In Part 1 of our Licensing blog series, we shared what a sober living home (SLH) actually is. We also explained other types of homes that are often confused for sober living homes, including behavioral health residential facilities (BHRF), which are also licensed by the Arizona Department of Health Services (ADHS).
In this installment of our Licensing series, we will share more information about ADHS’ role in regulating homes that require licensure as an SLH or a BHRF. We have prepared an easy to use fact sheet to help clarify some of these differences, as well.
Annual compliance inspections
ADHS has the authority to ensure SLHs and BHRFs operate in compliance with the statutes and rules that govern their licenses. We use several tools to make sure facilities stay in compliance with these rules. In fact, ADHS begins this process before a home is even licensed, by carefully reviewing and processing each application to make sure the facility meets all of the requirements before they are issued a license.
Most homes are also inspected by ADHS before they become licensed. SLHs certified by the Arizona Recovery Housing Association (AzRHA) are the one exception, as statute exempts them from this initial inspection, as well as annual compliance inspections by ADHS. All BHRFs are inspected before they become licensed; however, accredited BHRFs may be exempt from annual compliance inspections, and statute prohibits ADHS from conducting compliance inspections for 24 months if a BHRF receives a deficiency-free compliance inspection.
Although we are prevented from conducting inspections in some instances, annual compliance inspections are one of the best tools the Department has to help our licensees stay in compliance with the regulations. In fact, they are so beneficial that, earlier this year, ADHS began conducting an additional inspection within approximately 60 days of issuing a new SLH or BHRF license. The main purpose of this early touchpoint inspection is to provide technical assistance and educational guidance on applicable regulations related to the license, as well as identifying issues with new facilities quickly, rather than after they have been operating for a year.
In addition to annual compliance inspections, ADHS also completes complaint investigations. ADHS has an Online Complaint Form where anyone can share concerns about licensed facilities, or facilities they believe should be licensed. ADHS is committed to reviewing every complaint received within two business days. If the complaint contains allegations that a facility is not following a regulation that they are required to comply with to remain licensed, ADHS will assign a compliance officer to investigate.
Nearly all complaint investigations for licensed facilities involve an onsite inspection. ADHS has authority to investigate all licensed facilities for complaint investigations, even if the facility is exempt from annual compliance inspections for the reasons previously noted.
Deficiencies and enforcements
If a compliance officer identifies a deficient practice during an inspection, the licensee receives a Statement of Deficiencies (SOD), which lists the regulation that was violated and the evidence the compliance officer collected or observed. In many cases, the licensee is presented with an opportunity to correct the issues identified in the SOD by submitting a Plan of Correction (POC) to ADHS. Both the SOD and POC are public records in most cases, and are available to view for most facilities on AZCareCheck.com, after everything is finalized.
In some cases, where a licensee has been repeatedly cited for the same issue, or if the citations present a serious health and safety concern, ADHS may take enforcement action against the licensee. Enforcement actions may include fines or even revocation of the license. Completed enforcement actions are also public record for most licensees, and can be viewed on AZCareCheck.com.
ADHS also has authority to take enforcement action against some unlicensed facilities if we are able to substantiate that they are operating in a way that requires a license. For example, if we obtain evidence that a facility should be licensed as a BHRF or SLH, we can issue a cease and desist order to them. For SLHs, the order can also include fines of up to $1,000 per day that they were operating without a license. For BHRFs, the order can also include fines up to $500 for each day they were operating without a license.
Complaints outside of our authority
As you can see, ADHS uses many tools to ensure facilities have the appropriate license to conduct their business and to ensure that licensees are properly following the regulations for that license. However, there are some aspects of BHRF and SLH operations that are not regulated by their license.
ADHS does not have authority over:
- Location: We sometimes receive complaints regarding where BHRFs and SLHs are located, or regarding how many are operating in a certain area. However, where these facilities may be located is up to the local zoning jurisdiction. ADHS cannot control where these facilities are located or how many of them exist. If we receive an application for a facility that meets all regulatory requirements for licensure, we are required to issue them a license.
- Billing: ADHS also receives complaints regarding the billing practices of the facilities we license. However, billing issues are also outside of our authority to investigate. Billing issues should be reported to the resident’s insurance company, the Arizona Health Care Cost Containment System (AHCCCS), or the Arizona Department of Insurance and Financial Institutions (DIFI).
- Abuse, neglect, or exploitation: The Department also does not have authority to determine if abuse, neglect, or exploitation has happened to vulnerable adults or children. These concerns should be reported to the Arizona Department of Child Safety (DCS), or Adult Protective Services (APS) within the Arizona Department of Economic Security (DES). While ADHS does not have the authority that DCS and APS have related to these issues, we may be able to cite certain types of facilities if they do not comply with licensing requirements for reporting, documentation, and action taken when there are suspected allegations of abuse, neglect, or exploitation.
- Criminal activity: If you believe a licensed facility is involved in criminal activity, that should always be reported to law enforcement, since they have jurisdiction over those matters. ADHS does work with law enforcement, and sometimes their investigations may lead ADHS to take enforcement action against a license. However, to ensure we do not impede their investigations, these matters are investigated by law enforcement first.
To review SODs and enforcement actions for licensed facilities, please visit AZCareCheck.com.