Applications must be signed by:
1. The owner, if the applicant is an individual or partnership,
2. Two of its members, if the applicant is a limited liability company,
3. Two of its officers, if the applicant is a corporation,
4. The head of the governmental unit having jurisdiction over the facility to be licensed, if the applicant is a governmental unit.
List the names and addresses of all persons in control of the facility (do not include social security numbers or dates of birth), including:
• individual owners,
• limited liability members,
• parent companies, if any,
• members of boards of directors owning or managing the operations,
• any other persons with financial interests or investments in the facility,
• For publicly held corporations, list the stockholders who own 5% or more of the company’s stock.
The legal name of a business is the name under which the business conducts its operations. The legal name of the individual is the name that identifies a person for legal, administrative and other official purposes. Example: Licensee Name (as listed with the Secretary of State) dba Facility Name.
An Assisted Living Facility Administrator must be placed on the Registry within 6 months of working as an Administrator in an Assisted Living Facility. You can be placed on the Registry with an application and evidence of completing one of the following:
• A Department Approved Course
• At least 30 hours training with documentation that includes the date of training, number of hours, description of training, and the trainer qualifications. The training must include each of the following topics:
1. Resident care and services;
2. Social services;
3. Financial management;
5. Gerontology; and
6. Rules, regulations and standards relating to the operation of an assisted living facility
• College transcripts that include all of the above listed topics.
• Proof of a current license as a nursing home administrator
• A statement from the governing authority of the hospital that can verify administrator status.
A schematic is a simple floor plan showing room numbers and the number of beds in each room.
A bed capacity worksheet needs to be completed for all new facilities and current facilities requesting a bed increase to determine the maximum capacity for the facility based on Physical Plant Standards. The bed capacity is limited by the size of the resident rooms, the number of bathing fixtures, the number of toilet fixtures and the size of the dining room(s).
Provide documents that explain the additional care provided. Include:
1. A written statement of the Alzheimer’s special care unit’s philosophy and mission. It should reflect the needs of residents with Alzheimer’s, dementia, or related disorders.
2. The process and criteria for placement in, transfer to, or discharge from the unit
3. The process used to assess and establish the plan of care, including how the the plan of care responds and changes in response to changing conditions
4. Staff training and continuing education information
5. The physical environment and design features appropriate to support the functioning of cognitively impaired adult residents
6. Frequency and types of activities for residents
7. How families are involved and available family support programs
8. Costs of care and any additional fees
A generic email address should:
• Be accessed by more than one person at your facility
• Not change with personnel changes
• NOT use a person’s name in the email address
An example would be Administration@net.com or ABCNursingHome@AOL.com.
The Department may deem a licensee in compliance with 175 NAC 4-006 based on acceptance of accreditation as an assisted-living facility by a recognized independent accreditation body or public agency, which has standards that are at least as stringent as those of the State of Nebraska, as evidence that the assisted living facility complies with rules and regulations adopted and promulgated under the Assisted Living Facility Act.