Arizona Regulatory Compliance Resources for Residential Care Facilities

Prohibited Conditions for Acceptance or Retention

An assisted living facility shall not accept or retain an individual under certain conditions. These generally include:

• If the individual requires continuous medical services, continuous or intermittent nursing services (unless the facility complies with A.R.S. § 36-401(C)), or continuous behavioral health services.
• If the primary condition for which the individual needs assisted living services is a behavioral health issue.
• If the services needed by the individual are not within the assisted living facility’s scope of services and a home health agency or hospice service agency is not involved in the individual’s care.
• If the assisted living facility does not have the ability to provide the assisted living services needed by the individual.
• If the individual requires restraints, including the use of bedrails.

For assisted living facilities authorized to provide personal care services, there are additional prohibited conditions for acceptance or retention:

• If the resident is unable to direct self-care.
• If the resident is confined to a bed or chair because of an inability to ambulate even with assistance, unless the condition is a result of a short-term illness or injury or specific requirements are met. The requirements to accept or retain a resident confined to bed/chair (if not short-term) include the resident/representative requesting to stay, a medical practitioner examining the resident and determining the facility can meet their needs, and the service plan reflecting the increased need for personal care services.
• If the resident has a stage 3 or stage 4 pressure sore (as determined by a registered nurse or medical practitioner), unless specific requirements are met. The requirements to accept or retain a resident with a stage 3 or 4 pressure sore include the resident/representative requesting to stay, a medical practitioner examining the resident and determining the facility can meet their needs, and the service plan reflecting the increased need for personal care services. Assisted living facilities providing personal care services may accept or retain a resident receiving nursing services from a home health/hospice agency or requiring intermittent nursing services due to a short-term illness/injury, provided specific requirements are met.

For assisted living facilities authorized to provide directed care services, there are also additional prohibited conditions for acceptance or retention:

• If the resident is confined to a bed or chair because of an inability to ambulate even with assistance, except as allowed for personal care services (short-term illness/injury or meeting specific requirements).
• If the resident has a stage 3 or stage 4 pressure sore, except as allowed for personal care services.
• A manager shall not accept or retain a resident who is unable to direct self-care unless a resident’s representative is designated.

Assisted living facilities are required to establish and maintain various types of documentation:

• Administrative & Policy Documentation:
  • A facility’s scope of services, established in writing by the governing authority.
  • Written designation of a manager and acting manager by the governing authority.
  • Policies and procedures covering numerous areas including job descriptions, orientation, resident complaints, termination of residency, service provision, medical records, personal funds accounts, medication services, emergency/safety standards, and quality management. These policies must be reviewed at least once every three years and updated as needed.
  • Documentation of a quality management program plan and documented reports submitted to the governing authority detailing concerns and actions taken. This report and supporting documentation must be maintained for at least 12 months.
  • Documentation of current contracted services, including a description.
  • Documentation of having received an exception from the Department regarding fire alarm/sprinkler systems or swimming pool enclosure, if applicable.
  • Documentation of operating before November 1, 1998, with more than two individuals per room/unit if allowing higher occupancy.
• Resident-Specific Documentation:
  • Evidence of a resident’s freedom from infectious tuberculosis before or within seven days of occupancy.
  • Documentation dated within 90 days before acceptance stating resident’s needs (continuous services, restraints) signed by a medical practitioner, registered nurse, or physician assistant, or behavioral health needs signed by a behavioral health professional.
  • A documented residency agreement signed by the resident or representative and the manager, detailing terms, services, fees, and policies, which must be maintained in the resident’s medical record.
  • Documentation of written consent for photographs (except for identification).
  • Written consent for the release of information in the resident’s medical or financial records (except as permitted by law).
  • A written service plan for each resident, completed within 14 days of acceptance (or reviewed/updated for respite care within 3 working days), developed collaboratively, detailing needs and services. The service plan must include specific details based on the level of care received. It must be reviewed and updated periodically based on the level of care (supervisory: 12 months, personal: 6 months, directed: 3 months) or within 14 days of a significant change. The plan must be signed and dated by the resident/representative, manager, and relevant medical/behavioral health professionals. For respite care, updates based on significant changes must occur within three working days.
  • Documentation of services provided to the resident in the medical record.
  • Documentation of behavioral health professional or medical practitioner evaluation and determination for residents receiving behavioral care or behavioral health services other than behavioral care. This evaluation must occur within 30 days before acceptance and at least every six months.
  • For residents receiving personal care services who are confined to bed/chair or have Stage 3/4 pressure sores (under exceptions), documentation from a medical practitioner including examination and determination that the facility can meet the resident’s needs.
  • Documentation of the resident’s weight for directed care residents, unless contraindicated by a medical practitioner.
  • Documentation of any communication with a receiving health care institution during transport or transfer.
  • Documentation in the resident’s medical record including the date/time of transport/transfer, mode of transportation, and caregiver accompanying if applicable.
  • A medical record must be established and maintained for each resident. Entries must be dated, legible, and authenticated. If electronic, safeguards are needed to prevent unauthorized access and the date/time must be computer recorded. The medical record must contain comprehensive information including identifying details, contact info, representative info/documents, acceptance/termination dates, needs documentation, consent documents, tuberculosis evidence, healthcare directive copy, signed residency agreement, service plan/updates, services provided, medication orders and administration/assistance documentation, refusal documentation, actions for challenging behavior, evacuation harm determination, vaccination notification documentation, exit orientation documentation, behavioral care/health determination, directed care info, financial affairs notification, and termination notice/date.
• Personnel Documentation:
  • Documentation of a caregiver’s training completion or prior employment/licensure.
  • Verification and documentation of a caregiver’s or assistant caregiver’s skills and knowledge before providing services.
  • Documentation of caregivers and assistant caregivers working each day, including hours worked, maintained for at least 12 months.
  • Evidence of freedom from infectious tuberculosis for managers, caregivers, assistant caregivers, and certain employees/volunteers.
  • For certain individuals residing in an assisted living home (not staff or residents), documentation of fingerprinting compliance or supervision by someone with a valid card, and evidence of freedom from infectious tuberculosis if applicable.
  • Documentation of an assisted living home’s plan to ensure back-up staff availability.
  • A personnel record for each employee or volunteer, including identifying information, employment dates, and documentation of qualifications, education, experience, orientation, in-service education, licenses/certifications, clinical oversight (if BHT), tuberculosis evidence, CPR training, First Aid training, and fingerprinting compliance. Personnel records must be maintained throughout the individual’s service period and for at least 24 months after. Certain personnel records must be provided to the Department within 72 hours upon request.
  • Documentation of cardiopulmonary resuscitation training from approved organizations for caregivers in assisted living homes.
• Safety & Emergency Documentation:
  • A documented disaster plan (relocation, medical records availability, medication availability, food/water), reviewed at least annually with documented review details (date, time, participants, critique, recommendations).
  • Documentation of disaster drills for employees conducted quarterly on each shift.
  • Documentation of evacuation drills conducted semi-annually for employees and residents (with exceptions noted). Drill documentation must include date, time, evacuation duration, identification of residents needing assistance/not evacuated, problems, and recommendations, and must be maintained for at least 12 months.
  • Documentation of a resident’s orientation to exits and evacuation route within 24 hours of acceptance.
  • Documentation of a first-aid kit location.
  • Documentation of resident accidents, emergencies, or injuries, including date, time, description, witnesses, actions taken, individuals notified, and prevention actions.
  • Documentation of a current fire inspection.
  • Documentation of rechargeable fire extinguisher servicing.
  • Documentation of monthly smoke detector tests in assisted living homes, maintained for at least 12 months.
• Medication Documentation:
  • Policies and procedures for medication services, including preventing/responding to/reporting errors, responding to/reporting unexpected reactions, reviewing medication regimens, documenting administration/assistance, monitoring self-administration, procuring medication, and off-premises administration.
  • Documentation of verbal medication orders in the resident’s medical record, with a written order verifying it obtained within 14 days.
  • Policies and procedures for medication administration (if provided), reviewed/approved by a medical practitioner, registered nurse, or pharmacist.
  • Documentation of medication administered to a resident in the medical record.
  • Policies and procedures for assistance in the self-administration of medication (if provided), reviewed/approved by a medical practitioner or nurse.
  • Documentation of assistance in the self-administration of medication provided to a resident in the medical record.
  • A current drug reference guide and a current toxicology reference guide available for personnel use.
  • Documentation of who filled a resident’s medication organizer.
  • Policies and procedures for medication storage, inventory, tracking, dispensing, and discarding, including controlled substances.
  • Documentation of medication error or unexpected reaction reports to the medical practitioner.
  • Documentation of medication storage in the resident’s bedroom/unit in the service plan.
• Food Service Documentation:
  • A food menu, prepared weekly, posted conspicuously, updated, and maintained for at least 60 days.
  • If using a contracted food establishment, a copy of their license or permit.
  • A current therapeutic diet manual available for employees if offering therapeutic diets.
  • A written order from a medical practitioner for therapeutic diets.
• Environmental Documentation:
  • Documentation of a pest control program.
  • Documentation of water source testing (if not regulated) maintained for at least 12 months.
  • Documentation of swimming pool water quality tests maintained for at least 12 months.
• Physical Plant Documentation:
  • Written consent from the resident or representative if their sleeping area is used as a passageway and was used as such before October 1, 2013.

Assisted living facilities must ensure adequate and qualified staff are present and perform specific duties:

• Manager:
  • Must be 21 years of age or older.
  • Must possess a certificate as an assisted living facility manager or a temporary certificate, unless managing an adult foster care home.
  • Must be designated in writing by the governing authority.
  • Must be able to read, write, understand, and communicate in English.
  • Is directly accountable to the governing authority for the daily operation and all services.
  • Has the authority and responsibility to manage the facility.
  • Designates in writing a caregiver who is at least 21 years old and present/accountable when the manager is absent.
  • Must ensure policies and procedures are established, documented, implemented, available, reviewed, and updated.
  • Must ensure required information is conspicuously posted.
  • Must ensure required documentation is provided to the Department upon request.
  • Cannot act as a resident’s representative unless a family member.
  • Manages resident personal funds accounts according to specific requirements if authorized.
  • Notifies the resident’s representative/family/fiduciary/trust officer if the resident is determined to be incapable of handling financial affairs.
  • Ensures a resident receives at least 30 calendar days written notice before any fee/charge increase, unless the resident’s need for services changes as documented in the service plan.
  • Must permit the Department to interview employees, volunteers, and residents during surveys or investigations.
  • Must report alleged or suspected abuse, neglect, or exploitation according to A.R.S. § 46-454.
  • Must initiate an investigation of suspected abuse, neglect, or exploitation that occurred on the premises or while the resident received services from facility staff.
  • Must provide written notification to the Department of a resident’s death (if reportable) within one working day, and self-injury requiring emergency intervention within two working days.
  • Ensures that for residents receiving home health or hospice services, their information is in the medical record, care instructions are within scope, communicated to a caregiver, and documented in the service plan.
  • Ensures a quality management program is established and functioning.
  • Ensures contracted services comply with requirements.
  • Ensures personnel meet age, qualification, and documentation requirements.
  • Ensures daily staffing records are maintained.
  • Ensures required individuals provide evidence of freedom from infectious tuberculosis.
  • Ensures caregivers and assistant caregivers receive orientation before providing services.
  • Ensures caregivers and managers have current First Aid and adult-specific CPR training certification.
  • For assisted living homes, ensures individuals residing who are not residents/staff meet fingerprinting and tuberculosis requirements.
  • For assisted living homes, ensures a back-up plan for staff unavailability.
  • For assisted living homes, ensures at least the manager or a caregiver is present when a resident is present.
  • For assisted living homes, ensures the manager or caregiver is awake during the day, and during nighttime hours can hear/respond to needs and follows policies for checking on directed care residents if applicable.
  • Ensures personnel records are established, maintained, and accessible.
  • Ensures resident service plans are completed, developed, reviewed, and updated.
  • Ensures caregivers/assistant caregivers provide services according to the service plan and document them.
  • Ensures daily activities are planned and available.
  • Coordinates transport and transfer of residents according to policies.
  • Ensures resident rights are provided and respected.
  • Ensures medical records are established, maintained, and accurate.
  • Ensures behavioral health professional or medical practitioner evaluations and determinations are obtained for residents receiving behavioral care or behavioral health services.
  • Ensures a bell, intercom, or other mechanical means to alert employees to resident needs/emergencies is available/implemented for personal and directed care residents.
  • For directed care facilities, ensures policies and procedures for resident safety who may wander, and a means of exiting that controls or alerts employees of egress.
  • Ensures medication policies and procedures are established and followed.
  • Ensures medication storage complies with requirements.
  • Ensures food service requirements are met.
  • Ensures emergency and safety standards are met (disaster planning, drills, fire safety, accident/injury response).
  • Ensures environmental standards are met (cleanliness, pest control, garbage, temperature, water, equipment, pets).
  • If a swimming pool/spa is on premises, ensures safety requirements and water testing/documentation.
  • Ensures physical plant standards are met.
• Caregiver:
  • Provides supervisory care services, personal care services, or directed care services.
  • Must be 18 years of age or older.
  • Must provide documentation of training completion or prior experience/licensure.
  • Skills and knowledge must be verified and documented before providing services.
  • Must be able to read, write, understand, and communicate in English.
  • For assisted living centers, at least one manager or caregiver must be present and awake when a resident is on the premises.
  • Provides evidence of freedom from infectious tuberculosis.
  • Receives orientation specific to their duties before providing services.
  • Provides current documentation of First Aid and adult-specific CPR training certification.
  • For assisted living homes, the manager or a caregiver must be available as back-up.
  • For assisted living homes, the manager or a caregiver must be present when a resident is present.
  • For assisted living homes, must be awake during the day, and during nighttime hours able to hear and respond to a resident needing assistance, and if providing directed care services, follow policies for checking on residents.
  • Provides a resident with the assisted living services in the resident’s service plan.
  • Is only assigned services they have the documented skills and knowledge to perform.
  • Provides assistance with activities of daily living and personal hygiene according to the service plan.
  • Encourages participation in planned activities.
  • Documents the services provided in the resident’s medical record.
  • If 16 or 17 years of age, shall not provide assistance with bathing, toileting, moving, assistance in self-administration of medication, medication administration, or nursing services.
  • Responds to a resident’s sudden, intense, or out-of-control behavior according to policies and procedures.
  • For residents with an accident, emergency, or injury needing medical services, immediately notifies the resident’s emergency contact and primary care provider and documents the event.
  • Monitors resident activity in common areas (assisted by sufficient lighting).
• Assistant Caregiver:
  • Helps a manager or caregiver provide supervisory care services, personal care services, or directed care services.
  • Must be 16 years of age or older.
  • Interacts with residents under the supervision of a manager or caregiver.
  • Skills and knowledge must be verified and documented before providing services.
  • Provides evidence of freedom from infectious tuberculosis.
  • Receives orientation specific to their duties before providing services.
  • Provides a resident with the assisted living services in the resident’s service plan.
  • Is only assigned services they have the documented skills and knowledge to perform.
  • Provides assistance with activities of daily living and personal hygiene according to the service plan.
  • Encourages participation in planned activities.
  • Documents the services provided in the resident’s medical record.
  • If 16 or 17 years of age, shall not provide assistance with bathing, toileting, moving, assistance in self-administration of medication, medication administration, or nursing services.
  • Responds to a resident’s sudden, intense, or out-of-control behavior according to policies and procedures.
  • For residents with an accident, emergency, or injury needing medical services, immediately notifies the resident’s emergency contact and primary care provider and documents the event.
  • Monitors resident activity in common areas (assisted by sufficient lighting).
• Other Employees and Volunteers:
  • An employee or volunteer who has or is expected to have more than eight hours per week of direct interaction with residents must provide evidence of freedom from infectious tuberculosis.