§ 39-3355A — INSPECTIONS

(1) The licensing agency shall cause to be made such inspections and investigations to determine compliance with this chapter and applicable rules.
(2) Initial inspections, licensure or re-licensure inspections, follow-up inspections, and fire life safety inspections shall be scheduled in advance, with facilities receiving notice at least thirty (30) days prior to the inspection date.
(3) Initial surveys shall be conducted within ninety (90) days of licensure, followed by a licensure survey within fifteen (15) months.
(4) Complaint investigation surveys shall occur based on the potential severity of the complaint and shall be made unannounced and without prior notice.
(5) The department may accept the services of any qualified person or organization, either public or private, to examine, survey, or inspect any entity requesting or holding a facility license, including as described in subsection (13) of this section.
(6) An inspector shall have full access and authority to examine, among other things, quality of care and service delivery, a facility’s records, resident accounts, and physical premises, including buildings, grounds and equipment, and any other areas necessary to determine compliance with this chapter and applicable rules.
(7) An inspector shall have authority to interview the licensee, administrator, staff, and residents. Interviews with residents shall be confidential and conducted privately unless otherwise specified by the resident.
(8) The licensing agency shall notify the facility, in writing, of all deficiencies, provide a proposed plan of correction for all deficiencies, and approve a reasonable length of time for compliance by the facility. At the time of the exit conference, the licensing agency shall provide the facility a written report specifying the non-core issue deficiencies. Facilities are not required to submit plans of correction for non-core deficiencies.
(9) When core issues are identified during a survey, the licensing agency shall provide a written report within ten (10) business days of the exit conference or the last day of receipt of additional material. Facilities may either adopt the proposed plan of correction or submit an alternative plan of correction for approval by the department for core issue deficiencies.
(10) If any deficiencies constitute an immediate jeopardy, the department shall require immediate correction of deficient practice.
(11) Current lists of deficiencies, including plans of correction, shall be available to the public upon request in the individual facilities or by written request to the department.
(12) The licensing agency shall conduct follow-up surveys to ascertain corrections to issues are made according to the time frames established in the plan of correction for core issues. If the department identifies repeat deficient facility practices during any follow-up survey, the department may initiate or extend enforcement actions.
(13) The department shall accept an accreditation survey from an accreditation commission for a residential care or assisted living facility instead of regular compliance inspections conducted under the authority of this section if all of the following conditions are met:
(a) The accreditation commission’s standards meet or exceed the state requirements for licensure for residential care or assisted living facilities;
(b) The facility submits to the department a copy of its required accreditation reports to the accreditation commission in addition to the application and any other information required for renewal of a license;
(c) The inspection results are available for public inspection to the same extent that the results of an investigation or inspection conducted under this section are available for public inspection;
(d) The accreditation commission complies with the health insurance portability and accountability act and takes reasonable precautions to protect the confidentiality of personally identifiable information concerning the residents of the facility; and
(e) If the facility’s accreditation report is not valid for the entire licensure period, the department may conduct a compliance inspection of the facility during the time period for which the department does not have a valid accreditation report.
(14) The department shall establish a self-inspection program for facilities that receive a gold or silver rating, defined as high ratings with no significant deficiencies on the most recent inspection. Qualifying facilities shall conduct self-inspections for complaints received by the department that do not involve health or safety concerns. Facilities shall submit findings and corrective actions to the department. The department retains the authority to conduct verification inspections for complaints involving health or safety concerns or incomplete reports.
(15) The department shall not conduct an on-site compliance inspection of the residential care or assisted living facility during the time the accreditation report is valid except for complaint surveys or in cases of emergencies. Accreditation does not limit the department in performing any power or duty under this chapter or inspection authorized under this section, including taking appropriate action relating to a residential care or assisted living facility, such as suspending or revoking a license, investigating an allegation of abuse, exploitation, or neglect or another complaint, or assessing an administrative penalty.

Legislative History

[39-3355A, added 2025, ch. 208, sec. 18, p. 947.]