OAR 411-360-0050
AFH-DD License Application and Fees
(1)
An applicant for an AFH-DD license must complete a written application on the applicable Department forms and submit the application to the Department with a non-refundable fee of $50 per bed for each service recipient. Service recipients include private pay and publicly funded individuals. Service recipients do not include family members or recipients of day care services.(a)
An application is not complete until the Department receives the information and non-refundable fee described in this rule.(b)
An incomplete application is void 60 calendar days from the date the Department receives the application.(c)
Failure to provide accurate information may result in the denial of an application.(2)
An applicant applying to operate more than one AFH-DD must complete a separate application for each home.(3)
An application for an AFH-DD with a resident manager must include a completed application for the resident manager on the applicable Department forms.(4)
An application for an AFH-DD license must include the following:(a)
The applicant’s mailing address, if different from the address of the AFH-DD, and a business address for electronic mail.(b)
The maximum capacity in accordance with OAR 411-360-0060 (Capacity).(c)
Identification of the following:(A)
Each person that resides in the home and receives care, including family members that require care and recipients of respite, relief care, or day care services; and(B)
All other occupants that reside in the home or on the property of the home, including family members, friends, and room and board tenants.(d)
The classification being requested in accordance with OAR 411-360-0070 (Classification), including information and supporting documentation regarding qualifications, relevant work experience, and training of caregivers as required by the Department.(e)
The statement of a health care provider, on the applicable Department form, regarding the ability of the applicant to deliver services.(f)
Financial information, including the following:(A)
A completed Financial Information Sheet on the applicable Department form.(i)
An applicant must demonstrate the financial ability and maintain sufficient liquid resources to pay the operating costs of an AFH-DD for at least two months without solely relying on potential income from individuals and room and board payments.(ii)
An applicant applying to operate more than one AFH-DD must demonstrate the financial ability and maintain sufficient liquid resources to pay the operating costs of all the homes for at least two months without solely relying on potential income from individuals and room and board payments.(iii)
If an applicant is unable to demonstrate the financial ability and resources required by this rule, the Department may require the applicant to furnish a financial guarantee, such as a line of credit or guaranteed loan.(B)
Copies of bank statements from the last three months demonstrating banking activity in both checking and savings accounts, as applicable, or demonstration of cash on hand, if requested.(C)
Documentation of the following, if applicable:(i)
Unsatisfied judgments, liens, and pending lawsuits where a claim for money or property is made against the applicant.(ii)
Bankruptcy filings by the applicant.(iii)
Unpaid taxes due from the applicant including, but not limited to, property taxes, employment taxes, and state and federal income taxes.(D)
A copy of a complete and current credit report for the applicant, if requested.(g)
If an applicant is leasing or rents the home, a copy of the lease or rental agreement. The agreement must be a standard lease or rental agreement for residential use and include the following:(A)
Name of the owner and landlord;(B)
Verification the rent is a flat rate; and(C)
Signatures of the landlord and applicant and date signed.(h)
If an applicant is purchasing or owns the home, verification of purchase or ownership.(i)
A current and accurate floor plan for the home that indicates the following:(A)
Size of each room;(B)
Size of each window;(C)
Bedrooms to be used by individuals, the provider, and as applicable, caregivers, room and board tenants, and recipients of day care, relief care, or respite services;(D)
Each exit on each level of the home, including emergency exits such as windows;(E)
Wheelchair ramps, if applicable;(F)
Each fire extinguisher, smoke alarm, carbon monoxide alarm, and sprinkler if the home has an interior sprinkler system;(G)
Planned evacuation routes; and(H)
Designated smoking areas in or on the premises of the home, if applicable.(j)
The non-refundable fee for each individual service recipient as described in section (1) of this rule.(k)
Three personal references for the applicant. The personal references may not be family members, current or potential licensees, or co-workers of current or potential licensees.(l)
If applying to operate more than one AFH-DD, a plan covering administrative responsibilities and staffing qualifications for each home.(m)
A written description of the daily operation of the AFH-DD, including the following:(A)
The use of a resident manager and substitute caregivers, as applicable.(B)
The schedule of the provider, resident manager, and substitute caregivers, as applicable.(C)
The plan for coverage in the absence of the provider, resident manager, or substitute caregivers, as applicable.(n)
Documentation of the following for each subject individual as defined in OAR 411-360-0020 (Definitions and Acronyms):(A)
Signed background check, and if needed, the mitigating information and fitness determination form;(B)
Signed consent form for a background check with regards to abuse of children; and(C)
Founded reports of child abuse or substantiated adult abuse allegations, including the dates, locations, and resolutions.(o)
A copy of the Residency Agreement for the AFH-DD.(5)
After receipt of the completed application materials, including the non-refundable fee, the Department shall investigate the information submitted and inspect the home. Compliance is determined upon submission and completion of the application and the process described in these rules.(a)
An applicant shall receive a copy of the Department’s inspection form citing any deficiencies and specifying a time frame for correction, no later than 60 calendar days from the date of inspection.(b)
Deficiencies noted during an inspection of the home must be corrected in the time frame specified by the Department.(6)
An applicant must comply with these rules before the Department issues a license. An application is denied if cited deficiencies are not corrected within the time frames specified by the Department.(7)
Prior to being licensed, an applicant must attend the orientation offered by the local CDDP.(8)
An applicant may withdraw an application at any time during the application process by notifying the Department in writing.(9)
An applicant whose application has been denied or whose license has been revoked, non-renewed, or voluntarily surrendered during a revocation or non-renewal process, may not submit a new application for at least one year from the date the action is final, or for a longer period of time if specified in a final order.(10)
All monies collected under these rules are paid to the Quality of Care Fund.
Source:
Rule 411-360-0050 — AFH-DD License Application and Fees, https://secure.sos.state.or.us/oard/view.action?ruleNumber=411-360-0050.