This chapter establishes the licensing and operating requirements for assisted living homes in Alaska, covering both probationary and standard licenses. Operators must meet application, staffing, administrator qualifications, care provider training, background check, environmental, food service, life safety, and recordkeeping standards. The regulation also addresses license renewal, fees, inspections, physical restraint procedures, and emergency protocols. Homes serving persons with mental illness, developmental disabilities, physical disabilities, elderly residents, or those with dementia are all within scope.
View official sourceChapter 75 Assisted Living Homes Article 1 Licensing of Assisted Living Homes 7 AAC 75.010. Applicability. (a) The requirements of this chapter apply to the licensure and operation of assisted living homes as follows: (1) an assisted living home licensed on or after April 6, 2002 is subject to all applicable requirements of this chapter; (2) an assisted living home licensed before April 6, 2002 is subject to all applicable requirements of this chapter, except that the home is exempt from (A) those training and experience requirements of 7 AAC 75.230 (c), that an administrator of a home on April 6, 2002 does not already meet; that administrator shall comply with the continuing education requirements of 7 AAC 75.220 (e); however, an administrator hired after April 6, 2002 is subject to all requirements of 7 AAC 75.230 in addition to all other requirements for administrators in this chapter; and (B) the requirements of 7 AAC 75.260 (a)(7), dealing with bedroom standards. (b) A home licensed under 7 AAC 50 or 7 AAC 57 is exempt from licensing under AS 47.33 and this chapter. 7 AAC 75.020. Types of license; duration; licensing responsibility. (a) There are two types of assisted living home licenses, as follows: (1) probationary, for homes (A) that have not previously been licensed under AS 47.33 and this chapter; or (B) for which a standard license has been converted to probationary status because of noncompliance with AS 47.33 or this chapter; (2) standard, for homes that have passed the probationary period. (b) Subject to the possibility of suspension or revocation under AS 47.33 and this chapter, a license is valid for the following periods: (1) probationary: a period set by the department, not to exceed two consecutive years, with a possible one-year extension; and (2) standard: two years, except as stated in 7 AAC 75.090 . (c) Repealed 4/6/2002. (d) A license will be issued to a home providing care (1) primarily to persons with a mental or developmental disability; (2) primarily to persons who have a physical disability, who are elderly, or who suffer from dementia, but who are not diagnosed as chronically mentally ill; and (3) to approximately equal numbers of persons described in both (1) and (2) of this subsection, or to a home seeking its probationary license and for which the administrator has not yet decided which specific category of persons to serve; in such a case the department will consider the purposes of AS 47.33 , the service features of the particular home, and, if any, the preference of the home, and decide whether to issue that home a license entitling the home to serve persons described in both (1) and (2) of this subsection. 7 AAC 75.030. Powers and duties of the department. (a) The department will (1) license assisted living homes in accordance with AS 47.33 and this chapter; (2) investigate license applicants, licensees, and homes that are required to be licensed for compliance with AS 47.33 and this chapter; (3) enforce the standards established by AS 47.33 and this chapter; and (4) inspect and investigate complaints of abandonment, abuse, exploitation, neglect, or self-neglect in assisted living homes. (b) The department may designate by a written agreement conforming to (c) of this section a state, municipal, or private agency to investigate and make recommendations to the department for the licensing of assisted living homes under procedures and standards of operation established by the department. (c) An agreement executed under (b) of this section must include (1) a description of the respective regulatory responsibilities of the department and the other agency; (2) procedures for processing variance requests; (3) procedures for record maintenance and sharing; and (4) procedures for appealing the investigative findings and recommendations made by the designated agency for and to the department. 7 AAC 75.040. Conversion of other licenses. Repealed. 7 AAC 75.050. Voluntary licensure. The department may, as time permits, issue a license to an assisted living home that serves one or two adult residents whether or not the residents are related to the owner by blood or marriage, and that is not required by AS 47.33.010 and 47.33.400 to be licensed, but that wishes to become licensed voluntarily. All provisions of this chapter apply to this type of licensure. 7 AAC 75.060. Probationary license. (a) The department will issue a probationary license to operate an assisted living home if the department finds that the application and the home's plan for operation comply with AS 47.33 and this chapter. In determining compliance with AS 47.33 and this chapter, the department will consider the nature, size, and character of the home and its residents, and whether the prevailing residential standards of the community and neighborhood in which the home is located are protective of life, health, and safety. (b) At any time before the expiration of a probationary license, but after the assisted living home is operating, the department may convert a probationary license to a standard license. 7 AAC 75.070. Standard license. (a) The department will issue a standard license to operate an assisted living home if, upon completion of the probationary period, and after inspection or investigation, the department finds that the home is operating in compliance with AS 47.33 and this chapter. (b) In determining compliance with AS 47.33 and this chapter, the department will consider the nature, size, and character of the home and its residents, and whether the prevailing residential standards of the community and neighborhood in which the home is located are protective of life, health, and safety. 7 AAC 75.080. Application for license; modification. (a) A person may not begin operation of an assisted living home until that person has obtained a probationary or standard license from the department. A person may not move the location or make a major modification of a licensed assisted living home, or increase the number of residents the home is licensed to serve until that person has obtained approval for a modification of its license from the department. An application under this section must be made on a form supplied by the department. A person may not apply for a license to operate one or more additional homes until each current home has passed the probationary period and been issued a standard license. For purposes of this subsection, "major modification" means a change to the home that, during construction of the modification, would adversely affect the residents, services to the residents, or emergency evacuation of the residents. (b) An application for a license to operate an assisted living home must be notarized and must contain (1) the name, title, address, telephone number, and, if available, electronic mail address and facsimile number of (A) the applicant; (B) each person who has an ownership interest in the home; (C) the chief executive officer of the unit or subunit of government, if the applicant is a government entity; (D) the owner of the premises in which the home will be located, if the applicant is not the owner of the premises; and (E) the administrator of the home; (2) the name of the assisted living home, if known by a name; (3) the address of the assisted living home or the proposed new location of the assisted living home; (4) evidence that the administrator meets the requirements of 7 AAC 75.215 , 7 AAC 75.220 , and 7 AAC 75.230 ; (5) repealed 4/6/2002; (6) the number of individuals within the maximum occupancy number established by the fire safety inspection required under 7 AAC 10.1010 that a home intends to serve; (7) the number of residents the home intends to serve who are expected to be persons who (A) have a primary diagnosis of mental illness or physical or developmental disability; or (B) are elderly or suffering from dementia, but who are not mentally ill; (8) the services the home proposes to offer; (9) copies of all permits and approvals required by state or local government agencies, other than the department, for construction or operation of the home; (10) any request for a general variance from a provision of AS 47.32 , 7 AAC 10.1000 - 7 AAC 10.1095 , or this chapter, as provided in 7 AAC 10.9500 - 7 AAC 10.9535 and 7 AAC 75.405 ; (11) a staff plan that describes the number of employees that will be employed by the home and each employee's responsibilities; the application must indicate that the home is prepared to modify the proposed staff plan to meet the terms of an individual residential services contract executed under AS 47.33.210 or an assisted living plan prepared under AS 47.33.220 and 47.33.230; (12) a disaster preparedness and emergency evacuation plan that complies with 7 AAC 10.1010 to protect the residents of the home from a disaster or other emergency; (13) a business plan, if applying to operate a home licensed for 11 or more residents or to operate multiple homes; the plan must include a description of the plan, services offered, the location of the business, a management and personnel plan, and projected detail of anticipated monthly expenses for six months; and (14) information concerning any denial of a prior application, voluntary termination of a license during an investigation, or termination of an administrator or care provider for cause. (c) An application to modify a license must contain the applicant's name, title, address, telephone number, and, if available, electronic mail address and facsimile number. The application must also describe the modification sought. If the modification is to increase the number of residents served to 11 or more, the application must also include the business plan described in (b)(13) of this section. 7 AAC 75.085. Inspection of financial records. Before the department will approve an application under 7 AAC 75.080 , the applicant must demonstrate that the home has sufficient financial resources to operate for a minimum of three months without considering resident income. If requested by the department, the home shall allow the department to inspect the home's financial records to determine whether the home has sufficient financial resources to meet the requirements of this section. 7 AAC 75.090. Renewal; staggered renewal; extension. (a) Before a license expires, the department will notify the licensee that the license is due for renewal. (b) The department may inspect an assisted living home at any time before a license expires, to determine compliance with AS 47.33 and this chapter and eligibility for renewal. (c) If the department finds that the home is not in compliance with AS 47.33 or this chapter, the home, in coordination with the department, shall develop a plan of correction with a date for achieving compliance with each provision found to be in noncompliance. If the home is in substantial compliance by each applicable date set out in the plan of correction, the department will issue a probationary license. If the home is in compliance, the department will issue a standard license. (d) If the department finds that the home is in compliance with AS 47.33 and this chapter, has provided services to residents in accordance with its contracts and plans of care, has maintained the home in good repair, and is in compliance with all applicable local and state building code, fire code, and sanitation code requirements, the department will renew the home's standard license for two years. (e) If several licensees apply for renewal within a short time, the department may stagger the license renewal dates to facilitate handling the renewals. The department may adjust renewal dates to facilitate the licensing of each assisted living home located in the same geographic area at the same time. The department will not extend or adjust a renewal date for an assisted living home that, during the licensing period, has had more than one complaint filed against it for which the department (1) and the home have developed a plan of correction; or (2) has issued a notice of violation. (f) Repealed 4/6/2002. (g) Repealed 4/6/2002. (h) Repealed 4/6/2002. (i) The department will promptly notify the licensee in writing of any rescheduled renewal date. 7 AAC 75.100. Fees. (a) An application for a license, or renewal of a license, must be accompanied by the appropriate fee, as follows: (1) voluntary license........................................................$ 25 (2) probationary or standard license for homes with capacity to serve three to five residents.................................................. 75 (3) probationary or standard license for homes with capacity to serve six or more residents...................................................150. (b) In addition to the base license application fee, set out in (a) of this section, an application under (a)(2) of this section must be accompanied by a fee of $25 for each resident accommodation beyond three that the home seeks licensure to provide, and an application under (a)(3) of this section must be accompanied by a fee of $25 for each resident accommodation beyond six that the home seeks licensure to provide. (c) An assisted living home that applies for a license modification to move its location or make some other major modification, or to expand its capacity to serve additional residents, at any time other than at the time of license renewal, shall (1) in the case of a modification not involving additional resident capacity, pay a fee of $25; (2) in the case of a modification seeking only to add to the home's resident capacity, pay $25 for each additional resident accommodation, regardless of the amount of time left in the current license period; (3) in the case of a home seeking modifications described in both (1) and (2) of this subsection, pay the fees stated in both (1) and (2). (d) After the first two onsite visits following an inspection that reveals noncompliance with AS 47.33 or this chapter, the licensee shall pay a fee of $150 for each additional onsite visit by the department that results from failure of the licensee to achieve and maintain compliance within a reasonable time set by the department. (e) Fees due under this section are nonrefundable. 7 AAC 75.110. Content of license; posting. (a) A license to operate an assisted living home will state (1) whether it is a probationary or standard license; (2) the effective date of the license; (3) the name of the licensee; (4) the location and mailing address of the home to which the license applies; (5) the number of residents the home is licensed to serve; (6) the expiration date of the license; (7) the special conditions, waivers, or variances that have been approved by the department; and (8) the department's address and phone number. (b) An assisted living home shall post the license in the home or otherwise make it readily accessible to residents, prospective residents, or resident representatives, service providers, staff, and the public. 7 AAC 75.120. Denial of license. (a) If the department denies an application for a license, or a license renewal, the department will deliver to the applicant by hand or certified mail a notice of denial containing a summary of the reasons for denial of the application. (b) If an application is denied, the applicant may reapply or may contest the denial under AS 47.32 . (c) Deleted 7/1/2022. 7 AAC 75.130. License not transferable. Unless modified under 7 AAC 75.080 , a license issued under this chapter is limited to the location, individuals, and organizations named in the application and may not be transferred to a different location, individual, or organization. 7 AAC 75.140. Access and inspection. (a) An applicant for a license and a licensee shall permit representatives of the department to inspect a home when necessary to implement AS 47.32 , AS 47.33 , and this chapter. (b) If an applicant for a license refuses to permit an inspection, the department may take action under AS 47.32.110 . (c) A licensee that refuses to allow access and inspection is in violation of AS 47.32 and AS 47.33 . The department may take action under AS 47.32.110 . (d) If the department has reason to believe that a home is operating as an assisted living home and has not applied for a license or refuses to permit an inspection, the department may take action under AS 47.32.110 . Article 2 Operation of Assisted Living Homes 7 AAC 75.210. Organization; administration; staff. (a) An assisted living home shall (1) provide the department with (A) the name, address, telephone number, and, if available, electronic mail address and facsimile transmission number of the individual or entity ultimately responsible for operation of the home or proposed home; and (B) if the home is operated by an association, corporation, or other entity, the name, address, telephone number, and, if available, electronic mail address and facsimile transmission number of each member of its board or governing body and the executive director of the board or governing body; the home may provide information under this subparagraph with its application for a license, and annually thereafter; (2) appoint an administrator who meets the requirements of 7 AAC 75.230 and an administrator designee to act on the administrator's behalf for any period during which the administrator is on vacation, is ill, or is otherwise unable to perform regular duties for 24 hours or more; if the administrator designee will be required to manage the daily operation of the home for (A) less than 90 consecutive days, the designee must meet the requirements of 7 AAC 75.215 and 7 AAC 75.220 ; the administrator designee must be available and must receive proper orientation to manage the daily operation of the home in the administrator's absence; or (B) 90 consecutive days or longer, the designee must have the same qualifications as an administrator under 7 AAC 75.230 ; (3) adopt written personnel practices and, at the time of employment, inform each employee of the individual to whom the employee is responsible, the organization of the home and physical plant layout, the employee's duties and responsibilities, including those to be carried out in emergencies, and the policies, procedures, and equipment relevant to those duties and responsibilities; (4) provide the department with a current master list, updated as necessary, that includes the name, address, and telephone number of each resident and the name, address, telephone number, and, if available, electronic mail address and facsimile transmission number of each resident's representative; a home that serves three or more residents shall maintain a current copy of the master list in at least one place that can be easily accessed if the home must be evacuated; (5) ensure that recordkeeping complies with AS 47.33.070 and uses forms prescribed or approved by the department for the preparation and protection of resident records; and (6) establish policies and procedures for the completion of residential services contracts and involuntary termination of those contracts in compliance with AS 47.33.210 and 47.33.360, respectively; (7) repealed 6/24/2004; (8) repealed 6/24/2004. (b) The governing body of a home operated by an association, corporation, or other entity shall (1) determine policy and provide for implementation of that policy by an administrator; (2) select an administrator and evaluate the administrator's performance; and (3) maintain minutes of meetings, relevant portions of which must be made available to the department to enable the department to carry out its responsibilities under AS 47.33 and this chapter. (c) An assisted living home shall employ the type and number of care providers and other employees necessary to operate the home in compliance with AS 47.33 and this chapter. The home must have a sufficient number of care providers and other employees with adequate training to implement the home's general staffing plan and to meet the specific needs of residents as defined in the residents' residential services contracts and assisted living plans. (d) Subject to (e) of this section, an assisted living home shall (1) have on duty a care provider or another employee with documented proof of (A) cardiopulmonary resuscitation (CPR) training provided within the previous two years by an instructor certified as required in 7 AAC 26.985 ; the training must be provided through the (i) American Red Cross; (ii) American Heart Association's CPR for Family and Friends Training Program or a more advanced program offered by the American Heart Association; or (iii) an organization equivalent to those listed in (i) - (ii) of this subparagraph, as determined by the department; and (B) first aid training provided within the previous three years by an instructor certified by the American Red Cross, the American Heart Association, or an equivalent organization as determined by the department; and (2) have the means and materials available to enable the home to implement the home's disaster preparedness and emergency evacuation plan required by 7 AAC 10.1010 . (e) If the training required by (d)(1) of this section is not regularly available within 100 miles of where the home is located, the administrator shall ensure that care providers and other employees obtain this training not less than every three years. 7 AAC 75.215. Barrier crimes and conditions; background checks. An assisted living home is subject to the applicable requirements of AS 47.05.300 - 47.05.390 and 7 AAC 10.900 - 7 AAC 10.990 (barrier crimes and conditions; background checks). 7 AAC 75.220. General requirements. (a) An assisted living home shall provide safeguards to ensure that persons entering or living in the home, including employees, volunteers, contractors, and visitors do not abuse, neglect, or exploit a resident of the home. An assisted living home shall (1) develop and implement written policies and procedures that prohibit the abuse, neglect, exploitation, and mistreatment of residents; (2) report alleged or suspected abuse to a local, municipal, or state law enforcement agency; (3) take any necessary action to remove the potential for further abuse, neglect, exploitation, or mistreatment of a resident or further misappropriation of a resident's property; (4) document alleged or suspected incidents of abuse, neglect, exploitation, or mistreatment by an employee, a volunteer, a contractor, a visitor, or another resident; (5) investigate alleged or suspected incidents of abuse, neglect, exploitation, or mistreatment by an employee, a volunteer, a contractor, a visitor, or another resident; (6) document the result of the investigation and the corrective action taken; and (7) submit the documentation prepared under this subsection to the department as required in AS 47.32.200 (c). (b) A person seeking to be associated with an assisted living home in a manner described in 7 AAC 10.900 (b) shall provide (1) the names, addresses, and telephone numbers of at least three character references who are unrelated to the person seeking association with the assisted living home; (2) at least two employment references; an employment reference may also serve as a character reference required under (1) of this subsection; and (3) the signed release of information authorization and other items required to request a criminal history check under 7 AAC 10.910 . (c) A person who will be in direct contact with residents in an assisted living home shall provide evidence to the administrator that the person is free from active pulmonary tuberculosis before contact with a resident. This evidence must be provided annually and must be placed in the person's file for review by the department. (d) Before hiring, the administrator shall ensure that each person who will be in direct, unsupervised contact with residents in an assisted living home has sufficient language skills to meet the needs of the residents of the home and the ability to access emergency services, including giving clear directions to emergency personnel of the home's location and describing the nature of the emergency in the primary language of the community. The administrator shall assess language skill level for employees, contractors, and volunteers. The department will assess the language skill level of the administrator. (e) Each administrator, each administrator designee who will serve in that capacity for 90 consecutive days or longer, and each care provider who is an employee of an assisted living home shall participate in continuing education that is relevant to that person's primary job responsibilities and the ongoing care of residents. If courses for continuing education are not available within 100 miles of where the home is located or through correspondence or distance learning, the administrator shall ensure that the continuing education is obtained not less than every 18 months. Training requirements are as follows: (1) each administrator shall complete 18 clock hours of continuing education annually; (2) each care provider shall complete 12 clock hours of continuing education annually; (3) a home may count in-service training as continuing education if that training increases the knowledge, abilities, or skills of care providers and is approved by the department; (4) continuing education, whether in-service training or received from a state agency, a seminar, or a university, must be documented and placed in the employee's personnel file for review and approval by the department. An assisted living home is subject to the reporting requirements of AS 47.24.010 . (f) An assisted living home is subject to the reporting requirements of AS 47.24.010 . 7 AAC 75.230. Administrator. (a) An assisted living home shall have on staff an administrator who is at least 21 years of age and meets the requirements of 7 AAC 75.215 , 7 AAC 75.220 , and this section. (b) If the administrator does not manage the daily operation of the home, the administrator, or the governing body of a larger organization responsible for the home, shall appoint a resident manager who meets the requirements for an administrator under this chapter. (c) In addition to the other requirements of this chapter, an individual may not serve as an administrator of an assisted living home unless the individual meets the training and experience requirements of this subsection. The department will accept a baccalaureate or higher degree in gerontology, health administration, or another health-related field in place of all or part of the required experience, if the degree work serves, to the department's satisfaction, as an equivalent to the required experience. Training and experience requirements are as follows: (1) for a home licensed to serve 1 - 10 residents, the individual must fulfill at least one of the following requirements: (A) the individual must complete an approved management or administrator training course and have at least one year of documented experience, relevant to the population of residents to be served, as a care provider, if the administrator will be providing direct care in the home; (B) the individual must (i) complete a certified nurse aide training program that the Board of Nursing has approved under 12 AAC 44.830 , or that is equivalent in content to the requirements of 12 AAC 44.835 (c); and (ii) have at least one year of documented experience, relevant to the population of residents to be served, as a care provider; (C) the individual must have at least two years of documented experience, relevant to the population of residents to be served, as a care provider, with documented skills or training relevant to the population of residents to be served; (D) the individual must have sufficient documented experience in an out-of-home care facility, and sufficient training, education, or other similar experience to fulfill the duties of an administrator of the type and size of home where the individual is to be employed and to meet the needs of the population of residents to be served; an administrator under this subparagraph is subject to department approval on a case-by-case basis; for purposes of this subparagraph, an out-of-home care facility includes a foster care home, a board and care home, and a nursing home; (2) for a home licensed to serve 11 or more residents, or if operating multiple homes with a total capacity of 11 or more residents, the administrator must fulfill at least one of the following requirements: (A) the individual must complete an approved management or administrator training course and have at least two years of documented experience, relevant to the population of residents to be served, as a care provider, if the administrator will be providing direct care in the home; (B) the individual must (i) complete a certified nurse aide training program that the Board of Nursing has approved under 12 AAC 44.830 , or that is equivalent in content to the requirements of 12 AAC 44.835 (c); and (ii) have at least two years of documented experience, relevant to the population of residents to be served, as a care provider; (C) the individual must have at least five years of documented experience, relevant to the population of residents to be served, as an administrator or staff supervisor of a home serving 10 or fewer residents; (D) the individual must submit proof that the individual is a licensed practical nurse or a registered nurse with documented experience relevant to the population of residents to be served. 7 AAC 75.240. Care provider. (a) An individual may not be hired or retained as a care provider in an assisted living home subject to AS 47.32 , AS 47.33 , and this chapter unless the person meets the requirements of 7 AAC 75.215 and 7 AAC 75.220 and is at least (1) 21 years of age if the individual will serve as a supervisor of other care providers; (2) 18 years of age if the individual will serve as a care provider working without direct supervision; or (3) 16 years of age if the individual will serve only as a care provider and has access to assistance from the administrator or another care provider who is at least 21 years of age. (b) An administrator shall ensure and document that each care provider, within the first 14 days of employment, is oriented to the assisted living home's policies and procedures, including emergency procedures, fire safety, resident rights, prohibition against abuse, neglect, exploitation, and mistreatment of residents, recognition of abuse, neglect, exploitation, and mistreatment of residents, reporting requirements under AS 47.24.010 , universal precautions for infection control, biohazards, applicable state regulations and statutes, resident interaction, any house rules established under AS 47.33.060 , sanitation, duties and responsibilities, medication management and security, and physical plant layout. Before caring for a resident without direct supervision, a care provider shall receive the orientation required in this subsection and, unless the care provider has sufficient documented experience working with the population of residents to be served, shall work under the direct supervision of the administrator or an experienced care provider who is at least 21 years of age for not less than three complete work days. Direct supervision must be documented in the personnel file of the supervised care provider. (c) For purposes of this section, "direct supervision" means that the administrator, or a care provider who is at least 21 years of age and has received the training required under this chapter, is present in the same building as the individual being supervised and available for consultation or assistance. 7 AAC 75.250. Advertising. (a) An assisted living home may not advertise that it is a "nursing home" or that it provides "nursing care," unless it holds a license under AS 18.20.020 - 18.20.130. (b) A home may advertise that it provides housing, food service, personal assistance, assistance with the activities of daily living, or health-related services, as described in AS 47.33.010 and 47.33.020, including intermittent nursing care or short-term skilled nursing care. 7 AAC 75.260. General environmental requirements. (a) A home shall ensure that each resident has (1) room furniture that is typical for residents of homes in the community and neighborhood in which the assisted living home is located; the furniture may be provided by the resident; (2) storage space for clothing and personal possessions; (3) adequate linen, soap, and personal hygiene facilities necessary for cleanliness; (4) a signal device, as provided for in the assisted living plan of a resident who must use a device when verbal communication is not possible; (5) reasonable privacy when sharing a room; and (6) appropriate storage and work areas adjacent to the area of use to accommodate the following functions, if conducted on the premises: (A) food preparation and serving; and (B) laundry; (7) a bedroom that meets the following standards, subject to 7 AAC 75.070 (b): (A) if the bedroom is for single occupancy, it must contain at least 80 square feet of open floor space, measured before furniture is placed in the room; (B) if the bedroom is for double occupancy, it must contain at least 140 square feet of open floor space, measured before furniture is placed in the room; (C) no more than two residents may be assigned to a bedroom. (b) A home must occupy a building that is used exclusively for assisted living, except that a home may be licensed in a building that has more than one occupancy if (1) the other occupancy is consistent with the health, safety, comfort, and well-being of the residents of the assisted living home; and (2) the other users of the building comply with applicable state and municipal building and fire codes and environmental health codes. 7 AAC 75.265. Food service. (a) An assisted living home shall offer three balanced, nutritious meals and at least one snack daily at consistent times. A home shall ensure that the meals and snacks offered include the recommended number of servings of each food type set out in the United States Department of Agriculture publication, The Food Guide Pyramid, as revised as of October 1996 and adopted by reference. The home shall offer a wide variety of food that includes fresh fruits and vegetables as often as possible. (b) The home shall consider each resident's health-related or religious restrictions, cultural or ethnic preferences in food preparation, and preference for smaller portions, as reflected in the resident's residential services contract executed under AS 47.33.210 and assisted living plan prepared under AS 47.33.220 and 47.33.230. The home shall also consider a resident's decision, from time to time, to be served smaller portions even if that issue is not addressed in the contract or plan. (c) An assisted living home shall keep a written record of each day's menu, document whether the meals served were as described in those menus, and keep the documented menus on file for at least one year for review by the department. 7 AAC 75.270. Life and fire safety. An assisted living home must meet the applicable life and fire safety requirements of 7 AAC 10.1010 . 7 AAC 75.280. Sanitation and environmental protection. An assisted living home must satisfy applicable standards for sanitation and environmental protection, including the applicable standards of 7 AAC 10.1000 - 7 AAC 10.1095 . An assisted living home shall allow inspection by the department as required by AS 47.32.100 and 7 AAC 10.9600 - 7 AAC 10.9620 , and by any municipal authority responsible for ensuring that the home meets applicable municipal sanitation and environmental protection requirements. The home shall maintain a copy of each inspection report for at least two years and make any report from a municipal authority available for department review. The department may request an inspection by the municipal authority on the home's behalf. The home is responsible for any fee charged. 7 AAC 75.290. Emergency situations. (a) If a resident experiences a medical emergency, serious injury, or accident, is involved in assaultive behavior that could injure the resident or another person or that requires police intervention, or is absent without prior notice to the home and could pose a risk of harm to the resident or others, the assisted living home shall (1) access emergency services, if needed, and provide the emergency care that a reasonably prudent person would provide under the circumstances, including notice to the resident's physician and representative; and (2) record the date, time, and circumstances of the accident, serious injury, medical emergency, or incident in the resident's file and in any general daily log kept by the home, and provide a copy of the report to the department as required under 7 AAC 75.340 . (b) An assisted living home shall maintain readily-available first aid supplies appropriate to its size, and post or make readily available the first aid procedures. 7 AAC 75.295. Use of intervention and physical restraint. (a) An assisted living home must have a written procedure regarding the use of physical restraint. That procedure must be approved by the department under AS 47.33.330 . (b) As provided in AS 47.33.330 (a)(4), an assisted living home may use physical restraint if a resident's actions present an imminent danger to the resident or others, but only after other interventions, including the use of a time out, have failed. A time out or physical restraint may not be used as a punishment, as a substitute for a less restrictive form of intervention, or as a convenience for the home's staff. A time out or physical restraint must be terminated as soon as the resident no longer presents an imminent danger to that resident or others. (c) At the time of a resident's admission to the home, the home shall (1) explain its approved physical restraint procedures to the resident or resident's representative; (2) perform an assessment, at the time of admission, regarding the potential need for the use of time outs or physical restraint asking for information (A) about the resident's prior behavior that might indicate a need for the use of time outs or physical restraint; and (B) that might help minimize use of time outs or physical restraint; (3) address the need for using time outs or physical restraint in the resident's assisted living plan if the home has reason to believe that time outs or physical restraint may be necessary because the resident's prior behavior or medical condition indicates that the resident may occasionally present an imminent danger to the resident or others; the plan must include information regarding (A) when time outs or physical restraint should be used; (B) what forms of physical restraint should be used, based on recommendations from the resident's primary physician; and (C) any prenotification procedures requested by the resident's representative in addition to the 24-hour notice required by (d)(1) of this section or the five-day written report required under (d)(2) of this section. (d) If physical restraint is used, the assisted living home shall (1) notify the resident's representative (A) before physical restraint is used, if prenotification is made a part of the resident's assisted living plan under (c)(3)(C) of this section; and (B) within 24 hours, unless the representative has agreed, as reflected in the resident's assisted living plan, that notification under (2) of this subsection is sufficient; and (2) document any use of physical restraint in the written report required under 7 AAC 75.340 (a)(4) that includes (A) the resident's name; (B) a description of the incident that led to the decision to use physical restraint; (C) a brief description of any other form of intervention used or attempted before the use of physical restraint; (D) the type of physical restraint used; (E) the time when physical restraint began; and (F) the time when physical restraint ended. (e) For purposes of this section, a time out is the restriction of a resident, with that resident's consent, to a quiet area or unlocked quiet room for a period not to exceed 30 minutes. A home may not require a resident to take a time out without that resident's consent, and may not use a time out that exceeds 30 minutes, with or without that resident's consent. (f) For purposes of this section, physical restraint is a manual method that restricts body movement, or a physical or mechanical device, material, or piece of equipment that is attached or adjacent to the resident's body, that prevents the resident from easily removing it, and that restricts movement or normal access to the body. The use of the following safety equipment will not be considered physical restraint, if authorized in writing by the resident's primary physician, and if the necessity for its use is set out in the resident's assisted living plan: (1) self-release safety belts; (2) lap-top trays; (3) wedge chair cushions; (4) concave mattresses; and (5) bedside rails if used for a resident who (A) lacks independent mobility but has involuntary movement, including a seizure disorder, that could cause the resident to fall from bed; or (B) needs the rails to assist in mobility. 7 AAC 75.300. Assisted living plan. (a) Preparation of an assisted living plan in accordance with AS 47.33.220 , 47.33.230, and this chapter shall include a review of any other existing plan of care that may already be in place for the resident. A plan of care already in place for a resident may substitute for the assisted living plan required by AS 47.33.220 and 47.33.230 if the existing plan incorporates substantially the same provisions and addresses the same requirements as would an assisted living plan. (b) When an existing plan of care cannot be substituted for an assisted living plan, the assisted living plan required by AS 47.33.220 and 47.33.230 must, insofar as possible, incorporate the provisions of the plan of care already in place for the resident. (c) Evaluation of assisted living plans for residents will take into account the timelines established for evaluation of existing plans of care, and will, insofar as possible, set similar evaluation timelines to avoid duplicative evaluation efforts. (d) Copies of existing plans of care for a resident shall be placed in the assisted living file, along with the assisted living plan. 7 AAC 75.305. Determination regarding declarations for mental health treatment. An assisted living home shall make a reasonable effort to determine whether a resident has made a declaration of preferences or instructions regarding mental health treatment under AS 47.30.950 by consulting with the resident, the resident's primary physician, the resident's case manager, the resident's spouse, parent, or guardian, a person in the resident's household, a person designated by the resident, or the resident's representative. 7 AAC 75.310. Acceptance and management of residents' money. (a) Before an assisted living home accepts the money of a resident for safekeeping and management, the home shall obtain written authorization from the resident or the resident's representative or representative payee. The authorization must (1) be attested to by a competent witness who has no pecuniary interest in the home or its operations, and who is not connected to the home or its operations in any manner; (2) indicate exactly which or how much of the resident's money the assisted living home is authorized to manage; and (3) provide for an amount not to exceed $100 a month that the assisted living home may keep on hand for the resident to use to meet that resident's day-to-day needs, unless the resident has other sources of money for that purpose. (b) A home shall establish a system for residents to request withdrawals from the daily-needs money that the home controls. The home shall advise the resident of the available balance of the daily-needs money at the time of each withdrawal and shall keep a record of all withdrawals and balances. (c) After receiving authorization from the resident or resident's representative to manage the resident's money for the resident, the assisted living home shall (1) promptly deposit all of the resident's money that the home is authorized to manage, except the money in the resident's daily needs fund, in an interest-bearing designated trust account in a bank, savings and loan association, or licensed escrow agent, insured by the Federal Deposit Insurance Corporation (FDIC), separate from other money and property of the home; and (2) provide in writing to the resident, or the resident's representative, the account number and the name and address of the financial institution in which the resident's money has been deposited. (d) An assisted living home that is authorized to manage the money of more than one resident may deposit it in a common designated residents' trust account only if the home has the capability of tracking the account activity specific to each resident, and then issuing a detailed statement of each resident's money to those residents whose money is commingled in the same account. Those statements shall be provided at least quarterly. (e) When managing the money of a resident, the assisted living home shall, in accordance with the resident's assisted living plan, spend money only to meet the needs of the resident. (f) When managing the money of residents through deposits in separate trust accounts, the assisted living home shall (1) provide each resident or the resident's representative with a copy of each written account statement from the financial institution in which the money has been deposited; and (2) provide each resident or the resident's representative, without charge, a written, itemized statement, at least quarterly, of all financial transactions involving the resident's money being managed by the home. (g) Upon a written request by the resident or the resident's representative, the assisted living home shall return to the resident or the resident's representative, within three business days, as much of the resident's money as requested, including any interest accrued from deposits. The money may be returned by means of a check. (h) Upon a voluntary or involuntary termination of the resident's assisted living contract, the assisted living home shall, within three business days, return to the resident or the resident's representative at least 90 percent of the resident's money, less any accrued charges, whether the money is in a designated trust account or in the resident's daily-needs account. The home shall return all remaining money belonging to the resident within 60 calendar days after termination of the contract. (i) An assisted living home shall provide a complete accounting of the resident's money to the personal representative, as defined in AS 13.06.050 , of a resident's estate within 30 days after the resident's death. In the absence of a personal representative, the home shall provide the accounting and the deceased resident's assets to the public administrator appointed under AS 22.15.310 . (j) If a home or the entity operating the home is sold, the home shall provide the buyer with written verification of all resident money the home is authorized to manage and obtain a signed receipt for such money from the new owner. 7 AAC 75.320. Annual monitoring report. (a) At least once each year, the department will monitor an assisted living home or will require the home to submit a self-monitoring report to the department on a form supplied by the department. The annual report must contain the information requested by the department, to show that the home continues to comply with AS 47.32 , AS 47.33 , and this chapter. (b) The failure to submit an annual report as required by the department, or the submission of a false report, is grounds for enforcement action under AS 47.32 . (c) The department may accept the report of a third-party, independent evaluation of an assisted living home, made on behalf of the home, if the report contains substantially the same information required by the department under this section. 7 AAC 75.330. Refund of rent. (a) A home's written policy for the refund of advance payments, established in compliance with AS 47.33.030 (b), must conform to the following rules: (1) if a resident terminates a residential services contract by giving notice at least one rental period before the termination is to be effective, the home shall refund an advance rent payment on a prorata basis; (2) if a resident terminates the contract by giving notice less than one rental period before the termination is to be effective, the home need not refund a payment applicable to the current rental period, but shall prorate the refund of an advance rent payment for a subsequent period; if the home executes a new residential services contract with a new resident in place of the terminating resident, to become effective during the current rental period, the home shall refund the prorata amount of rent applicable to the days of the new contract; (3) if a resident dies, the home need not refund a payment applicable to the current rental period, but shall prorate the refund of an advance rent payment for a subsequent period; if the home executes a new residential services contract with a new resident in place of the deceased resident, to become effective during the current rental period, the home shall refund the prorata amount of rent applicable to the days of the new contract; (4) if a home terminates a residential services contract, in accordance with AS 47.33.360 , it shall refund an advance rent payment on a prorata basis. (b) In implementing AS 47.33.030 , "advance payment," in the case of rent, does not mean the rent paid at the beginning of a rental period for that period. It means rent advanced for a subsequent rental period. 7 AAC 75.340. Notification requirements. (a) An assisted living home shall provide, on a form supplied by the department, written notice to the department, to each affected resident or that resident's representative, and to any service coordinator, as follows: (1) within 24 hours or on the next business day if (A) that an administrator, a care provider, or an individual who resides in the home, other than a resident receiving services, (i) is subject to a department determination under 7 AAC 10.915 (background check) that a barrier crime or condition described in 7 AAC 10.905 exists with respect to the individual; for purposes of notice under this sub-subparagraph, a resident is an affected resident if the resident was a victim of the barrier crime or of the act determined to be a barrier condition, or if the barrier crime or the act determined to be a barrier condition was committed on the premises of the assisted living home; (ii) the individual is out of compliance with the association requirements described in 7 AAC 10.915 (g) and 7 AAC 10.935 (m); (iii) a variance for the individual has been denied under 7 AAC 10.930 and 7 AAC 10.935 ; for purposes of notice under this sub-subparagraph, a resident is an affected resident if the resident was a victim of the barrier crime for which the variance was granted or of the act determined to be a barrier condition for which the variance was granted, or if the barrier crime for which the variance was granted or the act determined to be a barrier condition for which the variance was granted was committed on the premises of the assisted living home; or (iv) a variance for the individual has been revoked under 7 AAC 10.945 ; for purposes of notice under this sub-subparagraph, a resident is an affected resident if the resident was a victim of a barrier crime that resulted in revocation or of an act determined to be a barrier condition that resulted in revocation, or if a barrier crime that resulted in revocation or the act determined to be a barrier condition that resulted in revocation was committed on the premises of the assisted living home; (B) unable to correct a violation constituting an emergency under 7 AAC 75.530 - 7 AAC 75.550 ; (C) a resident dies of other than a natural cause; or (D) physical restraint is used under 7 AAC 75.295 ; notification under this subparagraph shall be provided only to the resident's representative; notification under this subparagraph need not be made if the resident's assisted living plan indicates that notification under (4) of this subsection is sufficient as established under 7 AAC 75.295 (d)(1); notice must be given under this subparagraph or under (4) of this subsection even if prenotification is required under 7 AAC 75.295 (c)(3)(C); (2) within 48 hours after a resident (A) experiences a medical emergency, serious injury, or accident; notice under this subparagraph must include information as to whether the resident required more than 24 hours of hospitalization; (B) is involved in assaultive behavior that resulted in the need for medical treatment for the resident or another individual, or that required police intervention; or (C) is absent from the home for 24 hours or longer without prior notice to the home; (3) within 72 hours, and not less than 24 hours, before the termination, under AS 47.33.360 (a)(1) or (a)(4), of a resident's residential services contract with the home; (4) within five days if physical restraint is used under 7 AAC 75.295 unless a shorter time is provided in a resident's assisted living plan in accordance with 7 AAC 75.295 (c); notice must be given as required under (1)(D) of this subsection or under this paragraph even if prenotification is required under 7 AAC 75.295 (c)(3)(C); the notice must include the information required by 7 AAC 75.295 (d); (5) at least 14 days before a change in the home's mailing address; (6) at least 30 days before (A) a rate increase; (B) termination, under AS 47.33.360 (a)(2), (a)(3), (a)(5), or (a)(6), of a resident's residential services contract with the home; notice must be given in the manner required by AS 47.33.360 (b); or (C) amendment of a residential services contract to require an advance payment under AS 47.33.030 ; and (7) at least 90 days before (A) a closure of the home; or (B) a relocation of the home. (b) Repealed 6/24/2004. (c) An assisted living home shall notify the department, in writing, before taking an action that requires (1) a request for modification when the administrator, individual, or entity named in the current application changes; (2) a request for department approval of a modification to increase resident capacity; or (3) notification because the use of the home will change from exclusive occupancy as an assisted living home to shared use as a business or other enterprise; a notification under this paragraph must include information to show compliance with 7 AAC 75.260 (b). Article 3 Variances 7 AAC 75.405. Request for variance. (a) Subject to (b) of this section, an assisted living home may request a general variance under 7 AAC 10.9500 - 7 AAC 10.9535 if the home cannot meet an applicable requirement of AS 47.32 , 7 AAC 10.1000 - 7 AAC 10.1095 , or this chapter. (b) Variance requests regarding barrier crimes, barrier conditions, and background checks under 7 AAC 10.900 - 7 AAC 10.990 are subject to the provisions of 7 AAC 10.930 and 7 AAC 10.935 . (c) If the department has approved a plan of correction under 7 AAC 10.9610 following a notice of violation under AS 47.32.120 , a home may operate under the plan without submitting an application for a general variance. 7 AAC 75.410. Grounds for variance. Repealed. 7 AAC 75.415. Temporary variance to admit a child for care in an assisted living home. An assisted living home may apply for a temporary variance to admit a specific child by name for care if the home and a referring agency, in addition to meeting all other applicable requirements of 7 AAC 10.1000 - 7 AAC 10.1095 , develop a plan of safety that (1) ensures the health and safety of the adults in the home; (2) ensures the health and safety of the child; and (3) is approved by the department, by the child's representative, and by each resident of the home or the representative for each resident. 7 AAC 75.420. Application for variance, generally. Repealed. 7 AAC 75.430. Application for temporary variance. Repealed. 7 AAC 75.440. Evaluation of application for temporary variance. Repealed. 7 AAC 75.450. Grant or denial of temporary variance. Repealed. 7 AAC 75.460. Application for permanent variance. Repealed. 7 AAC 75.470. Evaluation of application for permanent variance. Repealed. 7 AAC 75.480. Grant or denial of permanent variance. Repealed. 7 AAC 75.490. Appeal from denial of variance. Repealed. Article 4 Violations 7 AAC 75.510. Violation conference. (a) At any time after an assisted living home has received a notice of violation under AS 47.32 , the home or the department may request a conference to discuss the violation and the home's options for correcting the violation. A conference, conducted in person or by telephone, will be held no later than seven days after the request is made. (b) A request for a conference does not extend any other time periods provided for in this chapter. 7 AAC 75.520. Report of compliance in response to notice of violation. (a) Upon correction of a violation described in a notice of violation, an assisted living home shall, within 10 days after correcting the violation, submit to the department a written report of compliance. The department may provide a copy of the report or require the home to provide a copy of the report to each resident of the home or to each resident's representative. The report of compliance must be signed by the administrator of the home and must contain a statement in which the administrator attests to the truth of the contents of the report. (b) A report of compliance must state how the home corrected each violation listed in the notice of violation. (c) A report of compliance is a public record. The department will retain it with the notice of violation to which it refers. (d) The department may reinspect the home within 30 days after receiving a report of compliance, upon consideration of the nature of the violation and the terms of correction. 7 AAC 75.530. Violation constituting an emergency. (a) Subject to (c) of this section, if the department determines that a violation cited by the department under AS 47.32 constitutes an emergency because of imminent danger to the health or safety of residents, the department will (1) issue the notice of violation within 24 hours after determining that an emergency exists; the notice will state the nature of the emergency, the actions required to comply with AS 47.32 , AS 47.33 , and this chapter, and a specific date and time for the home to correct the violation; and (2) determine whether the violation has been corrected within the date and time specified in the notice. (b) An assisted living home subject to a notice of violation constituting an emergency shall post the notice in a conspicuous location at the home until the department has determined that the violation has been corrected. (c) If the department determines that the nature of the emergency described in (a) of this section warrants immediate closure of the assisted living home, the department will immediately suspend or revoke the assisted living home's license under AS 47.32.130 . (1) deleted 7/1/2022; (2) deleted 7/1/2022. 7 AAC 75.540. Temporary inability to correct a violation constituting an emergency. Deleted. 7 AAC 75.550. Refusal to correct a violation constituting an emergency. If an assisted living home fails to correct a violation constituting an emergency within the date and time specified in the notice of violation, the department will (1) impose one or more of the administrative sanctions provided for in AS 47.32.140 and 7 AAC 50.570 ; and (2) provide notice as required by 7 AAC 75.340 that an emergency exists and the violation has not been corrected to (A) each resident of the home or the representative of the resident; (B) the agencies that provide services or treatment to the residents; (C) the resident's service coordinators; and (D) the department's adult protective services program. 7 AAC 75.560. Sanctions based on conviction of administrator. If the criminal conviction of an assisted living home administrator forms the basis of a possible enforcement action against the home under AS 47.32.130 , 47.32.140, or 7 AAC 50.570 , the department will take into consideration whether the conviction poses a risk to residents or has an adverse effect on the safety or effective operation of the home. 7 AAC 75.570. Sanctions for noncompliance. (a) The department will consider the following factors in determining an enforcement action against the home under AS 47.32.130 or 47.32.140: (1) the nature and extent of the violation, and the extent to which the health or safety of residents is adversely affected, specifically considering whether the assisted living home's noncompliance (A) is likely to have only a minor negative impact on a resident; (B) results in minimal physical, mental, or psychosocial discomfort to a resident; (C) results in actual harm to a resident as evidenced by compromising a resident's ability to maintain physical, mental, or psychosocial well-being; or (D) results in a situation in which immediate corrective action is necessary because the noncompliance has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident; (2) whether the violation substantially limits the home's ability to render adequate care; (3) whether the home has a history of violations, and, if so, the nature of the violations and whether the previous violations were corrected; (4) whether the home failed to provide records to the department upon request; (5) whether the home has submitted false or fraudulent information to the department. (b) If the department imposes an administrative sanction, the administrator may appeal that action as described in enforcement action against the home under AS 47.32.130 or 47.32.140, and under 47.32.150. Article 5 General Provisions 7 AAC 75.990. Definitions. In AS 47.33 and this chapter, unless the context requires otherwise, (1) "activities of daily living" has the meaning given in AS 47.33.990 ; (2) "administrator" has the meaning given in AS 47.33.990 ; (3) "business day" means a day other than Saturday, Sunday, or a state holiday; (4) "care provider" means an employee of an assisted living home who provides direct care services to a resident of the home; "care provider" does not include an individual who is an employee of a care-providing entity that is not affiliated with the home; (5) "department" means the Department of Health; (6) "direct care services" means assistance to a resident of an assisted living home with the activities of daily living and the instrumental activities of daily living; (7) "emergency shelter" means a home or facility for transient occupants whose occupancy is short-term in nature, not intended to exceed 30 days; "emergency shelter" includes a respite home or facility; (8) "food service" means the offering of food to residents of an assisted living home as required by 7 AAC 75.265 ; (9) "home" has the meaning given in AS 47.33.990 ; (10) "imminent danger to the health or safety of residents" means a situation that is likely to cause serious injury, harm, impairment, or death to one or more residents of an assisted living home; (11) "instrumental activities of daily living" has the meaning given in AS 47.33.990 ; (12) "provide" means to furnish, supply, or make available, whether by the owner or an employee of a home or by means of an independent contractor whose services are procured by the home; (13) "resident" has the meaning given in AS 47.33.990 ; (14) "residential services contract" means an agreement to provide services in an assisted living home as described in AS 47.33.010 (a); "residential services contract" does not include an agreement that is solely for rent or for rent and food service, or an agreement between an individual and a friend, personal care attendant, chore provider, or monitor who provides assistance to the individual; (15) "service coordinator" has the meaning given in AS 47.33.990 ; (16) "universal precautions" means the infectious control precautions that are recommended by the United States Department of Health and Human Services, Centers for Disease Control and Prevention to be used to prevent the transmission of blood-borne germs such as human immunodeficiency virus and hepatitis B virus.