Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 40 - ADULT FOSTER HOMES › Section 309-040-0315 - License Application and Fees

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 A completed, written application shall be submitted by the applicant on forms
			 supplied by the Division. The application is not complete until all information
			 is received by the Division. Incomplete applications are void 60 days after
			 initial receipt by the Division.
(2) An applicant shall submit a separate
			 application for each location operated as an AFH.
(3) The application shall include the
			 following:
(a) The maximum capacity requested
			 and a written statement describing family members needing care, individuals who
			 receive respite care, individuals who receive day care, or individuals who
			 receive room and board;
(b) A
			 written statement from an LMP regarding the mental and physical ability of the
			 applicant to provide care to individuals and to operate the AFH. If the
			 applicant employs a resident manager, the applicant shall provide a written
			 statement from a physician or a LMP regarding the mental and physical ability
			 of the resident manager to operate the AFH and to provide care to
			 individuals;
(c) A completed
			 financial information form provided by the Division. The applicant shall
			 demonstrate to the Division the applicant's financial ability and the resources
			 necessary to operate the AFH. Financial ability shall include but is not
			 limited to providing the Division with a list of unsatisfied judgments, pending
			 litigation, and unpaid taxes and notifying the Division regarding whether the
			 applicant is in bankruptcy. If the applicant is unable to demonstrate the
			 financial ability and resources required, the Division may require the
			 applicant to furnish a financial guarantee as a condition of initial licensure
			 in accordance with ORS
			 443.735(3)(e);
(d) A completed Facility Provider Enrollment
			 Application;
(e) A signed letter of
			 support from the Local Mental Health Authority or designee for the applicant to
			 be licensed to operate the AFH;
(f)
			 Documentation of a Criminal History Check approval in accordance with OAR
			 943-007-0001 through 0501 for
			 the provider, the resident manager, caregivers, volunteers, and other occupants
			 over the age of 16, excluding individuals and other persons as defined in ORS
			 443.735;
(g) Written background information pertaining
			 to any current or previous licensure or certification by a state agency,
			 including those licenses or certificates granted to a business or person
			 affiliated with the business, including:
(A)
			 Copies of all current licenses or certificates;
(B) Documentation showing the final
			 disposition of any suspension, denial, revocation, or other disciplinary
			 actions initiated on any current or previous license or certificate, including
			 settlement agreements, where applicable; and
(C) Documentation of any substantiated
			 allegations of abuse or neglect pertaining to the applicant or anyone employed
			 by or contracted with the applicant.
(h) A floor plan of the AFH showing the
			 location and size of rooms, exits, secondary emergency egress, smoke detectors
			 and fire extinguishers, and evidence of compliance with facility safety
			 requirements as outlined in OAR
			 309-040-0370;
(i) A completed AFH Self-Inspection Guide;
			 and
(j) Each application must be
			 accompanied by a fee of $20 per bed requested for license.