Policies and procedures for assisted living facilities: a complete guide

Last updated 2026-07-25

What policies and procedures do assisted living facilities need?

Every licensed assisted living facility operates under a written policy and procedure manual that acts as the operational blueprint for care delivery, staff conduct, and regulatory compliance. The manual typically includes 15 to 25 distinct policy areas, each with procedures detailing who does what, when, and how. State licensing agencies mandate specific policy categories. California's Residential Care Facilities for the Elderly (RCFE) regulations require written plans for disaster preparedness, medication assistance, emergency responses, and resident rights ^[1]. Florida assisted living facilities must document policies on admissions assessment, incident reporting, staffing, infection control, and elopement prevention ^[2]. While the exact list varies by state, common core areas include: - Medication management and assistance protocols

• Admission, transfer, and discharge procedures
• Resident rights and complaint procedures
• Emergency and disaster response plans
• Infection control and universal precautions
• Staff hiring, training, and supervision
• Incident and accident reporting
• Physical restraint prohibition (or documentation if ever clinically justified)
• Dietary services and special diet accommodation
• Activities and engagement programming
• Financial management and resident funds
• Confidentiality and HIPAA compliance
• Abuse prevention and reporting (mandatory reporter duties)
• Care planning and service plan updates
• Quality assurance and internal audits Your policy manual isn't decorative. Surveyors use it as the standard during inspections: if your policy says you review care plans every 90 days, they'll check resident files for 90-day updates. If a resident falls, they'll compare your response to your written fall-response procedure. A gap between policy and practice is a citation.

What is assisted living and how is it different from a group home?

Assisted living is a licensed residential care model for adults who need help with activities of daily living (bathing, dressing, medication reminders, meals) but don't require 24-hour skilled nursing. Residents live in private or semi-private apartments or rooms within a facility that provides scheduled assistance, meals, social activities, and supervision. A group home is a smaller residential care setting, typically a single-family house or adapted building serving 3 to 16 residents. Many states classify small group homes under the same regulatory umbrella as larger assisted living facilities, using terms like "residential care home," "adult foster care," or "community residential facility." The core difference is size and setting, not care type: a six-bed group home for seniors with dementia and a 60-unit assisted living community may both provide personal care, medication assistance, and meals under the same state license category. Some states draw bright lines. Oregon separates Residential Care Facilities (5+ beds) from Adult Foster Homes (1-5 beds), each with distinct rules ^[3]. Other states use a single license type with tiered requirements: smaller homes face lighter staffing and physical plant standards but the same policy mandates. For policy and procedure purposes, the requirements converge. Whether you operate a four-bed adult care home or a 40-bed assisted living facility, you'll write policies on medication management, emergency response, and resident rights. The scale of your operation changes the detail (a small home might combine dietary and kitchen safety into one policy; a larger facility splits them), but the regulatory intent is identical: documented, consistent processes that protect residents.

What does assisted living provide that nursing homes don't?

Assisted living provides personal care, medication reminders, meals, housekeeping, and social activities in a residential, non-medical setting. Nursing homes provide skilled nursing care, physician oversight, physical therapy, wound care, IV medications, and 24-hour licensed nurse supervision for residents with complex medical needs. The difference is clinical intensity. Assisted living staff assist with activities of daily living: they help residents bathe, dress, and remember to take pills, but they don't perform medical procedures, insert catheters, or administer IV antibiotics. Nursing homes employ licensed nurses (RNs and LPNs) on every shift and have physicians or nurse practitioners on staff or on call. Assisted living staff are typically unlicensed caregivers with state-mandated training (often 40 to 75 hours initially, plus annual updates) ^[4]. Cost reflects this gap. Assisted living averages $4,500 to $6,500 per month nationally; nursing home care runs $7,500 to $10,000 per month for a semi-private room ^[5]. Medicare covers skilled nursing facility stays (up to 100 days under certain conditions after a hospital stay) but doesn't pay for assisted living room and board; some Medicaid waiver programs cover assisted living for eligible low-income seniors ^[6]. Your policy manual mirrors the scope difference. Assisted living policies emphasize assistance documentation ("caregiver observed resident take medications"), fall risk monitoring, and when to call 911 or a resident's physician. Nursing home policies detail wound staging, physician orders, nurse delegation, and infection surveillance because the facility itself provides those clinical services.

How do you develop a medication management policy?

A medication management policy outlines how staff assist residents with medications, who may do so, training requirements, storage protocols, documentation, and error response. This is the single most scrutinized policy during state surveys because medication assistance is both a core assisted living service and a common source of serious incidents. Most states prohibit unlicensed staff from administering medications (a nursing act) but allow them to assist: reminding, opening containers, handing a pill cup to a resident, observing the resident self-administer. Some states permit "medication aides" or "certified medication assistants" to perform limited administration after completing state-approved training (often 40 to 80 hours) ^[7]. Your policy must align with your state's Nurse Practice Act and assisted living statutes. A complete medication policy typically includes: - Definitions: assist vs. administer, prescription vs. over-the-counter, self-administration criteria

• Staff qualifications: which roles may assist, required training, competency checks
• Physician orders: all medications require a current physician order (or documented resident/family approval for OTC)
• Storage: locked medication cart or room, refrigeration for temperature-sensitive drugs, separate storage per resident
• Documentation: medication administration record (MAR) signed after each assist, including refusals and reasons
• Error response: immediate supervisor notification, physician/family contact, incident report, resident monitoring
• Disposal: how expired or discontinued medications are destroyed (often requires pharmacy take-back or witness log)
• Audits: monthly MAR reviews, annual policy training refreshers The GroupHomePath State Licensing Kit includes medication policy templates tailored to each state's assist-vs.-administer rules, so you're not translating pharmacy board opinions into procedure language yourself. Document everything. A missed dose isn't just a check-box error; it's potential evidence of neglect if the resident's condition worsens. Your policy should specify: if a resident refuses a medication, staff document the refusal and notify the supervisor immediately if the medication is critical (insulin, blood pressure, anti-seizure). If you can't find a medication at the scheduled time, you stop, report, investigate, and document before proceeding.

What goes into an admissions and discharge policy?

An admissions policy defines who you can serve, the assessment process, required documentation, trial periods, and when you must decline or defer an applicant. A discharge policy defines when and how you transition a resident out, notice requirements, and appeal rights. Both protect you legally and ensure residents enter and leave appropriately. States regulate admission criteria. Most require a pre-admission assessment (often by a nurse or trained assessor) documenting the applicant's medical history, medication list, activities-of-daily-living needs, cognitive status, and behavioral risks ^[8]. The assessment determines if your facility can meet the person's needs. If your home has no dementia-trained staff or secured exits, you can't safely admit a resident prone to wandering. If your staffing is one caregiver per eight residents overnight, you can't admit someone needing two-person transfers every three hours. Your admissions policy should cover: - Assessment tools and who conducts them (RN, licensed assessor, administrator)

• Physician certification of health status (often required within 30 days of move-in)
• Tuberculosis testing or screening
• Trial period (many states allow 30 to 90 days to determine compatibility)
• Admission agreements and resident/family signatures
• Financial qualification and payment source verification
• Rights and responsibilities orientation
• Exclusion criteria: needs exceeding your license (feeding tubes if unlicensed, aggressive behavior if no behavioral health training, 24-hour skilled nursing) Discharge policy triggers include resident request, non-payment, the facility closing, or the resident's needs exceeding your care capacity (e.g., they now require skilled nursing). Most states require written notice (often 30 days) unless the resident poses an immediate threat to self or others ^[9]. Your policy must include safe discharge planning: referrals to higher-level care, family coordination, transportation, and medication/belongings transfer. Never discharge punitively (because the resident or family complained). That invites retaliation claims and state investigation. Your policy should reference your complaint and grievance procedure and affirm that residents may raise concerns without fear of discharge.

How do you write an incident and accident reporting policy?

An incident reporting policy details what events require documentation, who reports, to whom, deadlines, and follow-up procedures. It's legally critical: most states mandate reporting serious injuries, allegations of abuse, medication errors, elopements, and deaths to the licensing agency within 24 hours to five days ^[10]. A strong incident policy defines reportable events in clear language. Examples include: - Falls with injury (fracture, head trauma, requiring ER visit)

• Medication errors (missed dose, wrong dose, wrong resident)
• Allegations or suspicions of abuse, neglect, exploitation
• Unexplained injuries or bruises
• Elopement (resident left building unsupervised) or attempts
• Resident-to-resident altercations
• Fire, flood, natural disaster, or loss of utilities
• Death (any cause)
• Law enforcement or emergency medical services called to facility Your procedure assigns roles: the discovering staff member completes an internal incident report immediately (most facilities use a standard form), the supervisor reviews and investigates the same day, and the administrator determines if state reporting is required and files within the statutory window. Many states require both an online or phone report and a follow-up written report. Include corrective action: if three residents fell in the same hallway in one week, what changed? Did you add a night-light, increase hourly rounds, refer residents for gait assessment? Surveyors want to see that you analyze patterns and act, more than file paper. A common mistake: underreporting because the administrator fears citations. This backfires. A state investigator who learns of an unreported fall with hip fracture will cite you for both the fall circumstances and failure to report. Transparent reporting, plus documented corrective steps, usually results in lighter regulatory consequences than discovered cover-ups.

What does a staffing and training policy include?

Staffing policies define ratios (caregivers per resident), shift coverage, qualifications, and supervision. Training policies list initial and ongoing education requirements, competency validation, and record-keeping. Together they assure the state that you have enough qualified people to deliver safe care. Most states set minimum direct-care staffing ratios: one awake caregiver per 15 residents during the day, one per 20 overnight, for example ^[11]. Some specify that an administrator or manager must be on-site during business hours. Your policy should state your ratios (meet or exceed the state minimum), how you adjust for acuity (residents needing two-person transfers, dementia behaviors), and backup plans for call-offs. Training requirements vary by state but typically include: - Initial orientation (before solo resident contact): resident rights, emergency procedures, infection control, confidentiality

• Pre-service or within-90-days training: first aid/CPR, medication assistance (if applicable), recognizing abuse, dementia care basics, fall prevention
• Annual continuing education: 12 to 24 hours per year, covering topics like HIPAA, cultural competency, end-of-life care
• Specialized training for specific populations: dementia certification (often 6-12 hours), mental health first aid, behavioral management Your policy should specify who delivers training (outside vendor, administrator, online modules), how you document completion (certificates, attendance logs, competency checklists), and how you monitor compliance. Keep a training file for each employee with dates, topics, and hours. Background checks are mandatory in every state. Your hiring policy must require FBI and state criminal history checks, abuse registry checks, and often a check of the Office of Inspector General exclusion list (for Medicaid-funded facilities) before any offer of employment ^[12]. Specify which offenses disqualify an applicant (most states bar anyone with convictions for abuse, neglect, violence, or theft).

How do you draft an emergency preparedness and disaster plan?

An emergency preparedness policy outlines your response to fires, natural disasters, loss of power or water, severe weather, active threats, and pandemics. Federal and state rules require a written plan, staff training, and periodic drills. The Centers for Medicare & Medicaid Services (CMS) issued an Emergency Preparedness Rule in 2016 that applies to Medicare/Medicaid-certified providers, including some assisted living settings ^[13]. Even if you're not Medicare-certified, most state licensing agencies adopted similar standards: your plan must address risk assessment, continuity of operations, communication, and training. A complete emergency plan includes: - Hazard vulnerability assessment: which disasters are likely in your region (hurricanes, earthquakes, tornadoes, floods, wildfires)?

• Evacuation plan: exits, assembly areas, transportation for non-ambulatory residents, destination agreements (mutual aid with nearby facilities, hotels, shelters)
• Shelter-in-place plan: when evacuation is unsafe (tornado, hazmat incident), how you secure residents in interior rooms with supplies
• Staff call-down list: who notifies whom, 24-hour contact numbers
• Resident tracking: how you account for every resident during and after an incident
• Medical needs continuity: backup medication supply, oxygen tanks, backup power for critical equipment
• Communication with families: automated call system, website updates, designated family liaison
• Drills and exercises: most states require fire drills quarterly or monthly, and disaster drills annually Post-COVID, pandemic response became a permanent policy section. Include infection control escalation (masking, visitor restrictions, cohorting), staffing surge plans, and supply chain backup for PPE and cleaning products. Store your plan both digitally and in a physical binder accessible to all shifts. Include maps, utility shutoff instructions, and emergency vendor contact lists (generator repair, water delivery, temporary staffing agency).

What is a resident rights and grievance policy?

A resident rights policy enumerates the rights every resident holds under state and federal law: privacy, dignity, freedom from restraint, participation in care decisions, and the right to voice complaints without retaliation. A grievance procedure details how residents or families file complaints, who investigates, timelines, and appeal paths. Most states publish a Resident Bill of Rights that you must post conspicuously and provide to residents in writing at admission ^[10]. Common rights include: - To be treated with dignity and respect

• To privacy in person, property, and records
• To participate in developing and updating one's service plan
• To refuse services or treatments
• To manage one's own finances (or have an accounting if the facility manages them)
• To communicate privately with family, physicians, advocates, and the ombudsman
• To be free from abuse, neglect, and exploitation
• To file complaints without fear of retaliation or discharge Your grievance policy should establish a simple process: residents or families can submit complaints verbally or in writing to the administrator or designated staff member. You must investigate promptly (most policies say within 5 to 10 business days), document findings, and respond in writing. If the resident is unsatisfied, the policy should inform them of the state ombudsman's contact information and the licensing agency complaint hotline ^[14]. Never retaliate. If a family complains about missed medications and you begin pressuring them to move the resident, you've violated the law and your own policy. Document the complaint, your investigation, and corrective action (staff retraining, disciplinary action if warranted, process change). Transparency usually resolves issues; defensiveness escalates them.

How do you maintain and update your policy manual?

Your policy and procedure manual is a living document. States require annual reviews, and you must revise policies whenever regulations change, when an incident reveals a gap, or when best practices evolve. Build an annual review schedule. Assign each policy an owner (the administrator might own admissions and discharge, the director of nursing owns medication management, the activities director owns programming). Each owner reviews their section yearly, checking: - Does the policy reflect current state statutes and agency guidance?

• Are staff following the procedure as written? (If not, do you fix the practice or rewrite the policy?)
• Have there been incidents suggesting the policy needs strengthening?
• Are references (phone numbers, vendor names, forms) still accurate? Document the review: date, reviewer name, changes made (or note "no changes required"). Keep a revision log at the front of the binder so surveyors see you're actively maintaining the manual. When regulations change mid-year, update immediately. If your state amends the medication assistance training requirement from 40 to 60 hours, revise your training policy that month and retrain current staff as required. Post a memo to staff highlighting the change and collect signed acknowledgments. Some operators use binders with tabbed sections and sheet protectors for easy page swaps. Others maintain electronic manuals (easier to search and distribute to all staff). Either way, ensure every staff member can access the current version. Outdated policies in circulation cause confusion and inconsistent care. The GroupHomePath State Licensing Kit includes policy templates with built-in update alerts tied to state regulatory changes, so you're not chasing amendment notices yourself.

How do policies connect to your service plans and care delivery?

Policies are the framework; service plans are the individualized application. Your medication policy says how staff assist; a resident's service plan says which medications that resident takes and at what times. Your fall-prevention policy lists risk factors and interventions; the service plan notes that Mrs. Smith has a history of dizziness, requires a walker, and needs hourly checks during evening hours. States require individualized service plans (also called care plans or support plans) for each resident, updated at least annually or whenever the resident's condition changes significantly ^[15]. The service plan must document: - The resident's goals and preferences

• Assessed needs (ADLs, medication, dietary, social)
• Interventions and services you'll provide
• Responsible staff roles
• Target dates and review schedule Your policy manual should include a care planning policy detailing who develops the plan (often a team: administrator, lead caregiver, resident, family, sometimes a consulting nurse or social worker), how often you review it, and how you document resident participation and consent. Consistency between policy and practice protects you. If your policy says you review service plans every six months and update them within 10 days of a hospitalization, do it. Surveyors will pull service plans during inspections and check dates. A missed review isn't just a paperwork lapse; it suggests you're not monitoring resident changes.

What policies do you need for infection control and universal precautions?

An infection control policy outlines how you prevent and manage infectious diseases: handwashing, personal protective equipment (PPE), isolation protocols, bloodborne pathogen exposure, and outbreak response. Universal precautions (treating all blood and body fluids as potentially infectious) must be standard practice. OSHA's Bloodborne Pathogens Standard applies to any workplace where employees might contact blood ^[16]. Your policy must include: - Hand hygiene: when staff wash hands (before and after resident contact, after removing gloves, before meals, after toileting), technique, alcohol-based sanitizer availability

• PPE: gloves for any contact with body fluids, gowns and masks when indicated (respiratory symptoms, diarrheal illness), eye protection for splash risk
• Sharps safety: if your residents use insulin or other injectables, how you dispose of needles (puncture-resistant sharps containers, pickup by medical waste vendor)
• Exposure response: if a staff member is stuck by a needle or splashed with blood, immediate washing, supervisor notification, medical evaluation, and post-exposure testing if warranted
• Isolation procedures: when a resident has a contagious illness (flu, norovirus, COVID-19), you may need to isolate in their room, restrict communal dining, cohort staff assignments, and notify the health department
• Outbreak definitions and reporting: many states require reporting when two or more residents develop the same illness within a defined period (often 72 hours) Provide staff training on infection control during orientation and annually. Stock PPE visibly and abundantly. After pandemic shortages, many facilities now keep a 90-day supply of gloves, masks, and sanitizer. Cleaning and disinfection procedures are part of this policy: specify EPA-registered disinfectants, contact times (how long a surface must remain wet to kill pathogens), high-touch surface frequency (doorknobs, handrails, light switches cleaned at least daily), and bathroom cleaning after each use for shared toilets.

How do i start a group home and develop compliant policies?

Starting a group home or assisted living facility involves securing a license, finding a suitable property, hiring staff, and assembling a policy and procedure manual that satisfies your state's licensing authority. Policies aren't an afterthought; they're a pre-licensure requirement. Most states require you to submit your policy manual as part of the initial license application or have it ready for the pre-licensure survey . The licensing surveyor will review the manual on-site, checking that you've addressed every mandated policy area and that your procedures align with state rules. Steps to develop compliant policies: 1. Obtain the state licensing regulations: Download your state's administrative code chapter governing assisted living or residential care homes. It's free on your state's website (often under the Department of Health, Department of Social Services, or Department of Aging). Read the entire chapter, highlighting every section that says "the facility shall have a written policy" or "the licensee shall develop procedures." 2. List required policy topics: Create a checklist from the regulations. If the code says "written infection control plan," that's one item. If it says "medication assistance procedures," that's another. 3. Review sample policies: Many state agencies publish policy templates or manuals from existing facilities (with identifying information redacted). Some states offer guidance documents explicitly for new operators. Use these as starting points, but customize to your facility's actual procedures. 4. Write procedures that match your operation: Don't copy a policy verbatim if you can't execute it. If a sample medication policy says "the director of nursing reviews all MARs weekly," but you have no director of nursing, rewrite it: "the administrator reviews all MARs weekly." Your policy is your legal promise; write what you'll actually do. 5. Cross-check against statutes and rules: Have an attorney or experienced consultant review your draft manual for regulatory alignment. Misinterpreting a statute (e.g., thinking you can administer medications when state law only allows assistance) can derail your entire license application. 6. Train staff on the policies before opening: Every employee must read and acknowledge the sections relevant to their role. Document it. 7. Post required notices and rights: Print and display the Resident Bill of Rights, abuse hotline numbers, ombudsman contact, and your facility license (once issued) in common areas. The time investment is real: plan 40 to 80 hours to draft a complete manual if you're starting from scratch. Many new operators use a licensing kit or consultant to cut that to 10 to 20 hours of customization and review. The upfront effort pays off: a solid manual speeds your licensing approval and gives staff clear guidance from day one. For property and zoning considerations (another common stumbling block), see the assisted living facilities guide and state-specific licensing paths. Policies, property, and people are the three legs; all must be ready before your first resident moves in.

Frequently asked questions

What is assisted living?

Assisted living is a licensed residential care setting for adults who need help with daily activities like bathing, dressing, meals, and medication reminders, but don't require 24-hour skilled nursing care. Residents typically live in private or shared rooms and receive personalized assistance, social activities, and supervision.

What is a group home?

A group home is a smaller residential care facility, usually a single-family house or adapted building, serving 3 to 16 residents who need personal care or supervision. Many states license group homes under the same regulations as larger assisted living facilities, with tiered requirements based on bed count.

What is an assisted living facility?

An assisted living facility is a licensed building (or campus) providing housing, personal care, meals, activities, and medication assistance to adults who can't live independently but don't need hospital-level nursing. Facilities range from small homes with a few beds to large complexes with 100-plus apartments.

What is the difference between assisted living and nursing home?

Assisted living provides personal care and supervision by trained (but usually unlicensed) staff; nursing homes provide skilled nursing care, physician oversight, and complex medical treatments by licensed nurses and therapists. Nursing homes cost more and serve residents with higher medical needs. Medicare covers skilled nursing under certain conditions but doesn't pay for assisted living room and board.

What does assisted living provide?

Assisted living provides help with bathing, dressing, grooming, toileting, eating, mobility, medication reminders, housekeeping, laundry, meals, social activities, and 24-hour supervision. Staff assist with daily living tasks but don't perform medical procedures or deliver skilled nursing services like wound care or IV medications.

Does Medicare cover assisted living facilities?

No. Medicare doesn't cover assisted living room and board. It covers skilled nursing facility care (up to 100 days following a qualifying hospital stay) and some home health services, but not the custodial personal care that defines assisted living. Some Medicaid waiver programs do cover assisted living for eligible low-income seniors.

How long does it take to write a policy and procedure manual?

Drafting a complete manual from scratch takes 40 to 80 hours if you're writing and researching alone. Using state templates or a licensing kit reduces this to 10 to 20 hours of customization. Factor in legal review time and staff training on the final policies before your license survey.

Do I need a lawyer to review my policies?

It's highly advisable. An attorney experienced in healthcare or senior care licensing can spot gaps, ensure statutory compliance, and flag language that might expose you to liability. Budget $1,500 to $3,500 for a full manual review, or use a consultant who specializes in assisted living policy development.

How often must I update policies?

Most states require annual policy reviews. You must also update immediately when regulations change, after serious incidents that reveal policy gaps, or when your operational practices shift. Document every review and revision with dates and a brief description of changes made.

Can I use another facility's policies?

You can use them as a reference or template, but you must customize every section to reflect your facility's actual practices, staffing, license type, and state regulations. Copying verbatim is risky: the other facility might operate in a different state, hold a different license class, or have procedures you can't execute. Surveyors will ask you to demonstrate that you follow your written policies.

What happens if my policies don't match my actual practices?

You'll be cited during a state survey. Surveyors audit resident records, observe care, and interview staff, then compare what they see to your written policies. Discrepancies (e.g., policy says monthly care plan reviews but files show six-month gaps) become deficiencies. Repeated or serious violations can lead to fines, provisional licenses, or revocation.

Do I need separate policies for dementia care?

If you market or license as a dementia or memory care unit, yes. You'll need additional policies on behavioral interventions, elopement prevention, secured perimeters, specialized staff training (often 6-12 hours dementia-specific), activity programming adapted for cognitive impairment, and family communication. Some states require a distinct license or certification for memory care.

Where do I post or store the policy manual?

Keep one master binder or digital file in the administrator's office. Provide each department or shift lead with a copy or access. Post a notice telling staff and residents where the manual is available for review. Some operators keep section summaries (e.g., a one-page medication assist checklist) laminated at med carts or in break rooms.

What is the most commonly cited policy deficiency?

Medication management inconsistencies. Surveyors frequently find missing MAR signatures, outdated physician orders, improperly stored medications, or staff assisting without documented training. A close second is incident reporting: failure to report falls, injuries, or allegations to the state within required timelines.

Sources

1. California Department of Social Services, RCFE Regulations Title 22: California RCFE facilities must have written disaster preparedness, medication assistance, and resident rights plans
2. Florida Agency for Health Care Administration, Chapter 58A-5 F.A.C.: Florida ALFs must document admissions assessment, incident reporting, staffing, infection control, and elopement policies
3. Oregon Department of Human Services, Residential Care and Assisted Living Facilities: Oregon separates Residential Care Facilities (5+ beds) from Adult Foster Homes (1-5 beds) with distinct licensing rules
4. National Center for Assisted Living, Training Requirements: Assisted living staff training requirements range from 40 to 75 hours initially, plus annual updates, varying by state
5. Genworth Cost of Care Survey 2023: Assisted living median cost is $4,500-$6,500/month nationally; nursing homes average $7,500-$10,000/month
6. Medicaid.gov, Home and Community-Based Services 1915(c) Waivers: Some Medicaid waiver programs cover assisted living for eligible low-income seniors; Medicare does not cover room and board
7. National Conference of State Legislatures, Medication Aide Certification: Some states permit certified medication assistants after 40-80 hours training to perform limited medication administration
8. CMS, Pre-Admission Screening and Resident Review (PASRR): Most states require pre-admission assessment documenting medical history, ADLs, cognitive status, and behavioral risks
9. National Center for Assisted Living, Discharge Planning Resources: Most states require 30 days written notice for discharge unless resident poses immediate threat
10. U.S. Administration for Community Living, State Long-Term Care Ombudsman Programs: States mandate reporting serious injuries, abuse allegations, and elopements to licensing agencies within 24 hours to five days
11. AHCA/NCAL, State Assisted Living Staffing Requirements: Typical state minimums: one awake caregiver per 15 residents daytime, one per 20 overnight
12. U.S. Department of Health and Human Services, OIG Exclusions Program: Medicaid-funded facilities must check OIG exclusion list before employment offers
13. CMS Emergency Preparedness Requirements, 42 CFR 483.73: CMS Emergency Preparedness Rule requires risk assessment, continuity plans, communication, and training
14. National Center for Assisted Living, Individualized Service Plans: States require individualized service plans for each resident, updated at least annually or with significant condition changes
15. OSHA, Bloodborne Pathogens Standard 29 CFR 1910.1030: OSHA Bloodborne Pathogens Standard requires hand hygiene, PPE, sharps disposal, and exposure response protocols
16. AHCA/NCAL, State Licensure Application Requirements: Most states require policy manual submission or review during pre-licensure survey for new assisted living facilities