Licensure And Renewal

(1) Licensure. An applicant for an ACH license shall submit the following to the Board office: (a) A completed application on a form approved by the Board; (b) Nonrefundable application fee; STANDARDS FOR ADULT CARE HOMES – LEVEL 2 CHAPTER 0720-37 (c) The requirements contained in T.C.A. § 68-11-206(a)(1) and (2); (d) Demonstration of the ability to meet the financial obligations of the ACH with a financial statement prepared by a certified public accountant; (e) A copy of a local business license (if one is required by the locality); (f) A copy of any and all documents demonstrating the legal status of the business organization that owns the ACH. If the applicant is a corporation or a limited liability company the applicant must submit a certificate of good standing; (g) Proof of liability insurance; and (h) Any other documents or information requested by the Board. (2) Before a license is granted, the applicant shall cause to be submitted to the Board’s administrative office directly from the vendor identified in the Board’s licensure application materials, the result of a criminal background check. (3) Before a license is granted, the applicant shall submit to an inspection conducted by Department of Health inspectors to ensure compliance with all applicable laws and rules. (4) If the Board determines that a license for an ACH shall not be granted, it shall notify the applicant. The decision of the Board shall be final. (5) The applicant shall not use subterfuge or other evasive means to obtain a license, such as filing for a license through a second party when an applicant has been denied a license or has had a license disciplined or has attempted to avoid the survey and review process. (6) Renewal. ACH licenses shall expire and become invalid annually on the anniversary date of their original issuance and must be renewed by that date. (a) In order to successfully renew a license, a licensee shall submit a completed renewal application with the applicable fee to the Board office. Department inspectors will periodically inspect each ACH to determine its compliance with these rules and regulations. If the inspectors find deficiencies, the licensee shall submit an acceptable corrective action plan and shall remedy the deficiencies. (b) If a licensee fails to renew its license prior to the date of its expiration but submits the renewal form and fee within sixty (60) days thereafter, the licensee may renew late by paying, in addition to the renewal fee, a late penalty of one hundred dollars ($100) per month for each month or fraction of a month that renewal is late; provided that the late penalty shall not exceed twice the renewal fee. (c) In the event that a licensee fails to renew its license within the sixty (60) day grace period following the license expiration date, the licensee shall reapply for a license by submitting the following to the Board office: 1. A completed application for licensure; and 2. The license fee provided in Rule 0720-37-.03(1). (d) Upon reapplication, the licensee shall submit to an inspection of the ACH by Department of Health inspectors. STANDARDS FOR ADULT CARE HOMES – LEVEL 2 CHAPTER 0720-37 (7) The Board shall issue a license only for the licensee and the location designated on the license application. If an ACH moves to a new location, it shall obtain a new license and submit to an inspection of the new building before admitting residents. (8) A separate license shall be required for each ACH when more than one ACH is operated by an adult care home provider. (9) Before a second license is granted to an adult care home provider the applicant shall: (a) Operate a licensed ACH for a period of at least one (1) year; (b) Submit to an annual licensure inspection by Department of Health inspectors; (c) Have no findings of noncompliance resulting in penalties, suspensions or other disciplinary actions; and (d) Submit a separate application to the Board. (10) Before any additional licenses are granted to an adult care home provider the applicant shall: (a) Operate two (2) licensed ACHs for a consecutive period of at least one (1) year; (b) Submit both ACHs to an annual licensure inspection by Department of Health inspectors; (c) Have no findings of noncompliance resulting in penalties, suspensions or other disciplinary actions at either ACH; and (d) Submit a separate application to the Board. (11) The Board may grant an exception to the one-at-a-time license requirement for Level 2 ACHs for nursing facilities; assisted care living facilities and providers who specialize in the delivery of ventilator services, or in the delivery of residential and/or medical services to persons who are ventilator dependent; and providers who specialize in the delivery of residential and/or rehabilitation services to persons with traumatic brain injury when such nursing facility, assisted care living facility or provider has demonstrated expertise in delivering the specialized services necessary to the specific population that would be served by the licensed ACH. (12) Any admission in excess of five (5) residents is prohibited. (13) Change of Ownership. (a) A change of ownership occurs whenever the ultimate legal authority for the responsibility of the ACH’s operation is transferred, including a change in the legal structure by which the ACH is owned and operated and/or ownership of the preceding or succeeding entity changes. (b) A licensee shall notify the Board’s administrative office of a proposed change of ownership at least thirty (30) days prior to its occurrence by submitting the following to the Board office: 1. A completed change of ownership application on a form approved by the Board which includes all information required by Rule 0720-37-.02(1)(a); 2. Nonrefundable application fee; STANDARDS FOR ADULT CARE HOMES – LEVEL 2 CHAPTER 0720-37 3. Demonstration of ability to meet the financial obligations of the ACH with a financial statement prepared by a certified public accountant; 4. A copy of a local business license (if one is required by the locality); 5. A copy of any and all documents demonstrating the formation of the business organization that owns the ACH; 6. The bill of sale and/or closing documents indicating the transfer of operations of the business entity; 7. Comprehensive business plan for the first two (2) years of operation. 8. Proof of liability insurance; and 9. Any other documents or information requested by the Board. (c) Transactions constituting a change of ownership include, but are not limited to, the following: 1. Transfer of the ACH’s legal title; 2. Lease of the ACH’s operations; 3. Dissolution of any partnership that owns, or owns a controlling interest in, the ACH; 4. The removal, addition or substitution of a partner; 5. Removal of the general partner or general partners, if the ACH is owned by a limited partnership; 6. Merger of an ACH owner (a corporation) into another corporation where, after the merger, the owner’s shares of capital stock are canceled; 7. The consolidation of a corporate ACH owner with one or more corporations; or 8. Transfers between levels of government. (d) Transactions which do not constitute a change of ownership include, but are not limited to, the following: 1. Changes in the membership of a corporate board of directors or board of trustees; 2. Merger of two (2) or more corporations where one (1) of the originally-licensed corporations survives; 3. Changes in the membership of a non-profit corporation; 4. Transfers between departments of the same level of government; 5. Corporate stock transfers or sales, even when a controlling interest. STANDARDS FOR ADULT CARE HOMES – LEVEL 2 CHAPTER 0720-37 6. Sale/lease-back agreements if the lease involves the ACH’s entire real and personal property and if the identity of the lessee, who shall continue the operation, retains the same legal form as the former owner; or 7. Management agreements if the owner continues to retain ultimate authority for the operation of the ACH; however, if the ultimate authority is surrendered and transferred from the owner to a new manager, then a change of ownership has occurred. (14) Qualification and Training Requirements. (a) Qualifications for a Level 2 ACH serving ventilator dependent residents. 1. A Level 2 adult care home provider serving ventilator dependent residents shall be licensed as a physician, nurse practitioner, registered nurse or respiratory therapist trained and experienced in the care of ventilator dependent residents or shall employ a resident manager who meets the qualifications specified in Rule 0720-37-.02(14)(a)2. 2. A Level 2 resident manager serving ventilator dependent residents shall be licensed as a physician, nurse practitioner, registered nurse or respiratory therapist trained and experienced in the care of ventilator dependent residents. 3. A substitute caregiver for a Level 2 ACH serving ventilator dependent residents shall be licensed as a physician, nurse practitioner, registered nurse or respiratory therapist trained and experienced in the care of ventilator dependent residents and shall demonstrate competency in caring for ventilator dependent residents. (b) Qualifications for a Level 2 adult care home provider serving residents with traumatic brain injury. 1. A Level 2 adult care home provider serving residents with traumatic brain injury shall hold a national certification by the Academy of Certified Brain Injury Specialists as a certified brain injury specialist (CBIS) or be licensed as a physician, nurse practitioner, registered nurse, licensed rehabilitation professional or licensed mental health professional trained and experienced in the care of and rehabilitation of residents with traumatic brain injury, or shall employ a resident manager who meets the qualifications specified in Rule 0720- 37-.02(14)(b)2. 2. A Level 2 resident manager serving residents with traumatic brain injury shall hold a national certification by the Academy of Certified Brain Injury Specialists as a certified brain injury specialist (CBIS) or be licensed as a physician, nurse practitioner, registered nurse, licensed rehabilitation professional or licensed mental health professional trained and experienced in the care of and rehabilitation of residents with traumatic brain injury and shall demonstrate competency in caring for persons with traumatic brain injury. 3. A substitute caregiver for a Level 2 ACH serving residents with traumatic brain injury shall hold a national certification by the Academy of Certified Brain Injury Specialists as a certified brain injury specialist (CBIS) or be licensed as a physician, nurse practitioner, registered nurse, licensed rehabilitation professional or licensed mental health professional trained and experienced in the care and rehabilitation of residents with traumatic brain injury and shall demonstrate competency in caring for persons with traumatic brain injury. STANDARDS FOR ADULT CARE HOMES – LEVEL 2 CHAPTER 0720-37 (c) Training. The ACH provider is responsible for the supervision, training and overall conduct of resident managers, substitute caregivers and adult care home staff as it relates to their job performance and responsibilities. The ACH provider shall: 1. Train all staff to meet the routine and emergency needs of residents; 2. Orient all staff to the home including the location of any fire extinguishers; demonstration of evacuation procedures; location of residents’ records; location of telephone numbers for the residents’ physicians and other emergency contacts; location of medications and keys for medication cabinets; instructions for caring for each resident and delegation by a registered nurse for nursing tasks if applicable. 3. Train resident managers, substitute caregivers, and staff on the health care tasks that can be administered through self administration. (15) Continuing Education. All adult care home providers, resident managers and substitute caregivers shall complete annually twelve (12) hours of continuing education related to the following topics: (a) Care of elderly persons; (b) Care of persons with disabilities; (c) Business operations of ACHs; and (d) State rules and regulations for ACHs. (16) The licensee shall immediately notify the Board’s administrative office in the event of an absence or change of resident manager due to serious illness, incapacity, death or resignation of its named resident manager.