facility.
(iii) Resident confidentiality.
(iv) Admission and continued stay criteria.
(v) Discharge criteria and notification procedures forresidents and sponsors.
(vi) Facility responsibility when a resident's personalbelongings are lost.
(vii) What services the facility is capable and notcapable of providing.
(viii) Medication management.
(ix) Infection control.
(x) Meal service, timing, menus and food preparation,storage, and handling.
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(xi) Fire safety and emergency plan, fire drills, firealarm system, sprinkler and fire extinguisher checks, anddisaster preparedness.
(xii) Staffing and conduct of staff while on duty.
(xiii) Oxygen administration and storage if used in thefacility.
(xiv) Dietary Policies. The dietitian, with the approvalof the administrator, shall develop written policies andprocedures for the guidance of all personnel handlingfood as outlined by the most current Food and DrugAdministration Food Code published by the U.S. Departmentof Health and Human Services. The facility shall developand implement dietary policies and procedures to meet theneeds of the residents in the facility. In addition toother matters deemed necessary by the facility, dietarypolicies shall address:
(I) Sanitation of dishes, utensils, and serviceequipment, and sanitary food preparation andhandling.
(II) The attire and cleanliness of staff members whoprepare, handle, or serve food.
(III) A schedule of meals, which shall includebetween-meal nourishment or snacks, and fluids.
(IV) Food substitutions or alternatives.
(V) Method to ensure an adequate dietary plan isimplemented for any resident with a therapeutic dietor special dietary needs.
(VI) Procedure to be followed if a resident isnutritionally compromised or is not eating adequatequantities of food.
(VII) Provision of necessary services to any residentrequiring adaptive devices to eat.
(VIII) Procedure for the handling of potentiallyhazardous foods such as meat, milk, ice, and eggs.
(IX) Storage of food.
(X) Procedure for food service in the event of adisaster. Disaster menus shall be developed. Thepolicy shall address how food will be obtained andmaintained at safe temperatures if electricity is notavailable.
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(2) The Administrator.
(a) Responsibility.
1. The administrator shall be a direct representative ofthe governing authority in the management of the assistedliving facility and shall be responsible to the governingauthority for the proper performance of his or herduties.
2. Any individual employed as an administrator shall beproperly licensed.
3. Any individual employed as an administrator shall meetall applicable statutory requirements.
4. There must be an individual with experience in theday-to-day operation of the facility, who is authorizedin writing, to act for the administrator during absences.
5. The administrator and any individual authorized to actas a substitute shall be at least 19 years of age.
6. The administrator and any individual authorized to actas a substitute shall be of reputable and responsiblecharacter.
7. The administrator shall ensure that adequate personnelare employed and on duty to meet the care needs of allresidents 24 hours a day, 7 days a week.
8. The administrator shall manage and direct staffactivities in a manner that results in maintenance of aneat, clean, orderly, and safe environment and adequatecare being provided at all times. If a facility has anadequate number of staff members on duty to meet the careand safety needs of all residents, but adequate care andsafety is not being provided, then the facility does notmeet this administration and management requirement.
9. The facility administrator is responsible for ensuringthat required training is provided to all staff.
10. The administrator shall ensure that residents whohave health or safety needs beyond the capability of thefacility will be safely transferred or discharged to anappropriate setting.
11. The administrator shall ensure that facility staffmembers observe each resident for changes in health andphysical abilities and obtain appropriate medicalattention when needed.
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12. The administrator shall ensure that plans of care forall residents are current and appropriate. This shallinclude the prearranged discharge plan.
13. The administrator shall ensure that all deficientpractices cited by the Department are corrected in atimely manner and that corrections are maintained.
(b) In family and group assisted living facilities, thegoverning authority and the administrator may be the sameindividual.
(c) Department Notification.
1. The licensee of an assisted living facility shallprovide written notification of voluntary closure of thefacility to the State Board of Health at least 30 daysprior to the expected closure date.
2. The State Board of Health shall be provided writtennotification not later than 15 days after any change inadministrator.
3. The State Board of Health shall be provided writtennotification not later than 15 days after any change inmanagement company.
(d) Protection.
1. An assisted living facility must meet the applicableprovisions of federal law and regulations pertaining tonondiscrimination on the basis of race, color, gender,religion, or national origin; nondiscrimination on thebasis of handicap; nondiscrimination on the basis of age;protection of human subjects of research; and protectionfrom fraud and abuse. Although federal law andregulations are not normally surveyed and enforced by theState Board of Health in assisted living facilities,serious violations of these provisions of law maynevertheless constitute grounds for adverse licensureaction.
2. An assisted living facility shall obey all applicablefederal, state, and local laws, ordinances, andregulations.
3. Licensing of Staff. Staff of the facility shall becurrently licensed, certified, or registered inaccordance with applicable laws.
4. Compliance with Other Laws. An assisted livingfacility shall comply with laws relating to fire and life
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safety, sanitation, and communicable and reportablediseases.Author: Rick Harris, Kelley Mitchell, Walter GearyStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History: Filed November 20, 1991. Repealed and New Rule: FiledOctober 18, 2001; effective November 22, 2001. Amended: FiledAugust 20, 2015; effective September 24, 2015; operative October1, 2015. Repealed and New Rule: Filed February 20, 2019;effective April 7, 2019.
420-5-4-.04 Personnel.
(1) An assisted living facility shall ensure personnel areemployed and on duty to meet the care and safety needs of allresidents 24 hours a day, 7 days a week.
(a) An assisted living facility shall be staffed at all timesby at least one individual who has a current certification incardiopulmonary resuscitation (CPR).
(b) An assisted living facility must be staffed to ensure thesafe evacuation of all residents in the event of a fire oremergency.
(2) Employee Schedule. An assisted living facility shall post aschedule of employees indicating names and days and hoursscheduled to work. This schedule shall be retained in the facilityfor 6 months after use.
(3) Employee Screening.
(a) Prior to any resident contact, such as but not limited toassistance with activities of daily living, newly employedpersonnel shall have a physical examination certifying thatthe employee is free of signs and symptoms of infectious skinlesions and diseases that are capable of transmission toresidents through normal staff to resident contact. Employeeswho develop signs or symptoms of infectious skin lesions ordiseases that would be capable of transmission to residentsthrough normal staff to resident contact shall not bepermitted to have resident contact until free from such signsand symptoms.
(b) Not more than 30 days prior to any resident contact, newlyemployed personnel shall be properly evaluated fortuberculosis.
(c) Vaccines. Assisted living facilities shall immunizeemployees in accordance with current recommended Centers forDisease Control and Prevention (CDC) guidelines (www.cdc.gov/vaccines). Any particular vaccination requirement may be
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waived or delayed by the State Health Officer in the event ofa vaccine shortage.
(d) An assisted living facility shall not hire an individualwhose name is on the Alabama Department of Public Health NurseAide Abuse Registry.
(4) Personnel Records. An assisted living facility shall maintaina personnel record for each employee. This record shall contain:
(a) An application for employment which contains informationregarding the employee's education, training, and experience.
(b) Verification of current certification or licensure, ifapplicable.
(c) Record of required physical examinations and vaccinations.
(d) Verification the facility has not hired an individualwhose name is on the Alabama Department of Public Health NurseAide Abuse Registry.
(e) Date of hire.
(f) Date of initial resident contact.
(g) Date employment ceased.
(5) No member of the assisted living facility governing authority,and no employee of an assisted living facility, including theadministrator, shall serve as legal guardian, as conservator, oras attorney-in-fact for any resident of the facility, nor shallany such individual solicit or accept control over the property ofany resident, such as by becoming authorized to sign checks forthe resident, or by becoming authorized to enter a resident’s safedeposit box, or by having authority to control real property orsecurities owned by the resident. No member of the assisted livingfacility governing authority, and no employee of an assistedliving facility, including the administrator, shall accept gifts,cash, or any item of value from a resident of the assisted livingfacility other than what the resident is obligated to pay thefacility for services rendered, as specified in the resident’sfinancial agreement with the facility. Provided, however, thatassisted living facility residents, sponsors, and family membersmay offer, and employees may accept, gifts whose value does notexceed $25, on appropriate occasions such as holidays or birthdaysif the gift is offered freely and voluntarily. In the case of agift from a resident, the resident must have sufficient cognitiveability to knowingly, freely, and voluntarily offer a gift.Provided further, that none of these prohibitions shall applybetween a resident and any member of the governing authority oremployee if the two individuals are related to one another asdefined in Section 420-5-4-.01(2)(b). Notwithstanding the
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foregoing, individuals appointed before October 5, 2001, as legalguardians for assisted living facility residents may continue toserve. This subsection is not intended to prevent assisted livingfacilities from offering to place resident funds in an escrow ortrust account for the benefit of the resident whose funds aredeposited, so long as exclusive decision-making authority for funddisbursement is vested in the resident or responsible familymember, and so long as disposition of escrowed funds areperiodically reported to the resident or family member asappropriate. This subsection is also not intended to prohibitfacilities from accepting memorial gifts in any amount from familymembers of deceased relatives, nor is it intended to prohibitfacilities from accepting testamentary bequests in any amount fromthe estates of deceased residents.
(6) Training.
(a) All staff who have contact with residents, including theadministrator, shall have initial training prior to residentcontact and refresher training annually and as necessary.Documentation of all staff training to include attendancerecords and any required post-test or evaluations shall bemaintained in the facility. In addition to any informationotherwise required by the facility's policies and procedures,the facility shall ensure that prior to resident contact, allstaff members receive training on the subject matter listedbelow:
1. State law and rules on assisted living facilities.
2. Facility policies and procedures.
3. Resident rights.
4. Current certification from the American HeartAssociation or the American Red Cross in cardiopulmonaryresuscitation (CPR) within 90 days of hire.
5. Identifying and reporting abuse, neglect, andexploitation.
6. Basic first aid.
7. Advance directives.
8. Protecting resident confidentiality.
9. Resident fire and environment safety.
10. Special needs of the elderly, mentally ill, andmentally retarded.
11. Safety and nutritional needs of the elderly.
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12. Identifying signs and symptoms of dementia.
(b) Cardiopulmonary Resuscitation. An assisted living facilityshall be staffed at all times by at least one individual whohas a current certification from the American HeartAssociation or the American Red Cross in CPR. All employees ofan assisted living facility who have contact with residentsmust be certified in CPR from the American Heart Associationor the American Red Cross. New employees must obtaincertification in CPR within 90 days of hire. An assistedliving facility equipped with an automated externaldefibrillator (AED) shall be staffed at all times by at leastone individual who has a current certification from theAmerican Heart Association or the American Red Cross in AEDutilization. Substitute training approved by the Departmentfor use by emergency medical services personnel (EMSP) may beutilized in lieu of those courses or certifications offered bythe American Heart Association or American Red Cross in CPR orAED utilization.
(c) If the facility admits or retains residents with specialneeds such as diabetes, hospice, or oxygen therapy, thefacility shall provide staff with the appropriate training.
(d) Continuing Education. All staff must receive annualcontinuing education sufficient to remain knowledgeable of thetraining specified above.Author: Rick Harris, Kelley Mitchell, Walter GearyStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History: Filed November 20, 1991. Repealed and New Rule: FiledOctober 18, 2001; effective November 22, 2001. Amended: FiledMarch 21, 2007; effective April 25, 2007. Amended: Filed August20, 2015; effective September 24, 2015; operative October 1, 2015. Repealed and New Rule: Filed February 20, 2019; effective April7, 2019.
420-5-4-.05 Records And Reports.
(1) General.
(a) Responsibility for Records. The administrator shallprepare and file all records, or shall oversee the preparationand filing of records. This duty shall be assigned to otheremployees in the administrator's absence.
(b) All records and reports required by these rules shall becompleted in a timely manner, and shall be maintained andfiled in an orderly manner within the assisted living facilitypremises.
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(c) Storage and Safety. Provision shall be made for the safestorage of records within the facility. Records shall bestored in a manner to reasonably protect them from water orfire damage. Records shall be safeguarded fromunauthorized access.
(d) All facility records, including resident medical records,shall be made readily available for review and copying ondemand by representatives of the State Board of Health uponrequest.
(2) Administrative Records and Documents.
(a) Each assisted living facility shall maintain the followingrecords and documents. Unless otherwise specified below, aphotocopy of the record or document shall be sufficient tomeet this requirement.
1. Original Articles of Incorporation or certified copiesthereof, if the governing authority is incorporated, orpartnership documents if the governing authority is apartnership or limited partnership.
2. A current copy of the constitution or bylaws of thegoverning authority, with a current roster of themembership of the governing authority.
3. Up-to-date personnel records for all employees andformer employees of the facility. Personnel records forformer employees shall be retained for at least 3 yearsafter the employee leaves employment.
4. Current policy and procedure manual.
(3) Resident Records.
(a) Records shall be current from the time of admission to thetime of discharge or death and shall be retained in thefacility for at least three years after a resident's death ordischarge.
(b) When an individual is admitted to an assisted livingfacility, records and information regarding the resident shallbe protected from unauthorized disclosure. Employees andauthorized agents of the Department shall be permitted toreview all medical records and all other records to determinecompliance with these rules. With the written consent of theresident, or with the written consent of the legal guardian ofan incompetent resident, the local ombudsman shall bepermitted access to all records regarding the resident.Records necessary to assess a resident's medical condition orto otherwise render good medical care shall be provided to theresident's treating physician or physicians or to the resident
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or to his or her legally authorized representative. A residentor his or her legal guardian may grant permission to any otherindividual to review the resident's confidential records bysigning a standard release.
(c) In addition to all records required for the provision ofresident care, for each resident, the assisted living facilityshall maintain on its premises the required documents listedbelow and any other documents required by the facility'spolicies and procedures:
1. Statement of resident rights signed by the resident.
2. Financial agreement.
3. Inventory of personal effects.
4. Admission record.
5. Incident investigations and reports involving theresident.
In addition to the above documents, the facility shallalso maintain on its premises any Advance Directive orPortable Physician Do Not Attempt Resuscitation (DNAR)Order that has been executed by the resident. NOTE: Underno circumstances shall the facility require or refuse toallow a resident to execute an Advance Directive orPortable Physician DNAR Order. Advance Directives shallbe typewritten or legibly written in ink and may includethe appointment of a health care proxy consistent withthe specific language in the Natural Death Act (Code ofAla. 1975, 22-8A-1 et seq). A Portable Physician DNAROrder shall follow the rule and form found in the AlabamaAdministrative Code 420-5-19 Appendix II. These recordsshall be protected from unauthorized disclosure.
(d) Residents' Rights. Each resident shall be fully informed,prior to or at the time of admission of these rights. A copyof these rights shall be conspicuously posted in a residentcommon area. Each resident's file shall contain a copy of awritten acknowledgment that he or she has read these rights,or has had these rights fully explained by facility staff tothe resident, or, if appropriate, to the resident’s sponsor.The acknowledgment shall be signed and dated by theadministrator or the administrator’s designee and by theresident or sponsor, when appropriate.
1. No resident shall be deprived of any civil or legalrights, benefits, or privileges guaranteed by law or theConstitution of the U.S. solely by reason of status as aresident of the facility.
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2. Every resident shall have the right to live in a safeand decent environment, to be free from abuse, neglect,and exploitation, and to be free from chemical andphysical restraints.
3. Every resident shall have the right to be treated withconsideration, respect, and due recognition of personaldignity, individuality, and the need for privacy.
4. Every resident shall have the right to unrestrictedprivate communication, including receiving and sendingunopened correspondence, access to a telephone, andvisiting with any person of his or her choice, at anyreasonable time.
5. Every resident shall have freedom to participate inand benefit from social, religious, and communityservices and activities and to achieve the highestpossible level of independence, autonomy, and interactionwithin the community.
6. Every resident shall have the right to manage his orher own financial affairs. If a resident or his or herlegally appointed guardian authorizes the administratorof the facility to provide a safe place to keep funds onthe premises, an individual account record for eachresident shall be maintained by the administrator and anup-to-date record shall be maintained for alltransactions.
7. Every resident shall have the right to share a roomwith his spouse if both are residents of the facility andagree to do so.
8. Every resident shall have the right to a reasonableopportunity for regular exercise several times a week andto be outdoors at regular and frequent intervals.
9. Every resident shall have the right to exercise civiland religious liberties, including the right toindependent personal decisions. No religious beliefs orpractices, nor compulsory attendance at religiousservices, shall be imposed upon any resident.
10. Every resident shall have access to adequate andappropriate health care consistent with established andrecognized standards within the community including theright to receive or reject medical care, dental care, orother health care services except those required tocontrol communicable diseases.
11. Every resident shall have the right to at least 30days prior written notice of involuntary relocation or
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termination of residence from the facility unless theresident is a patient in a facility providing a higherlevel of care and no longer meets the eligibility andcontinued stay requirements in these rules, or formedical reasons the resident is considered by a physicianto require an emergency relocation to a facilityproviding a more skilled level of care, or unless theresident engages in a pattern of conduct that is harmfulor dangerous to himself or herself or to other residents.Such actions will be documented in the resident'sadmission record.
12. Every resident shall have the right to presentgrievances and recommend changes in policies, procedures,and services to the staff of the facility, the facility’smanagement and governing authority, and to any otherperson without restraint, interference, coercion,discrimination, or reprisal.
13. Every resident shall have the right to confidentialtreatment of personal and medical records. A resident mayauthorize the release of records to any individual of hisor her choice. Such authorization must be given by theresident in writing and the written authorization must beincluded in the resident's file.
14. Every resident shall have the right to refuse toperform work or services for the facility unless theresident expressly agrees to perform such work orservices and this agreement is plainly documented in theadmission agreement. A resident may voluntarily performwork or services for the facility, provided that:
(i) The facility has documented the resident’s desireto perform work in the resident’s plan of care, andthe resident has signed this plan of care.
(ii) The plan of care specifies the nature of thework to be performed and sets forth the compensationto be paid for the service, unless the service is tobe performed without compensation; and
(iii) The resident has the right and understands thathe or she has the right to terminate the agreement towork at any time without recourse.
15. Every resident shall be fully informed, prior to orat the time of admission and at regular intervals duringhis or her stay, of services available in the facility,and of related charges.
16. Every resident shall be fully informed, as evidencedby the resident’s written acknowledgment, prior to or at
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the time of admission, of all rules and regulationsgoverning residents' conduct and responsibilities.
17. Every resident shall have the right to have the name,telephone number, and address of the Department’s Bureauof Health Provider Standards, the Local Ombudsman, theDepartment of Human Resources, and the telephone numbersof the Department of Public Health toll-free AssistedLiving Facilities Complaint Hotline and the Department ofHuman Resources toll-free Elder Abuse Hotline. All ofthis information shall be posted in a conspicuouslocation in a resident common area.
18. All state inspection reports and any resultingcorrective action plan from the past 24 months shall beposted in a prominent location. If there has been noinspection in the past 24 months, then the results of themost recent inspection and any resulting correctiveaction plan shall be posted.
19. Every resident shall have the right to 30 days priorwritten notice to both resident and sponsor of anyincrease of fees or charges.
20. Every resident shall have the right to 30 days priorwritten notice of any involuntary change in theresident’s room or roommate unless the change isnecessary because the resident or the resident’s roommateengages in a pattern of conduct that is harmful ordangerous to himself or herself or to other residents.
21. Every resident shall have the right to wear his orher own clothes, to keep and use his or her own personalpossessions including toilet articles except for personalpossessions too large to be stored in the resident’sroom.
22. Every resident shall have the right to be affordedprivacy for sleeping and for storage of personalbelongings.
23. Every resident shall have the right to have freeaccess to day rooms, dining, and other group living orcommon areas at reasonable hours and to freely come andgo from the home.
24. Every resident shall have the right to participate indevising the resident’s care plan, including providingfor the resident's preferences for physician, hospital,nursing home, acquisition of medication, emergency plans,Advance Directives, and funeral arrangements. A copy ofthis care plan shall be kept in the resident's file.
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(e) Financial Agreement.
1. Prior to, or at the time of admission, theadministrator and the resident or the resident's sponsorshall execute a written financial agreement. Thisagreement shall be prepared and signed in two or morecopies with at least one copy given to the resident, orsponsor, if the resident did not sign the agreement, andone copy retained in the assisted living facility. Thisdocument shall be made readily accessible to personnelfrom the State Board of Health during inspections.
2. In addition to any information otherwise required bythe facility's policies and procedures this agreementshall contain the following:
(i) A complete list of the facility's basic charges(room, board, laundry and personal care andservices).
(ii) The period covered by the financial agreement.
(iii) A list of services not covered under basiccharges and for which additional charges will bebilled.
(iv) The policy and procedures for refunds of anypayments made in advance.
(v) The provisions governing termination of theagreement by either party.
(vi) The facility's bed-hold policy, procedures, andcharges.
(vii) Documentation that the resident and sponsorunderstand that the facility is not staffed and notauthorized to perform skilled nursing services nor tocare for residents with severe cognitive impairmentand that the resident and sponsor agree that if theresident should need skilled nursing services or carefor a severe cognitive impairment as a result of acondition that is expected to last for more than 90days, that the resident will be discharged by thefacility after prior written notice.
(viii) A reminder to the resident or sponsor that thelocal ombudsman may be able to provide assistance ifthe facility and the resident or family member areunable to resolve a dispute about payment of fees ormonies owed.
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(ix) Signatures of both parties or authorizedrepresentatives.
3. Prior to execution of the financial agreement thefacility shall ensure that the resident or sponsor fullyunderstands its provisions. In the event that a residentis unable to read the agreement due to illiteracy orinfirmity, the administrator shall take special steps toensure communication of its contents to the resident (forexample, by having the administrator or sponsor read theagreement to a vision-impaired or illiterate applicant).
(f) Inventory of Personal Effects.
1. Upon admission to the assisted living facility, allpersonal property of the resident with a value in excessof $150, as well as any other property designated by theresident, shall be inventoried by the administrator or bya designee of the administrator in the presence of theresident.
2. All inventories shall be entered on an Inventory ofPersonal Effects Record. Inventory forms shall be signedby both the administrator, the resident, or ifappropriate, the sponsor. One copy of the inventory shallbe filed in the resident's individual file and one copygiven to the resident or sponsor.
3. In the event the resident has no personal effects,this fact shall be entered on the Inventory of PersonalEffects Record.
4. Amendments or adjustments shall be made on all copiesof the Inventory of Personal Effects Record each timepersonal property valued in excess of $150 is brought tothe facility, or when personal property is brought to thefacility and the resident or sponsor requests that it beadded to the Inventory of Personal Effects Record, orwhen any item on the Inventory of Personal Effects Recordis removed from the facility. All amendments shall besigned by the administrator and the resident or sponsor.
(g) Admission Record. A permanent record shall be developedfor each resident upon his or her admission to the facilityand updated as necessary to remain current. This record shallbe typewritten or legibly written in ink. In addition to anyinformation otherwise required by the facility's policies andprocedures, it shall include the resident's:
1. Name.
2. Date of birth.
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3. Sex.
4. Marital status.
5. Social security number.
6. Veteran status.
7. Name, address, and contact information of theresident’s sponsor, responsible party, or closest livingrelative.
8. Name, address, and contact information of any personor agency providing assistance to the resident.
9. Name, address, and contact information of theresident’s attending physician.
10. Preferred pharmacy or pharmacist.
11. Date of admission.
12. Date of discharge.
13. Facility, setting, or location to which discharged.
14. Date of death.
15. Cause of death, if known.
16. Religious preferences.
17. Information from insurance policies regarding funeralarrangements and burial provisions.
18. Written documentation that the facility has devised aplan to transfer the resident to a hospital, nursinghome, specialty care assisted living facility, or otherappropriate setting if and when the facility becomesunable to meet the resident’s needs. The resident'spreference, if any, with respect to any particularhospital, nursing home, or specialty care assisted livingfacility shall be recorded. The facility shall keepwritten documentation that demonstrates the transfer planhas been thoroughly explained to the resident or sponsor,as appropriate, and that the resident or sponsorunderstands the transfer plan.
19. The written documentation of the procedure to followin case of serious illness, accident, or death to theresident (including the name and telephone number of thephysician to be called, the names and telephone numbersand addresses of family members or sponsor to be
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contacted, the resident’s or, if appropriate, thesponsor’s wishes with respect to disposition of personaleffects, and the name and telephone number of the funeralhome to be contacted).
(h) Incident Investigation. When an incident, as definedbelow, occurs in an assisted living facility, the facilityadministrator shall be immediately notified, the facilityshall conduct a thorough investigation, and appropriatecorrective actions and interventions shall be devised andimplemented immediately. A detailed and accurate report shallbe completed within 72 hours of the incident. The report shallbe given immediately upon completion to the administrator forreview.
1. Incidents which require investigation are:
(i) An accident or injury of known or unknown originthat was unusual or suspicious in nature such asbruising, pain, or injury that is not consistent withactions necessary in providing day to day care to aresident or for which medical treatment was sought.
(ii) A fracture or an injury resulting in medicalattention. For the purposes of these rules, medicalattention shall be defined as care that rises abovethe level of first aid, including but not limited to:a physician ordered portable X-ray, a visit to anemergency department, urgent care facility, clinic orphysician office.
(iii) The onset of wandering behavior by any residentwho is not fully cognitively intact.
(iv) Elopement by a resident.
(v) Suspected, alleged, confessed, witnessed, oractual abuse of a resident or residents by staff,visitors, or other residents. This includes all typesof abuse including mental abuse, physical abuse,sexual abuse, and verbal abuse as defined in theserules.
(vi) Suspected, alleged, confessed, witnessed, oractual neglect of a resident or residents as definedin these rules.
(vii) Suspected, alleged, confessed, witnessed, oractual exploitation of a resident or residents asdefined in these rules.
(viii) An outbreak (for purposes of these rules, anoutbreak is considered to be two or more affected
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people within 72 hours or less) of a contagiousdisease or condition including those listed inAppendix I of Alabama Administrative Code Sec.420-4-1-.04 (for example food-borne illness, scabies,influenza, or Staphylococcus aureus).
(ix) A fire, earthquake, storm, other act of God, orother occurrence (for example, a natural gas leak ora bomb threat) that causes physical damage to thebuilding in which the facility is located, or thatresults in the evacuation or partial evacuation ofthe facility.
(x) Intentional self-inflicted injury, suicide, orsuicide attempt by a resident.
(xi) An unplanned occurrence that results in mediaattention.
(xii) A medication error, overdose, or over sedation.
(xiii) Ingestion by a resident of a toxic substancethat requires medical attention.
(xiv) Any indication of malfunction of the sprinklersystem, or fire alarm system.
2. In addition to other items required by the facility’spolicies and procedures, the incident investigation shallcontain the following:
(i) Names of all residents involved.
(ii) Names of all staff involved including person incharge at the time of the incident.
(iii) When the administrator was notified (date andtime).
(iv) Circumstances under which the incident occurred.
(v) When the incident occurred (date and time).
(vi) Where the incident occurred (for example,bathroom, bedroom, street, or lawn).
(vii) Immediate actions taken.
(viii) The extent and description of injury, if any,to the affected resident or residents.
(ix) Immediate treatment rendered.
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(x) Symptoms, pain, or injury discussed with thephysician, and the date and time the physician wasnotified.
(xi) Names, telephone numbers, and addresses ofwitnesses.
(xii) Date and time relatives or sponsor werenotified.
(xiii) Out-of-facility treatment.
(xiv) Follow-up care.
(xv) Outcome resolution.
(xvi) The action taken by the facility to prevent theoccurrence of similar incidents in the future.
(xvii) The investigative file includes the incidentreport itself, the incident investigation and allrecords, documents, statements, images, andinformation created or reviewed in connection withthe investigation.
(xviii) The entire investigative file shall be madeavailable for inspection and copying byrepresentatives of the Department upon request.
(xix) The entire investigative file and documentationof all corrective action taken shall be retained fora period of not less than 3 years after the residentis discharged or dies.
(xx) Interventions devised as a result of theinvestigation shall be included in a resident recordthat is available to the personal care staff.
3. In addition, the following incidents shall be reportedto the Department’s Online Incident Reporting Systemwithin 24 hours of the incident:
(i) A fracture or an injury resulting in death, EMSactivation, or the need for medical attention asdefined in these rules.
(ii) Elopement by a resident.
(iii) Suspected, alleged, confessed, or witnessedabuse, neglect, or exploitation of a resident orresidents by staff, visitors, or other residents.This includes all types of abuse including mentalabuse, physical abuse, sexual abuse, and verbal abuse
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as defined in these rules. The victim's sponsor orresponsible family member shall be notified within 24hours. All incidents of suspected abuse, neglect, orexploitation shall be reported immediately to theDepartment of Human Resources or to appropriate lawenforcement authorities as required by law. Thesedocuments shall be retained with the facilityinvestigative file.
(iv) A fire, earthquake, storm, other act of God, orother occurrence (for example, a natural gas leak ora bomb threat) that causes physical damage to thebuilding in which the facility is located, or thatresults in the evacuation or partial evacuation ofthe facility.
(v) Intentional self-inflicted injury, suicide, orsuicide attempt by a resident.
(vi) An unplanned occurrence that results in mediaattention.
(vii) Any medication error, overdose, or oversedation. The incident shall be immediately reportedto the attending physician, facility medicaldirector, or back-up physician.
(viii) Ingestion by a resident of a toxic substancethat requires medical attention.
(ix) Notifiable diseases and health conditions listedin Appendix I of the Alabama Administrative Code Sec.420-4-1-.04 shall be reported by the facility to theState Health Officer or the County Health Officerwithin the time frames specified in 420-4-1-.04. Thefacility shall maintain documentation of any reportsof notifiable diseases or health conditions. Thisdocumentation shall be retained for a period of notless than 3 years.
(x) Any indication of malfunction of the sprinklersystem, or fire alarm system.
4. The report to the Department’s Online IncidentReporting System shall include the following:
(i) Facility name and direct phone number.
(ii) Time and date of the report.
(iii) Reporter’s name.
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(iv) Name of resident(s), staff, or visitor(s)involved in the incident.
(v) Names of staff on duty at the time of theincident.
(vi) Date and time of the incident.
(vii) A brief description of the incident.
(viii) Any injury or injuries to resident(s).
(ix) Action taken by the facility in response to theincident.Author: Rick Harris, Kelley Mitchell, Walter GearyStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History: Filed November 20, 1991. Repealed and New Rule: FiledOctober 18, 2001; effective November 22, 2001. Amended: FiledJune 23, 2004; effective July 28, 2004. Amended: Filed December17, 2004; effective January 21, 2005. Amended: Filed March 21,2007; effective April 25, 2007. Amended: Filed August 20, 2015;effective September 24, 2015; operative October 1, 2015. Repealedand New Rule: Filed February 20, 2019; effective April 7, 2019.
420-5-4-.06 Care Of Residents.
(1) Medical Direction and Supervision. The medical care ofresidents shall be under the direction and supervision of aphysician.
(a) Designation of Attending Physician. Upon admission, eachresident shall be asked to designate an attending physician ofhis or her choice. If the resident is unable to designate anattending physician, or does not wish to designate anattending physician, the facility shall assist the resident inidentifying an attending physician who will serve theresident. A resident shall be permitted to change thedesignation of his or her attending physician at any time.Whenever a resident requires medical attention, an attemptshall first be made to contact the resident’s attendingphysician, except in medical emergencies requiring activationof the local EMS system (911 or another emergency call).
(b) Back-up Physician Support. Each assisted living facilityshall have an agreement with one or more duly licensedphysicians to serve in those instances when a resident's ownattending physician cannot be reached, and to providetemporary medical attention to any resident whose attendingphysician is temporarily not available. A nurse practitioneror physician’s assistant shall not serve as the back-upphysician in an assisted living facility.
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(c) All physician orders shall be written in accordance withcommunity standards. If verbal orders are used, they are to beused infrequently. A physician verbal order shall only beaccepted by an RN or LPN employed by the facility andauthorized to do so by facility policy and procedures andstate law. All verbal orders shall be reduced to writing onthe physicians’ order sheet by a licensed facility nurse andshall be dated and signed by the nurse receiving the order.All orders, including verbal orders, shall be dated, timed,and authenticated promptly by the ordering practitioner, oranother practitioner who is responsible for the care of theresident and authorized to write orders by facility policy.All verbal orders must be authenticated within such timeperiod as provided by facility policy, but in no case shallexceed 30 days following entry of the order.
(2) Medical Examination Record.
(a) Initial Physical Examination. Not more than 30 days priorto admission of any resident to an assisted living facility,the resident or prospective resident shall be examined by aphysician. For purposes of the initial physical examinationonly, a currently licensed physician in good standing with theMedical Licensure Commission of any state may complete thisphysical assessment. The physician shall report his or herfindings in writing to the facility. In addition to anyinformation otherwise required by the facility's policies andprocedures, and in addition to any other information thephysician recommends or believes is pertinent, the initialphysical examination record shall contain the following:
1. All of the physician's diagnoses, and the resident'sbaseline weight and vital signs.
2. Medication presently prescribed (name, dosage, andstrength of drug, frequency, and route ofadministration).
3. A statement by the physician that the resident is freeof signs and symptoms of infectious skin lesions anddiseases that are capable of transmission to otherresidents through normal resident to resident contact.
4. Documentation of evaluation for tuberculosis withinthe previous 12 months.
(b) Annual Physical Examination. In addition to the admissionphysical examination, each resident shall be examined annuallyby a physician, and findings from the annual physicalexamination shall be documented with a copy placed in theresident’s medical examination record. In addition to anyother items specified in the facility’s policies andprocedures, and in addition to any information deemed
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necessary, pertinent, or recommended by the resident’sattending physician, the annual physical examination shallcontain the following:
1. The resident’s weight and vital signs.
2. Changes in diagnoses.
3. Changes in medications prescribed (name, dosage, andstrength of drug, frequency, and route ofadministration).
4. Changes in treatment.
(c) Change of Condition Physician Examinations. Changes in theresident’s condition that require a physician examination andresult in a change in diagnoses, medications, or treatmentsshall be reported to the facility and documented in theresident’s medical examination record. In addition to anyother items specified in the facility’s policies andprocedures, and in addition to any information deemednecessary, pertinent, or recommended by the resident’streating physician, this physical examination shall contain alisting of the following:
1. New diagnoses.
2. Changes in condition.
3. Changes in medications prescribed (name, dosage, andstrength of drug, frequency, and route ofadministration).
4. Changes in treatment.
(d) Vaccines. Assisted living facilities shall immunizeresidents in accordance with current recommended CDCguidelines. Any particular vaccination requirement may bewaived or delayed by the State Health Officer in the event ofa vaccine shortage.
(3) Health Supervision.
(a) Initial Assessment. No more than 30 days prior toadmission, the facility shall assess prospective residents forfacility eligibility. This assessment shall documentidentified care needs and serve as a baseline for futureassessments.
(b) Monthly Assessments. The facility shall assess eachresident monthly and more often when necessary to identifychanges in resident’s status. In addition to other items that
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may be required by the facility’s own policies and procedures,the monthly assessment shall:
1. Assess the resident’s ability to safely self-managemedications or safely self-administer medications withassistance.
2. Accurately weigh and record the weight of eachresident. A significant weight loss is defined as a 5percent or greater weight loss in a period of 1 month orless, or a 7 ½ percent or greater weight loss in a periodof 3 months or less, or a 10 percent or greater weightloss in a period of 6 months or less. Any weight lossshall be considered to be an unplanned weight loss unlessthe affected resident has been placed on a restrictedcalorie diet specifically for the purpose of reducing theresident’s weight, and such diet has been approved by theresident’s attending physician or by a dietitian licensedby the Alabama Board of Examiners for Dietetics andNutritionists as authorized by the medical director.
3. Document identified changes in resident status.
4. Assess the appropriateness of each resident’s plan ofcare. Any decline in resident status requires immediateimplementation and documentation of interventions orreassessment of existing interventions.
(c) Observation. Each assisted living facility shall providegeneral observation and health supervision of the residents toidentify changes in all residents’ health conditions andphysical abilities, and awareness of the need for medicalattention or nursing services as the changes develop. Whenevera resident requires medical attention, nursing services, orchanges in personal care and assistance with activities ofdaily living provided by the facility, the facility shallarrange for or assist the residents in obtaining necessaryservices.
(d) Services Beyond Capability of Assisted Living Facility.Whenever a resident requires hospitalization, medical,nursing, or other care beyond the capabilities and facilitiesof the assisted living facility, arrangements shall be made todischarge the resident to an appropriate setting, or totransfer the resident promptly to a hospital or other healthcare facility able to provide the appropriate level of care.
(e) Care During Emergency or Illness. The resident’s attendingphysician, or a backup physician, if the attending physicianis unavailable, shall be promptly called at the onset of anillness or in case of an accident or injury to a resident. Incase of a medical emergency that could result in death,serious medical impairment, or disability to a resident,
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the local EMS system shall be activated by calling 911 orother emergency local telephone number.
(f) All assisted living facilities shall maintain thefollowing telephone numbers, properly identified, and postedin a prominent location readily accessible and known to allstaff members:
1. Each resident’s attending physician, and thefacility’s backup physician or physicians.
2. 911, or the local emergency telephone number if thecommunity is not served by a 911 telephone service.
(g) Mechanical Restraint and Seclusion. No form of physicalrestraint or seclusion shall be applied to residents of anassisted living facility except in extreme emergencysituations when the resident presents a danger of harm tohimself or herself or to other residents. In such an event,the facility shall use the least restrictive intervention thatwill be effective to protect residents, immediately notify theresident's physician and sponsor, and appropriate treatment,transfer to an appropriate health care facility, or both shallbe provided without any avoidable delay. In no event shallemergency behavioral symptoms of residents be treated withsedative medications, anti-psychotic medications, anti-anxietymedications, or other psychoactive medications in an assistedliving facility.
(h) Resident Abuse, Neglect, and Exploitation. Each facilityshall develop and implement a policy and procedure to protecteach resident of the facility from abuse, neglect, andexploitation. The facility shall ensure that all staff candemonstrate an understanding of what constitutes abuse,neglect, and exploitation, and shall ensure that all staffunderstands his or her responsibility to immediately reportsuspected, alleged, confessed, witnessed, or actual incidentsof abuse, neglect, or exploitation of a resident to theadministrator. When abuse, neglect, or exploitation issuspected, alleged, confessed, witnessed, or actual thefacility shall conduct and document a thorough investigationand take appropriate action to prevent further abuse. Allallegations, suspicions, confessions, witnessed, or actualincidents shall be reported to the Assisted Living Unit of theAlabama Department of Public Health and to the victim'ssponsor or responsible family member within 24 hours.Suspected, alleged, confessed, witnessed, or actual abuse,neglect, or exploitation of a resident shall be reported tothe Department of Human Resources or law enforcement inaccordance with Code of Ala. 1975, Section 38-9-8. At any timethat a resident has been the victim of sexual assault orsexual abuse perpetrated by a staff member or visitor, locallaw enforcement authorities shall be immediately notified.
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(i) Laboratory Tests. Any facility conducting or offeringlaboratory tests for its residents, including routine bloodglucose monitoring, shall comply with federal law, andspecifically with the applicable requirements of the federalClinical Laboratory Improvement Act (CLIA) as well as withapplicable federal regulations. This requirement in some caseswould require the facility to obtain a CLIA certificate, andin other cases would require the facility to obtain a CLIAwaiver. For more information about CLIA requirements, afacility may contact the department, Bureau of Health ProviderStandards. For testing or monitoring requiring blood, eitherthe resident must draw his or her own blood or the blood mustbe drawn by a physician, an R.N. or L.P.N., or a phlebotomistfrom a licensed Independent Clinical Laboratory. Blood andblood products, needles, sharps, and other paraphernaliainvolved in collecting blood must be handled in a mannerconsistent with requirements of the federal OccupationalSafety and Health Administration (OSHA). Personnel handlingsuch materials must be vaccinated against blood borne diseasesif such vaccinations are required by OSHA. Blood, bloodproducts, needles, sharps, and other paraphernalia involved incollecting blood shall be treated as medical waste and shallbe disposed of in a manner compliant with the requirements ofthe State of Alabama Department of Environmental Management.
(4) Personal Care and Services. The facility shall provide careand services consistent with community standards.
(a) Portions of residents' records necessary for staff toprovide care, including the plans of care and relevantportions of the medical examination records and admissionrecords, shall be accessible to the direct care staff at alltimes.
(b) Plan of Care. There shall be a written plan of caredeveloped for each resident prior to or at the time ofadmission. The plan of care shall be based on the initialmedical examination, diagnoses, and recommendations of theresident’s treating physician. The plan of care shall bereviewed and updated based on the annual examination, and allother physician examinations, diagnoses, and recommendationsof the resident’s treating physician, and the resident’smonthly assessments. The plan of care shall be developed andupdated in cooperation with the resident and, if appropriate,the sponsor. All entries on the plan of care shall beaccurately dated.
1. The plan shall at all times reflect the currentcondition of the resident and document the personal careand services required from the facility by the resident.In addition to other items that may be required by thefacility’s own policies and procedures, the plan of careshall contain the following:
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2. A listing of the resident’s individual needs orproblems that require intervention by the facility.
3. A listing of interventions provided by the facility toaddress the resident’s identified needs or problems.
4. A copy of any outside provider's certification andplan of care, such as the current Home HealthCertification and Plan of Care for each residentreceiving care from an outside provider.
5. Activities of Daily Living. Residents of assistedliving facilities shall be assisted and encouraged tomaintain a clean, well-kept personal appearance. Eachfacility shall provide all needed assistance withactivities of daily living to each resident.
(i) Bathing. Residents shall be offered a bath orpartial bath or shall be assisted with a bath orpartial bath daily, and more often when necessary orrequested.
(ii) Oral Hygiene. Residents shall be assisted withoral hygiene to keep mouth, teeth, or dentures clean.Measures shall be used to prevent dry, cracked lips.
(iii) Hair. Resident’s hair shall be kept clean,neat, and well groomed.
(iv) Manicure. Fingernails and toenails shall be keptclean and trimmed.
(v) Shaving. Men shall be assisted with shaving orshaved as necessary to keep them clean and wellgroomed.
(vi) Personal Safety. Residents shall be providedassistance with personal safety.
6. As changes in medication and personal services becomenecessary, the plan of care shall be promptly updated andall changes shall be documented.
(c) The facility shall offer appropriate activity programs toeach resident, maintaining supplies and equipment as necessaryto implement the activity programs. Every day the facilityshall provide activities appropriate to each resident.
(d) Pets residing at the facility or used in activity programsshall be in good health and shall have current vaccinations asrequired by law. Vaccination certificates, or copies ofvaccination certificates, shall be kept on file at thefacility to demonstrate compliance with this requirement.
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(e) Mail, Telegrams, and Other Communications.
1. Incoming mail, telegrams, and other writtencommunications addressed to the resident shall bedelivered to the resident unopened. Outgoing mail shallbe promptly delivered to regular postal channels uponreceipt from the resident. Residents shall be permittedto place and receive telephone calls at the facility incomplete privacy.
2. Personnel of the facility shall assist residents withcommunications, such as writing letters or assisting withwriting letters, or reading mail out loud if requested todo so.
(f) Appointments. Residents shall be assisted in making andkeeping appointments.
(5) Medications.
(a) Medications as defined in these rules, may be administeredto a resident of an assisted living facility only after thedrugs have been prescribed specifically for the resident by anindividual currently licensed to prescribe medications inAlabama. A currently licensed physician in good standing withthe Medical Licensure Commission of any state may prescribemedications to a resident of an assisted living facility onlyduring the initial physical examination.
(b) A physician order is required for a resident to manage andhave custody of his or her own medications.
(c) A resident may have custody of and manage over the countertopical medications with the written approval of a physician.A physician order is not required for over the counter topicalmedications that are self-administered by residents andapproved by the physician for resident possession.
(d) Nothing in these rules shall preclude a facility fromusing a licensed nurse employed by the facility or nursingagency to administer medication to any resident. An R.N. orL.P.N. shall administer medications to residents in theassisted living facility only in accordance with physicianorders and the Nurse Practice Act.
(e) A resident who is incapable of recognizing his or hername, or understanding the facility unit dose medicationsystem, or does not have the ability to protect himself orherself from a medication error shall require medicationadministration. Medication administration shall be providedonly by a physician or by an R.N. or L.P.N. If the residentcannot understand or be trained to understand the unit dosemedication system used by the facility or cannot protect
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himself or herself from medication errors by facility staff,the resident will be appropriately discharged.
(f) A resident may self-manage his or her medications. For thepurposes of these rules, self-manage shall mean the residentis capable of maintaining possession and control of his or hermedications, who does maintain possession and control of hisor her medications, and self-administers his or hermedications without creating an unreasonable risk to healthand safety.
(g) A resident that cannot self-manage his or her ownmedication without creating an unreasonable risk to health andsafety may be assisted with self-administration of medicationby any assisted living facility staff, including staff memberswho hold no professional licensure provided:
1. The resident can and does identify his or her name onthe medication package and has a reasonable understandingof the unit dose packaging system in use by the facilitysuch that the resident could protect himself or herselffrom medication errors when unit dose packages arebrought to the resident by facility staff. The residentshall have the opportunity to demonstrate his or herability to correctly utilize the unit dose package systemat every opportunity for medication use.
(6) Assistance with self-administration of medication includes thefollowing practices:
(a) Reminding a resident that it is time to take a medicationor medications, where such medications have been prescribedfor a specific time of day, a specific number of times perday, specific intervals of time, or for a specific time inrelation to mealtimes or other activities such as arising frombed or retiring to bed.
(b) Physically assisting a resident by opening or helping toopen a container holding medications.
(c) Offering liquids to a resident to assist that resident iningesting oral medications.
(d) Physically bringing a container of medication to aresident.
(7) Assistance with self-administration of medications shall underno circumstances include any of the following practices:
(a) Medication administration as defined in these rules.
(b) Determining the amount of medication to be given. If amedication is not available in unit dose packaging, unlicensed
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facility staff may measure the prescribed amount of medicationonly under the direction and control of the resident, providedthat the resident is capable of determining the amount ofmedication to be given.
(c) Giving a resident injections of any kind.
(d) Telling or reminding a resident that it is time to take aPRN, or as needed medication.
(e) Placing medications in a feeding tube.
(f) Giving enemas or suppositories.
(g) Crushing or splitting medications, provided that aphysician has ordered a specific medication to be crushed orsplit and the resident is capable of self-managing his or herown medication or the resident is capable of medication self-administration with assistance and would be capable ofcrushing or splitting his or her own medications but forlimitations of mobility or dexterity, may be assisted withcrushing or splitting medications by unlicensed staff so longas the assistance provided is under the total control anddirection of the resident. If the facility chooses to offerthis assistance, the facility shall develop and implement apolicy and procedure to ensure safe practices by facilitystaff.
(h) Mixing medications with food or liquids, provided that aphysician has ordered a medication to be mixed with food orliquid and the resident is capable of self-managing his or herown medications or the resident is capable of medication self-administration with assistance and would be capable of mixinghis or her own medications with food or liquid but forlimitations of mobility or dexterity, may be assisted withmixing medications with food or liquid by unlicensed staff solong as the assistance provided is under the total control anddirection of the resident. If the facility chooses to offerthis assistance, the facility shall develop and implement apolicy and procedure to ensure safe practices by facilitystaff.
(i) Assisting with self-administration of eye drops, eardrops,nose drops, inhalers, nebulizers, or topical medications,provided that a resident who is capable of self-managing hisor her own medication or a resident who is capable ofmedication self-administration with assistance and who wouldbe capable of self-administration of his or her ownmedications but for limitations of mobility or dexterity, maybe assisted with eye drops, ear drops, nose drops, inhalers,nebulizers, or topical medications by unlicensed facilitystaff so long as the assistance provided is under the totalcontrol and direction of the resident. If the facility chooses
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to offer this assistance, the facility shall develop andimplement a policy and procedure to ensure safe practices byfacility staff.
(j) All medications administered to residents and allmedications self-administered with assistance of facilitystaff in an assisted living facility shall becontemporaneously recorded on a standard medicationadministration or medication assistance record."Contemporaneously recorded" means recorded at the same timeor immediately after medications are administered. Themedication administration or medication assistance recordshall include at least the following:
1. The name of the resident to whom the medication wasadministered or assisted.
2. The name of the medication administered or assisted.
3. The dosage of the medication administered or assisted.
4. The method of administration or assistance.
5. The site of injection or application, if themedication was injected or applied.
6. The date and time of the medication administration orassistance.
7. Any adverse reaction to the medication.
8. The printed name, initials, and written signature ofthe individual administering the medication or assistingthe resident with self-administration of the medication.
(k) Medications kept under the control or custody of anassisted living facility shall be packaged by the pharmacy andshall be maintained by the facility in unit dose packaging.Medications kept under the control or custody of an assistedliving facility that are not available in unit dose packagingmust be packaged by the pharmacy and administered by aphysician, R.N., or L.P.N. or self-administered withassistance under the total control and direction of theresident.
(l) Unless a resident can and does self-manage his or her ownmedications, an assisted living facility shall require eachresident to use a single pharmacy. This does not apply toemergency pharmacy services. All residents need not use thesame pharmacy that is used by other residents unless expresspolicy of the assisted living facility provides otherwise andall residents are informed of such policy and provided a copyof such policy prior to or at the time of admission. The
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assisted living facility shall require pharmacies used formedication supply for residents not self-managing theirmedications to review all ordered medication regimens forpossible errors or adverse drug interactions and to advise thefacility and the prescribing health care provider when theseare detected.
(m) If controlled substances prescribed for residents of anyassisted living facility are kept in the custody of theassisted living facility, they shall be stored in a mannerthat is compliant with state and federal laws, therequirements of the Alabama State Board of Pharmacy, and anyrequirements prescribed by the State Board of Health. At aminimum, controlled substances in the custody of the facilityshall be stored using a double lock system, under propertemperature and humidity controls and permit only authorizedpersonnel access. The facility shall maintain a system toaccount for all controlled substances in its possession. Allother medications in the custody of the facility shall bestored using at least a single lock, under proper temperatureand humidity controls and permit only authorized personnelaccess. This shall include medications stored in a resident'sroom when the staff and not the resident have access to themedications. Medications may be kept in the custody of anindividual resident who can safely manage his or hermedications. Such medications may be stored in a lockedcontainer accessible only to the resident and staff, or may bestored and secured in the resident's living quarters, if theroom is single occupancy and has a locking entrance.
(n) Medication administration or medication assistance recordsand written physician orders for all over-the-counter drugs,legend drugs, and controlled substances shall be retained fora period of not less than three years. They shall be madeavailable for inspection at reasonable times by residents,anyone authorized by the resident, and by the sponsors ofresidents.
(o) Labeling of Drugs and Medicines. All containers ofprescribed medicines and drugs shall be labeled in accordancewith the rules of the Alabama State Board of Pharmacy andshall include appropriate cautionary labels, such as, "ShakeWell," or "For External Use Only."
(8) Disposal of Medications.
1. Controlled substances and legend drugs dispensed toresidents, that are expired or unused because the medicationis discontinued or because the resident dies, shall bedestroyed within 30 days. Unused legend drugs that are notexpired may be donated to a charitable clinic pursuant toAlabama Administrative Code, Chapter 420-11-11. Under nocircumstances should expired, discontinued, or unused
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medications be stored or housed in the facility beyond 30days.
2. Medications of residents who are discharged or transferredto another facility shall be returned to the residents. Theresponsible party will sign a statement that these medicationshave been received. The statement shall list the pharmacy,prescription number, date, resident's name and strength of themedication, and the amount. This statement shall be maintainedin a file for at least 3 years.
3. When medications are destroyed on the premises of theassisted living facility, a record shall be made and retainedfor at least 3 years. This record shall include: the name ofthe assisted living facility, the method of disposal, thepharmacy, the prescription number, the name of the resident,the name, strength, and dosage of the medication, and theamount and the reason for the disposal. This record shall besigned and dated by the individual performing the destructionand by at least one witness.
(9) Oxygen Therapy.
(a) A resident of an assisted living facility that requiresoxygen therapy shall self-manage his or her own oxygen therapyor self-administer his or her own oxygen therapy withassistance of facility staff. A resident that cannot safelyself-manage or self-administer his or her own oxygen therapywith assistance shall have oxygen administered only by aphysician, R.N., or L.P.N. A resident that cannot direct hisor her administration of oxygen and cannot be taught to directhis or her administration of oxygen shall be appropriatelydischarged.
(b) Oxygen use including date, time, rate, and proper functionof the equipment shall be documented on the medicationadministration or medication assistance record at least onceper shift unless oxygen therapy is self-managed by theresident.
(c) If a resident receives oxygen therapy in a facility:
1. All oxygen equipment, such as tubing, masks, and nasalcannula shall be maintained in a safe and sanitarycondition.
2. All oxygen tanks shall be safely maintained andstored.
3. The facility shall require safe use of oxygen therapy.No smoking and appropriate precautionary signs shall beposted.
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4. The facility shall ensure that each resident usingoxygen therapy maintains an adequate supply of oxygen.
Refer to National Fire Protection Association (NFPA) 99for oxygen storage requirements.
(10) Storage of Medical Supplies. First Aid Supplies. First aidsupplies shall be maintained in a place readily accessible topersons providing personal care and services in the assistedliving facility. These supplies shall be inspected at leastannually to ensure their usability.
(11) Admission and Retention of Residents.
Residents admitted to and retained in assisted living facilitiesmust meet all eligibility and continued stay requirementsspecified in these rules.
(a) Admission
1. An assisted living facility shall not admit anyindividual who:
(i) Is receiving or requires skilled nursing care.
(ii) Has a wound that requires care beyond basicfirst aid.
(iii) Lacks the ability to make decisions related topersonal safety.
(iv) Cannot direct his or her care.
(v) Has behaviors that may be dangerous to themselvesor others.
(vi) Cannot safely self-manage medications or self-administer medications with assistance.
(vii) Is receiving or in need of hospice services.
(viii) Cannot safely reside in the facility unlesshis or her egress from the facility is restricted.
(ix) Is diagnosed with acute infectious pulmonarydisease, such as influenza, or active tuberculosis,or with other diseases capable of transmission toother individuals through normal person-to-personcontact.
(b) Retention
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1. An assisted living facility shall not allow anyresident to return to the assisted living facility from ahigher level of care if that resident requires care thatexceeds the level of care the facility is licensed toprovide or the facility is capable of providing.
2. An assisted living facility shall not retain aresident that has symptoms or behaviors that infringe onthe rights or safety of residents currently in thefacility.
3. Residents who have unmanageable behaviors or behaviorsthat may be dangerous to themselves or others shall notbe retained in an assisted living facility.
4. An assisted living facility shall not retain aresident who requires medical or skilled nursing carewhich is expected to exceed 90 days unless:
(i) The individual is capable of performing and doesperform all tasks related to his or her own care; OR
(ii) The individual is incapable of performing someor all tasks related to his or her own care due tolimitations of mobility or dexterity BUT theindividual has sufficient cognitive ability to directhis or her own care AND the individual is able todirect others and does direct others to provide thephysical assistance needed to complete such tasks,AND the facility staff is capable of providing suchassistance and does provide such assistance. If thefacility chooses to offer this assistance, thefacility shall develop and implement a policy andprocedure to ensure safe practices by facility staff.
5. If a resident of an assisted living facility isdiagnosed with a terminal illness other than dementia andrequires hospice care, the resident may be admitted to aproperly licensed and certified hospice program. Aresident receiving hospice care may remain in thefacility beyond 90 days. If the facility is unable orbecomes unable to meet the needs of a resident receivinghospice care, or if a resident receiving hospice carerequires care beyond what the facility may lawfullyprovide pursuant to this section, then the facility shallpromptly make arrangements to discharge or transfer theresident to a safe and appropriate placement inaccordance with the discharge procedures and prearrangedplan required by these rules for assisted livingfacilities.
The facility would in all cases remain responsible forensuring the appropriate delivery of care and must take
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all necessary steps to ensure that care needed by aresident is delivered to the resident.
6. All skilled services provided in the facility, such asbut not limited to wound care or insertion of a urinarycatheter, shall be provided by the staff of properlylicensed or certified agencies. Skilled services shallnot be delegated to facility staff.
7. Residents that develop acute infectious pulmonarydisease, such as active tuberculosis, or other diseasescapable of transmission to other individuals throughnormal person-to-person contact shall be immediatelytransferred to an appropriate level of care untilcertified by a physician to be free of a contagiouscondition.
8. No assisted living facility shall be operated in wholeor in part in a manner that prevents free and unhinderedegress from the facility by any of its residents.
9. An assisted living facility shall not retain anyresident who cannot safely reside in the facility unlesshis or her egress from the facility is restricted.
(12) Resident Transport. If a resident is unable to ride in anupright position or if such resident’s condition is such that heor she needs observation or treatment by an emergency medicalservice provider (EMSP), or if the resident requirestransportation on a stretcher, gurney, or cot, the facility shallarrange or request transportation services only from providers whoare ambulance service operators licensed by the State Board ofHealth. If such resident is being transported to or from a healthcare facility in another state, transportation services may bearranged with a transport provider licensed as an ambulanceservice operator in that state. For the purposes of this rule, anupright position means no more than 20 degrees from vertical.Author: Rick Harris, Kelley Mitchell, Walter GearyStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History: Filed November 20, 1991. Amended: Filed September 20,2000; effective October 25, 2000. Repealed and New Rule: FiledOctober 18, 2001; effective November 22, 2001. Amended: FiledJune 23, 2004; effective July 28, 2004. Amended: Filed March 21,2007; effective April 25, 2007. Amended: Filed August 20, 2015;effective September 24, 2015; operative October 1, 2015. Repealedand New Rule: Filed February 20, 2019; effective April 7, 2019. Amended: Published March 31, 2022; effective May 15, 2022.
420-5-4-.07 Food Service.
(1) General.
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(a) Direction and Supervision. The services of a dietitianshall be provided to any resident of an assisted livingfacility who requires a therapeutic diet. Congregate assistedliving facilities shall be under the direction and supervisionof a full or part-time professionally qualified dietitian or aconsulting dietitian that is licensed in the State of Alabama.Responsibility for the supervision of dietary services shallbe delegated to a responsible employee who is a graduate of aDietary Managers course or has completed an approved coursethat includes basic sanitation. The facility shall providemeals, fluids, and snacks to the residents that meet theDietary References Intakes from the basic food groups. Themeals shall be of the quality and quantity necessary to meetthe residents’ needs, and must be in accordance with therecommended dietary allowances of the Food and Nutrition Boardof the National Research Council, National Academy ofSciences.
(2) Food Handling Procedures.
(a) Dish and Utensils Washing, Disinfection, and Storage.
1. Wash water shall be changed with sufficient frequencyto avoid gross contamination, and final rinse water shallbe kept clean and clear.
2. Hand washed repeated service and multi-serviceutensils and dishes, after washing and rinsing, shall besanitized by either of the following methods:
(i) Utensils and dishes shall be completely immersedfor a period of not less than 30 seconds in waterthat is at least 171 degrees Fahrenheit (pouringscalding water over utensils and dishes does not meetthis requirement); or
(ii) A cold water sanitizer. A sanitizing solutionshall be used in accordance with manufacturer'sinstructions. Utensils and dishes shall be completelyimmersed for a period of not less than 10 seconds ina clean solution containing not less than 50 ppm, andnot more than 200 ppm, of available chlorine bleach,or 30 seconds in 12.5 ppm of iodine or the amount oftime set by the manufacturer in a 200 ppm quaternaryammonium solution. Water temperature must be at least75 degrees Fahrenheit. Water temperatures andchemical concentrations shall be monitored anddocumented prior to dishwashing. A record of eachtest shall be maintained for at least 3 months.
3. Dishes and utensils shall be allowed to air dry.
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4. After washing, rinsing, sanitizing, and air-drying,all repeated use service ware (utensils and dishes) shallbe stored in a clean, dry place that is protected frompests, dust, splash, and other contaminants. Utensilsshall be handled in such a way as to preventcontamination from hands and clothing.
5. The results from the use of dishwashing machines shallbe equivalent to those obtained from the method outlinedabove, as documented in material provided from themanufacturer and kept on file at the facility.
(b) Ice. Crushed or chipped ice shall be protected fromsplash, drip, and hand contamination during storage andservice. The ice scoop may be stored in the ice bin in amanner to prevent ice from coming into contact with thehandle, or it may be stored in an airtight container outsidethe ice bin.
(c) Protection of Food from Contamination.
1. Food and food ingredients shall be stored, handled,and served so as to be protected from pests, dust,rodents, droplet infection, unsanitary handling, overheadleakage, sewage back flow, and any other contamination.Sugar, syrup, and condiment receptacles shall be providedwith lids and shall be kept covered when not in use.
2. Medications, biologicals, poisons, detergents, andcleaning supplies shall not be kept in the refrigeratoror in other areas used for storage of food.
3. Food shall not be stored on the floor. All food andfood ingredients stored on shelving must be placed onshelving that is at least 6 inches above the floor.
4. Refrigerators shall maintain a maximum temperature of41 degrees Fahrenheit. Freezers shall be maintained at amaximum temperature of 0 degrees Fahrenheit. Thermometersshall remain in refrigerators and freezers at all times.
5. All leftover foods shall be labeled and dated with a“use by date”, so that it may be consumed or discarded bythat date, which is no more than 3 days from the date itwas prepared.
6. All food products shall be used by the manufacturer’sindicated date or discarded.
7. Food shall be prepared either in the licensed facilityor another location even when that location is not partof the licensed facility. All food preparation areas usedby the facility shall be subject to the same inspections
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as though part of the licensed facility. The licensedfacility is responsible to ensure adequate equipment andmeasures are used to ensure that food is not contaminatedin transport and that foods that are transported are heldand served at the appropriate temperatures at all times.
8. Hot food shall be maintained at a minimum of 135degrees Fahrenheit and cold foods at a maximum 41 degreesFahrenheit.
9. Frozen food items (raw and cooked) shall be thawedunder refrigeration or under running water prior topreparation. Frozen food may also be thawed as part ofthe cooking process when indicated by package directions.Raw meats shall be stored below and away from vegetables,fruits, and other foods to prevent contamination (meatjuices dripping on other foods).
10. Laundry shall not be brought through the foodpreparation or service area.
(d) Storage and Service of Milk and Ice Cream.
1. Milk and fluid milk products shall be served only fromthe original containers in which they were received fromthe distributor. This shall not apply to cream forcoffee, cereals, and milk for milk drinks which may bedispensed from a readily cleanable container approved forsuch use.
2. Milk and fluid milk products shall be stored in such amanner that bottles or containers, from which the milk ormilk product is to be poured or drunk, will not becomecontaminated from drip or contact with foods. Milk shallbe maintained and stored at a maximum temperature of 41degrees Fahrenheit and shall not be served at atemperature warmer than 45 degrees Fahrenheit unlessspecifically requested to be served at a warmertemperature by a resident.
3. Contaminating substances shall not be stored with orover open containers of ice cream. Ice cream dippers,spatulas, and other serving utensils shall be cleanedbetween uses.
(e) Kitchen Garbage and Trash Handling.
1. Kitchen garbage and trash shall be placed in suitablecontainers with tight-fitting lids and properly storedpending removal. Kitchen garbage and trash shall not beallowed to accumulate in the kitchen and shall be removedfrom the premises at frequent intervals.
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2. After being emptied, all garbage cans and trash cansshall be washed and dried before reuse.
(f) Employees' Cleanliness.
1. Employees engaged in the handling, preparation, andserving of food shall wear clean clothing at all times.Employees shall wear hair restraints, for example,hairnets, headbands, caps, or other adequate means toprevent contamination of food from hair. Employees whoseduties include contact with residents shall changeclothing or wear a clean covering over clothing beforehandling, preparing, or serving food.
2. Employees handling food shall wash their handsthoroughly before starting work each day, immediatelyafter contact with any soiled matter, and beforereturning to work after each visit to the rest room.
3. Street clothing not worn by the employee shall bestored in lockers, dressing rooms, or closets designatedfor staff use.
(g) Live Fowl or Animals. Live fowl or animals shall not beallowed in the food service area.
(h) Smoking and Spitting. Smoking, other use of tobaccoproducts, and spitting within the food service area shall beprohibited for all staff, residents, and visitors.
(i) Dining in Kitchen. Dining in the kitchen shall not bepermitted in congregate assisted living facilities.
(j) Paper for Food Wrapping. Only new paper, foil, or plasticwrap shall be used for wrapping of foods.
(k) Laundering of clothing shall not be permitted in foodpreparation or service areas.
(3) Dietary Service.
(a) Number of Meals. No fewer than three meals shall beprovided each 24 hours. Food service shall be provided in aresident's room during temporary illness if necessary. Thediet shall be well-balanced, palatable, properly prepared, andsufficient in quantity and quality to meet the nutritionalneeds of the residents in accordance with Dietary ReferenceIntakes of the Food and Nutrition Board of the NationalResearch Council, National Academy of Sciences. The food mustbe adapted in type and preparation to the habits, preferences,and physical abilities of the residents.
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(b) Timing of Meals. A time schedule for serving meals toresidents and personnel shall be established. Meals shall beserved approximately 5 hours apart with no more than 14 hoursbetween the evening meal and breakfast. The time schedule ofmeals shall be posted with the menu. The facility shall makeevening snacks available after service of the evening meal.The facility shall provide fluids throughout the day and shallmake between-meal nourishment (snacks) available.
(c) Menu. The menu shall be planned and written at least 1week in advance. The current week's menu shall be posted inthe food service area and shall be kept on file for thefollowing 2 weeks. For any resident with a physician’s orderfor a therapeutic diet, or by a dietitian licensed by theAlabama Board of Examiners for Dietetics and Nutritionists asauthorized by the medical director, the facility shall have acopy of the diet and the facility shall document theadjustment of its menu to accommodate the resident’s needs.
(d) Alternate food selections or substitutes shall be madeavailable to all residents.
(e) A facility shall not obtain food from charitableorganizations. A facility shall not avoid serving a meal bysending or transporting residents to missions, soup kitchens,or other charitable facilities for meals.
(f) The amount of food on hand shall be sufficient to serve 3meals per day to all residents for 3 days. Non-perishable foodand potable water shall be maintained in the facility insufficient quantity to serve 3 meals per day to all residentsfor 3 days.Author: Rick Harris, Kelley Mitchell, Dana BillingsleyStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History: iled November 20, 1991. Repealed and New Rule: FiledOctober 18, 2001; effective November 22, 2001. Amended: FiledMarch 21, 2007; effective April 25, 2007. Repealed and New Rule:Filed February 20, 2019; effective April 7, 2019. Amended:Published March 31, 2022; effective May 15, 2022.
420-5-4-.08 Physical Facilities.
(1) Administrative Facilities. Each assisted living facility shallprovide office space(s) or administrative office(s).
(a) As a minimum, the administrative office(s) shall beprovided with a desk, file cabinet, and related officeequipment and supplies.
(b) Congregate assisted living facilities shall provideseparate rooms for administrative and office purposes.
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(c) Communication Facilities. Each assisted living facilityshall have an adequate number of telephones to summon help incase of fire or other emergency, and these shall be located soas to be quickly accessible from all parts of the building.
(d) Fire Protection Arrangements. The facility shall havearrangements for fire protection with the nearest availablefire department for assistance in case of fire. Each facilityshall have a monitoring service for its fire alarm system.
(e) Center Staff Station. New Group and Congregate facilities,and existing Group and Congregate facilities that are enlargedor renovated to accommodate bed increases, shall have acentrally located staff station with call for assistance andfire alarm system annunciation panels.
(2) Physical Facilities (Drugs and Medicines).
(a) Medicine Storage. There shall be a medicine cabinet orstorage area in the facility for safekeeping and to avoidcontamination of individual medicine and drugs. The medicinestorage area shall:
1. Be provided with lock and key and be kept locked whennot being used.
2. Have adequate storage space with shelving.
3. Be adequately lighted with artificial illumination.
4. Have proper temperature and humidity levels.
(b) Refrigerator. A refrigerator, capable of being secured,and dedicated to medicine and drug storage, shall be requiredfor medicines and drugs which must be refrigerated.
(3) Resident's Physical Facilities.
(a) All resident bedrooms shall have an outside window andshall not be below grade. Window areas shall not be less thanone-eighth of the floor area, unless proper lighting,ventilation, and air-conditioning are provided. All assistedliving facilities submitted for plan review on or afterOctober 5, 2001, shall ensure that each resident bedroom hasat least one outside window with a minimum of 20 feet of clearspace to any structure, measured perpendicularly. A peripheralview of the exterior shall be provided from newly constructedbedrooms.
(b) Residents bedrooms shall be located so as to minimize theentrance of odors, noise, and other nuisances.
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(c) Residents bedrooms shall be directly accessible to a maincorridor or through no more than one intervening sitting roomwithin the bedroom suite. In no case shall a resident bedroombe used for access to another resident room.
(d) Group and Congregate resident bedrooms shall beindividually and consistently identified, (numbered, lettered,or named).
(e) Bedroom Size. As a minimum, floor area shall be asfollows:
1. Private bedroom without sitting area: 80 square feet.Double bedroom without sitting area: 130 square feet.
2. Private bedroom with sitting area: 160 square feet.Double bedroom with sitting area: 200 square feet.
3. Bedrooms shall accommodate no more than two residents.
4. Facilities licensed prior to December 25, 1991, areexempt.
(f) Bedroom furnishings. The resident has the right to furnishhis or her room as he or she so chooses, within the facility’sguidelines. If the facility offers to provide some or all ofthe furniture, as a minimum, bedrooms shall contain thefollowing for each resident:
1. A suitable built-in clothes closet or wardrobe withshelving space and clothing pole.
2. A bed with good springs and mattress and sufficientclean bedding. In no case shall a cot or rollaway bed beprovided for residents.
3. A dresser or chest of drawers.
4. A bedside table and bed lamp.
5. At least one comfortable chair, preferably anarmchair, recliner, or rocker.
6. Window shades, venetian blinds, or other suitableprovisions for closing the view from the window.
7. Adequate number of electrical outlets shall beprovided. Extension cords, U.L. approved with overloadprotection capability may be used for light dutyappliances and shall not pose a hazard to residents.
8. A mirror in the bedroom or bedroom suite, unlesscontraindicated by a resident’s condition.
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(g) Toilet and Bathing Facilities. As a minimum, the followingtoilet and bathing facilities shall be provided.
1. For all residents’ bedrooms, which do not haveadjoining toilet and bathing facilities, plumbingfixtures shall be provided within the resident sleepingarea according to the following ratio:
(i) Bathtubs or showers one per eight beds.
(ii) Lavatories one per six beds.
(iii) Toilets one per six beds.
2. When a semi-private bedroom is provided, the facilityshall provide a means of privacy for dressing, bathing,and personal care. When common area bathrooms areprovided, there shall be separation by partitions,curtains, or screens to provide for privacy in the bathsand toilets.
3. Non-skid mats or equal surface treatment and safetyhand grips or grab bars shall be provided in tubs,showers, and at each toilet fixture. Grab bars shall beinstalled in new Group and Congregate facilities toconform to the currently adopted building code.
(h) All essential mechanical, electrical, and resident careequipment shall be clean and maintained in safe operatingcondition.
(i) Bed and bath linens shall be clean and in good condition.
(j) Housekeeping and maintenance shall provide servicesnecessary to maintain a sanitary, orderly, and comfortableinterior.
(4) Food Service Facilities.
(a) Floors. Floors in food service areas shall be of suchconstruction as to be easily cleaned, sound, smooth, non-absorbent, without cracks or crevices, and shall be providedwith approved and conveniently located facilities for thedisposal of floor wash water.
(b) Walls and Ceilings. Walls and ceilings of food serviceareas shall be of tight and substantial construction, andsmoothly finished. The walls and ceilings shall be withouthorizontal ledges and shall be washable up to the highestlevel reached by splash and spray. Roofs and walls shall bemaintained free of leaks. All openings to the exterior shallbe provided with doors or windows which prevent the entranceof rain or dust during inclement weather.
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(c) Screens or Outside Openings. Openings to the outside shallbe effectively screened, or suitable provisions made equal toscreening (such as fly fans). Screen doors shall be equippedwith self-closing devices.
(d) Lighting. The kitchen, dishwashing area and the diningroom shall have adequate light.
(e) Ventilation. Vent/exhaust hoods, vented to the outdoors,shall be provided over cooking surfaces to aid in removingcooking odors. Existing recirculating vent hoods in Familyfacilities may remain in use when filters are cleaned orreplaced regularly to prevent excess grease accumulation.Group assisted living facilities with residential stoves mayuse a residential hood sized for the stove. Commercial exhausthoods shall be installed when commercial cooking equipment isused. Congregate facilities shall use a commercial exhausthood system.
(f) Employee Toilet Facilities. Toilet rooms, if provided,shall not open directly into any room or space in which foodis prepared, stored, displayed, or served, nor into any roomin which utensils are washed or stored. Toilet rooms shallinclude a lavatory and shall be well lighted and ventilated.
(g) Hand Washing Facilities. Each Group and Congregateassisted living facility shall provide a hand washing lavatoryin the kitchens which shall be equipped with a soap dispenserand a supply of soap, disposable towels, and hot and coldrunning water through a mixing valve or combination faucet.The use of a common towel and common bar soap is prohibited.Hands shall not be washed in sinks where food is prepared.Existing Group and Congregate facilities that enlarge orrenovate kitchens shall install a hand wash sink.
(h) Refrigeration Facilities. Adequate refrigerationfacilities, automatic in operation for the storage ofperishable foods shall be provided. Refrigeration shall bemaintained at 41 degrees Fahrenheit or less. All refrigeratorsshall be provided with thermometers. All refrigerators shallbe kept clean.
(i) Equipment and Utensil Construction. Equipment andutensils, except single service utensils, shall be soconstructed as to be easily cleaned and shall be kept in goodrepair. No cadmium plated, lead, or readily corrodibleutensils or equipment shall be used.
(j) Separation of Kitchen from Resident Rooms and SleepingQuarters. Any room used for sleeping quarters shall beseparated from the food service area by a solid wall with nodirect openings. Sleeping accommodations shall not bepermitted within the food service area.
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(k) Clean Rooms. Floors, walls, and ceilings of rooms in thefood service area shall be clean and free of an accumulationof rubbish, dust, grease, dirt, etc.
(l) Clean Equipment. Equipment in the food service area shallbe clean and free of dust, grease, dirt, etc.
(m) Clean Counters, Tables, Tablecloths, and Napkins. Tablesand counters, which are used for food service, shall be keptclean. Tablecloths and cloth napkins shall be laundered aftereach use.
(n) Location and Space Requirements. Food service facilitiesshall be located in a specifically designated area and shallinclude the following rooms and space: kitchen, dishwashing,food storage, and dining room.
(o) Equipment. Minimum equipment in the kitchen shall includethe following:
1. Range. In a Family or Group assisted living facility,a residential use range is permitted. A Congregateassisted living facility shall have a heavy-duty rangesuitable for institutional use with double oven, orequivalent.
2. Refrigerator. A Family or Group assisted livingfacility may use a residential refrigerator. A Congregateassisted living facility shall have a heavy dutyrefrigerator suitable for institutional use.
3. Fire extinguisher. A five-pound type BC forresidential hoods, and K type for commercial hoods.
4. Dishwashing. The dishwashing equipment for Family andGroup assisted living facilities shall be eitherresidential type using cold water sanitizers orcommercial type with a booster water heater. Dishwashingequipment for all Congregate assisted living facilitiesshall be commercial type using a booster water heater oran automatic dispensing sanitizing chemical system.
5. A three-compartment sink with a booster heater orchemical sanitizing system for the third compartmentshall be provided in Congregate assisted livingfacilities.
6. Garbage cans with cover.
(p) Food Storage. A well-ventilated, cool food storage room,pantry, or cabinets shall be provided. Adequate shelving,bins, suitable cans, and raised platforms shall be providedand kept clean. Perishable food shall be stored at least six
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inches above the floor. The storeroom shall be of suchconstruction as to prevent the invasion of rodents andinsects, the seepage of dust and water, leakage, or any othersource of contamination.
(q) Dining Room. A resident dining room, or rooms, shall beprovided which is large enough to seat not less than 100percent of the bed capacity.
(r) Water Heating Equipment. Equipment for heating an amplesupply of water, under pressure, for all washing purposesshall be provided. Hot water shall be piped to all hand-washing facilities, and to each compartment of all dishwashingand laundry sinks. Water heaters shall be automatic type.
(5) Recreational.
(a) Living and Recreational Room(s). Each assisted livingfacility shall provide adequate living and recreationalroom(s) for group activities, and for social events, such asholiday celebrations, without crowding. The following shall beincluded:
1. Small living room(s) of a personal or family type sothat residents may read or visit with relatives andfriends in private. This requirement may be met whenprivate bedrooms are large enough for use as smallsitting rooms and are furnished for this use. Furniturefor small living rooms and sitting spaces in bedroomsshall include clean comfortable chairs, tables, and lampsof good repair.
2. Central living or recreational room in which groupactivities can take place. This requirement may be met bycombining the resident dining room with a central livingor recreational room.
(i) The usual type of small family dwelling which hasa central living room, dining room, and den orenclosed sun porch, may meet the requirements infacilities classified as Family assisted livingfacilities.
(ii) The living and recreational room shall befurnished according to the activities offered.Furniture shall include clean comfortable chairs,tables, and lamps of good repair.
(b) Yards and Gardens. Each assisted living facility shallprovide safe space for outside activities.
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(c) Hobbies or Leisure Activities. Each assisted livingfacility shall provide adequate space(s) for hobbies andleisure activities.Author: Victor Hunt, Kelley MitchellStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History: Filed November 20, 1991. Repealed and New Rule: FiledOctober 18, 2001; effective November 22, 2001. Amended: FiledJune 23, 2004; effective July 28, 2004. Amended: Filed March 21,2007; effective April 25, 2007. Amended: Filed September 22,2008; effective October 27, 2008. Amended: Filed August 20, 2015;effective September 24, 2015; operative October 1, 2015. Repealedand New Rule: Filed February 20, 2019; effective April 7, 2019.
420-5-4-.09 Laundry.
(1) General.
(a) Direction and Supervision. Responsibility for laundryservices shall be assigned to an employee.
(b) Linen. Linens shall be handled, stored, processed, andtransported in a manner consistent with generally acceptedinfection control practices.
(2) Location and Space Requirements.
(a) Each assisted living facility shall have launderingfacilities unless commercial laundries are used. An on-sitelaundry shall be located in a specifically designated area,and there shall be adequate rooms and spaces for sorting,processing, and storage of soiled material. Laundry rooms inGroup and Congregate facilities shall not open directly intoresident rooms or food service areas. Domestic washers anddryers which are for the exclusive use of residents may beprovided in resident areas, provided they are installed insuch a manner that they do not cause a sanitation problem oroffensive odors.
(b) Each assisted living facility shall have a system in placeto keep clean linen and dirty linen separated and to preventthe reuse of dirty linen before it is cleaned. Dirty linensand clothing shall not be stored, even temporarily, in thearea set aside for clean linen.
(c) Ventilation of Laundry. Provisions shall be made forproper mechanical ventilation of the laundry, if locatedwithin the assisted living facility. Provisions shall also bemade to prevent the re-circulation of air in commercialequipment laundries into the heating and air conditioningsystems outside the laundry area.
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(d) Lint Traps. Adequate, effective, and clean lint trapsshall be used in all dryers.Author: Victor HuntStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History: Filed November 20, 1991. Repealed and New Rule: FiledOctober 18, 2001; effective November 22, 2001. Amended: FiledSeptember 22, 2008; effective October 27, 2008. Repealed and NewRule: Filed February 20, 2019; effective April 6, 2019.
420-5-4-.10 Sanitation And Housekeeping.
(1) Sanitation.
(a) Water Supply.
1. If at all possible, all water shall be obtained from apublic water supply. If it is impossible to connect to apublic water system, the private water supply shall meetthe approval of the local County Health Department.
2. Water under pressure of not less than 15 pounds persquare inch shall be piped within the building to allsinks, toilets, lavatories, tubs, showers, and otherfixtures requiring water. Tubs, showers, sinks,lavatories, and other fixtures used by residents shallhave hot water supplied. Hot water accessible toresidents shall in no case exceed 110 degrees Fahrenheit.
(b) Disposal of Liquid and Human Wastes.
There shall be installed within the building a properlydesigned waste disposal system, connecting to all fixtures towhich water under pressure is piped.
2. All liquid and human waste, including floor wash waterand liquid waste from refrigerators, shall be disposedthrough trapped drains into a public sewer in localitieswhere such system is available.
3. In localities where a public sanitary sewer is notavailable, liquid and human waste shall be disposedthrough trapped drains into a sewage disposal systemapproved by the local County Health Department. Thesewage disposal system shall be of a size and capacitybased on the number of residents and personnel housed andemployed in the institution. Where the sewage disposalsystem is installed at an existing facility prior togranting of a license, it shall be inspected and approvedby the local County Health Department.
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(c) Premises. The premises shall be kept neat and clean. Theproperty shall be free of rubbish, weeds, ponded water, orother conditions that may create a health, safety, orsanitation hazard.
(d) Control of Insects, Rodents and Other Pests. Each facilityshall be kept free of ants, flies, roaches, rodents, and otherpests. Proper and lawful methods for their eradication orcontrol shall be used. Droppings shall be evidence ofinfestation by pests.
(e) Toilet Room Cleanliness. Floors, walls, ceilings, andfixtures of all toilet rooms shall be kept clean and free ofobjectionable odors. These rooms shall be kept free of anaccumulation of rubbish, cleaning supplies, and toiletryarticles. The use of a common towel and common bar soap isprohibited.
(f) Garbage Disposal.
1. Garbage must be kept in water-tight suitablecontainers with tight-fitting covers. Garbage containersmust be emptied at frequent intervals and shall bethoroughly cleaned and aired before using again.
2. Garbage and waste shall be disposed of in accordancewith local and state regulations.
(g) Control of odors. The facility shall be free ofobjectionable odors.
(2) Housekeeping and Physical Plant Maintenance. The facility mustprovide a safe, functional, sanitary, decent, and comfortableenvironment for residents, staff, and the public.
(a) Equipment and Supplies. The home shall maintain anadequate quantity of housekeeping and maintenance equipmentand supplies.
(b) Bathtubs and Lavatories. Bathtubs and lavatories shall bekept clean and in proper working order, and shall not be usedfor laundering.
(c) Resident Bedrooms. Resident bedrooms shall be cleaned anddusted as often as necessary to maintain a clean, attractiveappearance.
(d) General Storage.
1. Broken beds, extra mattresses, mop buckets, and dustrags shall not be kept in hallways, closets, corners, oroccupied resident rooms. Such items must be stored neatlyand orderly in designated storage rooms.
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2. The use of attics for storage of combustible materialsshall be prohibited unless protected by an automaticsprinkler system and then only in small quantities so asnot to create a hazardous condition.
3. Basements used for storage shall meet acceptablestandards for storage and shall be designed andconstructed in a manner that protects against firehazards.
4. Flammable materials such as gasoline, motor fuels,lighter fluid, turpentine, acetone, and oil-based paintshall not be stored in the facility. Unless prohibited bya facility’s own policies, however, a cognitively intactresident who uses lighter fluid to fill a personalcigarette lighter, or one who uses flammable materialssuch as paint or glue in connection with a personalhobby, may store small quantities of those materials in asafe and secure manner within his or her own room.
5. Poisonous or External Use Substances. Facilitycleaning supplies and poisons shall be attended at alltimes or shall be kept in a secure area.Author: Victor Hunt, Kelley MitchellStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History: Filed November 20, 1991. Repealed and New Rule: FiledOctober 18, 2001; effective November 22, 2001. Amended: FiledSeptember 22, 2008; effective October 27, 2008. Repealed and NewRule: Filed February 20, 2019; effective April 7, 2019.
420-5-4-.11 Fire And Safety.
(1) General.
(a) Fire Safety and Emergency Plan. All assisted livingfacilities shall maintain a current written fire safety,relocation, and evacuation plan. In facilities which do nothave multiple smoke compartments, an evacuation floor planshall be appropriately posted in a conspicuous place.
(b) Fire Drills. Fire drills shall be conducted at least onceper month in all facilities at varying times and days andquarterly on each shift of Group and Congregate facilities.All fire drills shall be initiated by the fire alarm system.The drills may be announced in advance to the residents. Thedrills shall involve the actual evacuation of residents toassembly areas in adjacent smoke compartments or to theexterior as specified in the emergency plan to provide staffand residents with experience in exiting through all exitsrequired by the currently adopted Life Safety Code. Written
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observations of the effectiveness of the fire drill plan shallbe assessed monthly, filed, and kept for at least three years.
(c) Fire Drills During Resident Sleeping Hours. When drillsare conducted between 9 PM and 6 AM, a coded announcementshall be permitted to be used instead of the normal audiblefire alarm signals. These drills may be conducted withoutdisturbing sleeping residents, by using simulated residents orempty wheelchairs.
(d) Roller latches are prohibited on doors separatingcorridors from adjacent spaces.
(e) If alcohol-based hand rub dispensers are used in thefacility, the dispensers must be installed in a manner that:
1. Minimizes leaks and spills.
2. Adequately protects against inappropriate access.
3. Complies with the requirements of the currentlyadopted Life Safety Code.
(f) Fire Alarm and Sprinkler System.
1. Fire Alarm System. Where fire alarm systems arerequired, a corridor smoke detection system shall beinstalled on each floor, including areas open to the exitaccess corridor, to comply with NFPA 72, connected to thefacility's fire alarm system. In lieu of corridor smokedetection, smoke detectors connected to the building firealarm system may be installed in each resident's room,open areas, and at smoke doors (except that corridorsmoke detection shall not be deleted when its use isdictated by other requirements).
2. Fire alarm and sprinkler system outages of more than 4hours require evacuation of the facility or theestablishment of a continuous fire watch. The fire watchprocedure must be coordinated with the Department and thelocal Fire Marshal. Outages and fire watch documentationshall be reported to the Department within 12 hours or nolater than the next duty day, and shall be correctedexpeditiously.
3. The fire alarm system and the sprinkler system shallbe inspected by licensed, trained, and qualifiedpersonnel at least semiannually for compliance with therespective codes. Inspection and testing reports shall bemaintained in the facility for a period of at least 3years.Author: Victor HuntStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.
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History: Filed November 20, 1991. Repealed and New Rule: FiledOctober 18, 2001; effective November 22, 2001. Amended: FiledSeptember 22, 2008; effective October 27, 2008. Repealed and NewRule: Filed February 20, 2019; effective April 7, 2019.
420-5-4-.12 Physical Environment.
(1) Buildings and Grounds.
(a) The assisted living facility including site and groundsmust be constructed, arranged, and maintained to ensure thesafety of the residents and building occupants.
(b) Building Classification.
1. Family assisted living facilities shall be planned toserve the types of residents to be admitted and shallcomply with the Life Safety Code Chapter for One- andTwo-Family Dwellings, and shall comply with Sections (1),(2), (3), and (4) of AAC Rule 420-5-4-.12.
2. Group assisted living facilities shall be planned toserve the residents to be admitted and shall comply withSection (1), (2), (3), and (5) of AAC Rule 420-5-4-.12.
3. Congregate assisted living facilities shall be plannedto serve the residents to be admitted and shall complywith Sections (1), (2), (3), (6) of AAC Rule 420-5-4-.12.
4. Renovation within the exterior walls of an assistedliving facility shall in no case be of such nature as tolower the character of the structure below the applicablebuilding requirements for the classification of licenseheld by the assisted living facility.
5. Dually Licensed Facility.
(i) For the purposes of meeting physical facility andbuilding code requirements, a building housing both aregular assisted living facility and a specialty careassisted living facility shall be classified as aGroup or Congregate facility in accordance with thecombined licensed bed capacities of both facilities.For the purposes of meeting resident care andadministrative requirements, the specialty careassisted living facility and the regular assistedliving facility shall be separately considered, andeach shall be classified as a Congregate facility ora Group facility in accordance with the licensed bedcapacity of each, and the determination shall not bebased on their combined bed capacity. See Rule
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420-5-20 for Specialty Care Assisted LivingFacilities and requirements.
(ii) When a facility has a portion of a buildinglicensed for specialty care residents, instead of theentire facility, the sleeping, bathing, dining, andactivity areas shall be in a distinct and separateunit within the building, licensed for specialty careassisted living. Administrative, kitchen, and serviceareas may be shared between the two licensedportions.
(c) Location. All assisted living facilities established orconstructed shall be located so that they are free from unduenoises, smoke, dust, or foul odors. New assisted livingfacilities shall be located at least 1,000 feet fromrailroads, freight yards, or disposal plants. This distancecan be reduced to 500 feet when facility is separated by aboarded fence at least six feet high. This rule shall notprevent enlargement or expansion of existing assisted livingfacilities.
(d) Local Restrictions. The location and construction of allassisted living facilities shall comply with local zoning,building, and fire ordinances. Evidence to this effect, signedby local fire, building, or zoning officials, may be requiredas a condition of licensure. If a facility is to be located inan area that does not have any zoning, building, or fireauthority review, a letter stating such shall be obtained fromthe local county commission through official board action orfrom the office of the probate judge.
(e) Assisted living facilities shall be located on publiclymaintained streets or roads, and connected with drivewayswhich shall be kept passable at all times.
(f) Occupancy. No part of an assisted living facility may berented, leased, or used for any commercial purpose notreasonably necessary for the residents of the facility or theresidents of other licensed facilities on the same campus. Acampus consists of the premises occupied by the licensedfacility together with all parcels or property that thegoverning authority owns or has the legal right to occupy, andwhich are separated from the remainder of the campus only by apublic right of way. Services provided within the facilityshall be limited to serving the residents of facilities on thecampus that are licensed by the Department. The Departmentshall approve all plans for occupancy.
(g) Basements. The basement shall be considered as a story ifit meets criteria established by the codes for a story.
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(h) The assisted living facility must maintain adequatefurnishings, fixtures, supplies, and equipment for itsservices.
(i) Facilities, supplies, and equipment must be maintained insafe operating condition.
(j) There must be proper ventilation, light, and temperaturecontrols in pharmaceutical, food preparation, and otherappropriate areas.
(2) Submission of Plans and Specifications.
(a) New Facilities, Additions, and Alterations. Plans andspecifications shall be submitted for review and approval tothe Department, for any building that is intended to containan assisted living facility, and for additions and alterationsto existing facilities. Submissions shall be in accordancewith Alabama Administrative Code 420-5-22, "Submission ofPlans and Specifications for Health Care Facilities."
(3) Inspections. The State Board of Health and its authorizedrepresentatives shall have access to all facilities forinspection.
(4) Remodeling.
(a) The remodeled area of existing facilities shall beupgraded to comply with the current requirements for newconstruction.
(b) Any remodeling to existing facilities shall not diminishthe level of safety which existed prior to the start of thework.
(5) General Building Requirements - Family, Group, and Congregate.
(a) Structural Soundness and Repair. The building shall bestructurally sound, free from leaks and excessive moisture, ingood repair, and painted with sufficient frequency to bereasonably attractive inside and out. The interior andexterior of the building shall be kept clean and orderly.
(b) Temperature to be Maintained. The facility shall maintaina comfortable temperature. A comfortable range is between71-81 degrees Fahrenheit.
(c) Lighting. Each resident's room shall have artificial lightadequate for reading and other uses as needed. All entrances,hallways, stairways, inclines, ramps, cellars, attics,storerooms, kitchens, laundries, and service units shall havesufficient artificial lighting to prevent accidents and
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promote efficiency of service. Night lights shall be providedin all hallways, stairways, and bathrooms.
(d) Screens. All screen doors and operable windows shall beequipped with tight-fitting, full-length insect screens.Screen doors shall be equipped with self closing devices.
(e) Emergency Lighting.
1. All assisted living facilities shall provide emergencyartificial lighting to adequately illuminate halls,corridors, kitchens, dining areas, and stairwells in caseof electrical power failure. As a minimum, dry cellbattery-operated lighting shall be provided to light suchspaces.
2. Emergency lighting must provide illumination inaccordance with the currently adopted Life Safety Codefor at least 90 minutes.
(f) Floors.
1. All floors shall be level, smooth and free of cracks,and finished so as to be easily kept clean. The basicrequirement for floor finishes shall be wall-to-wall withsuch finishes as paint, stain, sealer, carpet, sheetvinyl, vinyl tile, hard tile, or other appropriate floorfinish.
2. Any differences in floor levels shall not prevent aresident from navigating safely throughout the facility.
(g) Walls and Ceilings. All walls and ceilings shall be ofsound construction with an acceptable surface and shall bekept clean and in good repair.
(h) Windows. Operable windows shall be so constructed andmaintained so that they fit snugly, and are capable of beingopened and closed easily.
(i) Ceiling Height. Each room occupied by residents shall havea ceiling height of eight feet or more. Existing facilitieswith ceiling heights less than eight feet shall be acceptablewhen the height complies with the codes.
(j) Handrails. If handrails are installed in halls orcorridors, the handrails shall be mounted at 30-36 inchesabove the floor and returned to the wall at each end.
(k) Stairways. Stairways shall be well lighted, kept in goodrepair, and have handrails. Open space under stairs shall notbe used for storage purpose. All walls and doors under stairsshall meet the same fire rating as the stairwell.
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(l) Doors.
1. In each new assisted living facility, doors ofresident bathrooms connected to resident bedrooms shallswing into the bedroom.
2. Bedroom and bathroom doors may be equipped withhardware that will permit a resident to lock himselfwithin the room, provided a master key is readilyaccessible for the staff at a central location.
3. Resident bedroom and other exit access doors in eachassisted living facility shall be at least three feetwide.
Bedroom doors in Family assisted living facilities shallnot be less than 32 inches wide.
4. Exterior egress doors except the main entry/exit door,may be equipped with a delayed egress lockingsystem installed in accordance with NFPA 101. Otherspecial lockingarrangements are permitted only in specialty careassisted living facilities.
5. Exit doors swinging outward shall swing out over alanding having a minimum length and width equal to thedoor's width at the same level as the floor level, exceptexisting doors shall not have more than a four inch stepdown. Exit doors of Family facilities may swing inward.
(m) Ventilation. The building shall be well-ventilated at alltimes to prevent accumulation of objectionable odors.Kitchens, laundries, service rooms, toilets, and bathroomsshall be ventilated by windows, gravity vents, or mechanicalmeans as necessary to prevent offensive odors from enteringother parts of the facility.
(n) Fire Extinguishers. Fire extinguishers shall be providedfor each hall, kitchen, and laundry, of type and capacityappropriate to the need.
1. Each fire extinguisher shall receive an annualinspection with maintenance, and recharging whennecessary, by a fire equipment servicing representative.An annual servicing tag shall be attached to theextinguisher reflecting the name of the servicingcompany, representative, day, month, and year ofmaintenance.
2. A visual inspection of each fire extinguisher shall beconducted monthly by designated staff of the facility and
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documented on the attached extinguisher tag by thedesignated staff person.
(o) Call System. Except in Family facilities, a centralelectric or electronic call system shall be convenientlyprovided for each resident, usable in bedrooms and bathrooms.The call system shall be certified to meet the applicableUnderwriters Laboratories standard.
(p) Manufactured homes/mobile homes are not permitted.
(q) Fireplaces and inserts, shall be inspected and cleanedannually, and shall comply with the currently adopted buildingcode. Openings shall be protected with screens, or doors.
(r) Exit marking. In Group and Congregate facilities, a signbearing the word "EXIT" in plain legible block letters shallbe placed at each exit. Additional signs shall be placed incorridors and passageways wherever necessary to indicatethe direction of exit. Letters of signs shall be at leastfour inches high. All exit and directional signs shall bekept clearly legible by continuous internal electricillumination and have battery back-up or emergency power.
(s) Heating, Lighting, and other Service Equipment.
1. Central or individual room gas heating systems shallbe of the enclosed flame type equipped withautomatic flame shut-off control and shall be venteddirectly to the outside. Heating units of any type shallbe located to avoid direct contact with any combustiblematerial and shall be maintained in accordance withmanufacturer's recommendation.
2. Open flame and portable heaters are prohibited inassisted living facilities. This does not apply to a fireplacewith gas logs protected as noted elsewhere in theserules.
3. Lighting shall be restricted to electricity. Electricwiring, motors, and other electrical equipment in allassisted living facilities shall be in accordance withlocal electrical codes and the NFPA National ElectricalCode.
(6) Building Requirements-Family Assisted Living Facility.
(a) General. Family assisted living facilities shall complywith the provisions of this section. Such facilities shall berenovated to comply with the provisions of the National FireProtection Association, Life Safety Code Chapter for One-and
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Two-Family Dwellings, and other minimum standards of safetyestablished by the Board.
(b) Fire Protection.
1. Fire Extinguishers. A five-pound BC fire extinguishershall be provided in the kitchen. A five-pound ABC fireextinguisher shall be provided in the laundry andhall(s).
2. Smoke Detectors. Smoke detectors tied into electricalsystems are required in all bedrooms, activity rooms, andhallways. Detectors shall be tested monthly for localalarm activation and documented. Defective detectorsshall be replaced within 24 hours.
(c) Mechanical and electrical systems shall be inspected bylocal building, electrical, plumbing officials, or the StateFire Marshal, or such other person(s) as the State Board ofHealth may request, and their recommendations relating toadequacy and safety presented to the Board.
(7) Building Requirements - Group Assisted Living Facilities.
(a) General. Group assisted living facilities licensed,constructed, or renovated after December 25, 1991, shall belimited to one story buildings and shall comply with thecurrently adopted building code and National FireProtection Association, Life Safety Code. Facilities, orportions of facilities, built under the currently adoptedcodes shall comply with the Life Safety Code Chapter for NewResidential Board and Care Occupancies (excluding NFPA 101AAlternative Approaches to Life Safety). Facilities, orportions of facilities, built under previous adopted editionsof the codes shall comply with the currently adopted LifeSafety Code Chapter for Existing Residential Board and CareOccupancies, Impractical Evacuation Capability (excluding NFPA101A Alternative Approaches to Life Safety).
(b) Required Fire Exits.
1. At least two exits, remote from each other andso located that there will be no dead-end corridors inexcess of 20 feet, shall be provided.
2. Exits shall be so located that the distance of travelfrom the corridor door of any occupied room to anexit shall not exceed 100 feet.
3. Each bedroom or suite shall have at least one doorwayopening directly to the outside, or to an exitcorridor leading directly to the outside.
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4. Exit doors shall swing to the exterior.
5. Panic hardware shall be installed on all exit doors offacilities submitted for plan review. As aminimum, single action hardware is required on all exitdoors of existing facilities.
(c) Corridors and Passageways. Corridors and passageways usedas a means of exit, or part of a means of exit, shall be atleast 36 inches wide, shall be unobstructed, and shall notlead through any room or space used for a purpose that mayobstruct free passage.
(d) Smoke Barrier Separations.
1. Buildings exceeding 3,000 square feet in area shall bedivided into separate areas by smoke barriers so locatedas to provide ample space on each side forapproximately one-half the beds. Smoke barriers shallhave a fire-resistive rating of not less than one hour orminimum one-half hour for existing sprinkled facilities.
2. Doors provided in smoke barriers shall be smoke-resistive, so installed that they may normally be keptin the open position, but will close automatically uponfire alarm activation.
3. Duct penetrations in smoke barriers shall be properlyprotected with smoke dampers.
4. Penetrations of smoke barriers with wiring, conduits,pipes, etc., shall be sealed to maintain the fire andsmoke rating.
(8) Building Requirements - Congregate Assisted Living Facility.
(a) General. Congregate assisted living facilities licensed,constructed, or renovated under the currently adopted codesshall comply with the building code and the requirements forlimited care facilities in the “New Health Care Occupancies”Chapter of the Life Safety Code (excluding NFPA 101A,Alternative Approaches to Life Safety). Facilities, orportions of facilities, built under previously adoptededitions of the codes shall comply with the currently adopted Life Safety Code Chapter for Existing Residential Board andCare Occupancies, Impractical Evacuation Capability, therebyrequiring compliance with the requirements for limited carefacilities in the “Existing Health Care Occupancies” Chapterfor the Life Safety Code (excluding NFPA 101A AlternativeApproaches to Life Safety).
(b) Exit doors. Panic hardware shall be installed on all exitdoors.
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(c) Corridors and Passageways. Corridors and passageways shallbe unobstructed and shall not lead through any room or spaceused for a purpose that may obstruct free passage.
(d) In new construction, the temperature of hot wateraccessible to residents shall be automatically regulated bytempering valves and a circulating pump system, unless thewater heater is dedicated to resident use.
(e) Utility rooms shall be provided for each floor ofCongregate assisted living facilities. The following equipmentshall be provided:
1. Paper towel holder with an adequate supply of papertowels.
2. Wall cabinet or shelves.
3. Table or counter.
4. Soap dispenser with soap.
5. Sink - counter top, wall or floor mounted.
6. Space and facilities for cleaning equipment andsupplies.Author: Victor Hunt, Kelley MitchellStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History: Filed November 20, 1991. Amended: Filed February 20,1997; effective March 27, 1997. Repealed and New Rule: FiledOctober 18, 2001; effective November 22, 2001. Amended: FiledJune 18, 2002; effective July 23, 2002. Amended: Filed June 23,2004; effective July 28, 2004. Amended: Filed June 21, 2006;effective July 26, 2006. Amended: Filed September 22, 2008;effective October 27, 2008. Amended: Filed August 20, 2015;effective September 24, 2015; operative October 1, 2015. Repealedand New Rule: Filed February 20, 2019; effective April 7, 2019.
Ed. Note: Previous Chapter 420-5-4 "Domiciliary Care Facilities"filed September 1, 1982. Repealed: Filed November 20, 1991.
420-5-4-.03 (Repealed)Classification Of Assisted LivingFacilities.Author: Faye HaygoodStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History: Filed November 20, 1991. Repealed: Filed October 18,2001; effective November 22, 2001.
420-5-4-.07 (Repealed)Storage of Drugs and Medicines.
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Author: Faye HaygoodStatutory Authority:Code of Ala. 1975, §§22-21-20, et seqHistory: Filed November 20, 1991. Repealed: Filed October 18,2001; effective November 22, 2001.
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420-5-4-A Appendix A Code of Ala. 1975, Sections22-21-20, et seq..
§22‐21‐20. Definitions.
For the purpose of this article, the following terms shallhave the meanings respectively ascribed to them by thissection:
(1) Hospitals. General and specialized hospitals,including ancillary services; independent clinicallaboratories; rehabilitation centers; ambulatory surgicaltreatment facilities for patients not requiringhospitalization; end stage renal disease treatment andtransplant centers, including free‐standing hemodialysisunits; abortion or reproductive health centers; hospices;health maintenance organizations; and other relatedhealth care institutions when such institution isprimarily engaged in offering to the public generally,facilities and services for the diagnosis and/ortreatment of injury, deformity, disease, surgical orobstetrical care. Also included within the term are longterm care facilities such as, but not limited to, skillednursing facilities, intermediate care facilities,assisted living facilities, and specialty care assistedliving facilities rising to the level of intermediatecare. The term “hospitals” relates to health careinstitutions and shall not include the private offices ofphysicians or dentists, whether in individual, group,professional corporation or professional associationpractice. This section shall not apply to county ordistrict health departments.
(2) Person. The term includes individuals, partnerships,corporations, and associations. (Acts 1975, 3rd Ex.Sess., No. 140, p. 382, §1; Acts 1979, No. 79‐798, p.1461; Acts 1991, No. 91‐548, p. 1010, §1; Act 2001‐1058,4th Sp. Sess., p. 1044, §1.)
§22‐21‐21. Purpose of Article.
The purpose of this article is to promote the public health,safety and welfare by providing for the development,establishment and enforcement of standards for the treatmentand care of individuals in institutions within the purview ofthis article and the establishment, construction, maintenanceand operation of such institutions which will promote safe andadequate treatment and care of individuals in suchinstitutions. (Acts 1949, No. 530, p. 835, §1; Acts 1962, Ex.Sess., No. 122, p. 157, §1.)
§22-21-22. License -- Required; exceptions.
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No person shall establish, conduct or maintain any hospital asdefined in Section 22-21-20 without first obtaining thelicense provided in this article. Hospitals operated by thefederal government and mental hospitals under the supervisionof the board of trustees of the Alabama State Hospitals shallbe exempt from the provisions of this article. (Acts 1949, No.530, p. 835, §2; Acts 1962, Ex. Sess., No. 122, p. 157, §2.)
§22‐21‐23. License ‐‐ Application.
Any person desiring licensing under this article shall applyto the State Board of Health therefore. The applicant shallstate the name of the applicant and whether an individual,partnership, corporation or other entity, the type ofinstitution for which a license is desired, the locationthereof and the name of the person in direct supervision andcharge thereof. The person in charge of such hospital must beat least 19 years of age and of reputable and responsiblecharacter. The applicant shall submit evidence of ability tocomply with the minimum standards provided in this article orby regulations issued under its authority. (Acts 1949, No.530, p. 835, §4; Act 2001‐1058, 4th Sp. Sess., p. 1044, §1.)
§22‐21‐24. License ‐‐ Fees; Expiration and Renewal; Accreditation.
The application for a license to operate a hospital other thanan assisted living facility or a specialty care assistedliving facility rising to the level of intermediate care shallbe accompanied by a standard fee of two hundred dollars($200), plus a fee of five dollars ($5) per bed for each bedover 10 beds to be licensed in accordance with regulationspromulgated under Section 22‐21‐28. Increase in a hospital'sbed capacity during the calendar year is assessed at thestandard fee of two hundred dollars ($200) plus five dollars($5) each for the net gain in beds. The initial licensure feeand subsequent annual licensure renewal fee for an assistedliving facility and for a specialty care assisted livingfacility rising to the level of intermediate care shall be twohundred dollars ($200) plus fifteen dollars ($15) for eachbed. A license renewal application for any hospital, asdefined by this article, which is not received by theexpiration date in a properly completed form and accompaniedby the appropriate renewal fee shall be subject to a latepenalty equal to two hundred fifty dollars ($250) or 100percent of the renewal fee, whichever is greater. No fee shallbe refunded. All fees received by the State Board of Healthunder the provision of this article shall be paid into theState Treasury to the credit of the State Board of Health andshall be used for carrying out the provisions of this article.A license granted under this article shall expire on December31 of the year in which it was granted. A license certificateshall be on a form prescribed by the department, and shall beposted in a conspicuous place on the licensed premises.
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Licenses shall not be transferable or assignable and shall begranted only for the premises named in the application.Licenses may be renewed from year to year upon application,investigation, and payment of the required license fee, as inthe case of procurement of the original license. All feescollected under this article are hereby appropriated forexpenditure by the State Health Department. All hospitalswhich are accredited by the joint commission on accreditationof hospitals shall be deemed by the State Health Department tobe licensable without further inspection or survey by thepersonnel of the State Department of Health. Furtheraccreditation by the joint commission on accreditation ofhospitals shall in no way relieve that hospital of theresponsibility of applying for licensure and remitting theappropriate licensure fee as specified in this article. (Acts1949, No. 530, p. 835, §5; Acts 1975, 3rd Ex. Sess., No. 140,p. 382, §2; Acts 1980, No. 80‐642, p. 1213; Acts 1988, 1st Ex.Sess., No. 88‐902, p. 470; Act 2001‐1058, 4th Sp. Sess., p.1044, §1.)
§22‐21‐25. License ‐‐ Issuance; Suspension or Revocation; NewApplications After Revocation.
(a) The State Board of Health may grant licenses for theoperation of hospitals which are found to comply with theprovisions of this article and any regulations lawfullypromulgated by the State Board of Health.
(b) The State Board of Health may suspend or revoke a licensegranted under this article on any of the following grounds:
(1) Violation of any of the provisions of this article orthe rules and regulations issued pursuant thereto.
(2) Permitting, aiding or abetting the commission of anyillegal act in the institution.
(3) Conduct or practices deemed by the State Board ofHealth to be detrimental to the welfare of the patientsof the institution.
(c) Before any license granted under this article is suspendedor revoked, written notice shall be given the licensee,stating the grounds of the complaint, and the date, time, andplace set for the hearing of the complaint, which date ofhearing shall be not less than 30 days from the date of thenotice. The notice shall be sent by registered or certifiedmail to the licensee at the address where the institutionconcerned is located. The licensee shall be entitled to berepresented by legal counsel at the hearing.
(d) If a license is revoked as provided in this section, a newapplication for license shall be considered by the State Board
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of Health if, when, and after the conditions upon whichrevocation was based have been corrected and evidence of thisfact has been furnished. A new license shall then be grantedafter proper inspection has been made and all provisions ofthis article and rules and regulations promulgated under thisarticle have been satisfied. (Acts 1949, No. 530, p. 835, §7;Act 2001‐1058, 4th Sp. Sess., p. 1044, §1.)
§22‐21‐26. License ‐‐ Judicial Review of Suspension or Revocation.
Any party aggrieved by a final decision or order of the Boardof Health suspending or revoking a license is entitled to areview of such decision or order by taking an appeal to thecircuit court of the county in which the hospital is locatedor is to be located. (Acts 1949, No. 530, p. 835, §11.)
§22‐21‐27. Advisory Board.
(a) There shall be an advisory board of 17 members to assistin the establishment of rules, regulations, and standardsnecessary to carry out the provisions of this article and toserve as consultants to the State Health Officer. The boardshall meet at least twice each year and at the call of theState Health Officer. The members of the board shall annuallyelect one of its members to serve as chairman.
(b) The advisory board shall be constituted in the followingmanner:
(1) Four representatives of hospitals, who shall beappointed by the Board of Trustees of the AlabamaHospital Association as follows:
a. One administrator of a governmental hospital.
b. One administrator of a nongovernmental nonprofithospital.
c. One owner or administrator of a proprietaryhospital.
d. One member of a managing board of a nonprofithospital.
(2) Three representatives who shall be doctors ofmedicine appointed by the Board of Censors of the MedicalAssociation of the State of Alabama.
(3) One representative who shall be a registered nurseappointed by the Executive Board of the Alabama StateNurses Association.
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(4) One representative from the State Board of HumanResources who shall be appointed by the board.
(5) One registered pharmacist actively engaged in thepractices of pharmacy in the State of Alabama, to beappointed by the Executive Committee of the AlabamaPharmacy Association.
(6) Three members who shall be appointed by the ExecutiveCommittee of the Alabama Nursing Home Association, eachof whom shall be the operator of a duly qualifiedlicensed nursing home.
(7) One member who shall be appointed by the AlabamaHospice Association.
(8) Two members who shall be appointed by the AssistedLiving Association of Alabama, one of whom shall be theoperator of a licensed assisted living facility orlicensed specialty care assisted living facility risingto the level of intermediate care with 16 or fewer beds,and one of whom shall be the operator of an assistedliving facility or licensed specialty care assistedliving facility rising to the level of intermediate carewith more than 16 beds.
(9) One member who shall be appointed by the Governor torepresent the interests of consumers. The consumerrepresentative shall be at least 65 years of age andshall have no financial interest in any facility licensedunder this article. Each new appointee shall serve forfive years or until his or her successor is appointed,whichever is later. Any vacancy caused by a memberleaving the position before the expiration of his or herterm shall be filled by the organization selecting theoriginal member. The replacement member appointed shallserve for the remainder of the unexpired term.
(c) A member of the advisory board shall not be eligible tosucceed himself or herself after serving one full five‐yearterm, but shall be eligible for reappointment if he or she hasserved only a portion of a five‐year term or if he or she hasnot served immediately preceding the reappointment.
(d) Members of the advisory board shall serve withoutcompensation, but shall be entitled to reimbursement forexpenses incurred in the performance of the duties of theoffice at the same rate allowed state employees pursuant togeneral law. (Acts 1949, No. 530, p. 835, §9; Acts 1959, No.134, p. 656, §1; Acts 1991, No. 91‐548, p. 1010, §1; Act 2001‐1058, 4th Sp. Sess., p. 1044, §1.)Author: Rick Harris, Kelley MitchellStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.
Health Chapter 420-5-4
Revised 5/15/22 4-83
History:New Rule: Filed September 20, 2000; effective October25, 2000. Repealed and New Rule: Filed October 18, 2001;effective November 22, 2001. Repealed and New Rule: FiledFebruary 20, 2019; effective April 7, 2019.
Chapter 420-5-4 Health
Revised 5/15/22 4-84