3701-16-03 License application and renewal procedures.

(A) Application for a license to operate a community alternative home shall be made by the operator to the director on a form prescribed and provided by the director, which shall include the following items:

(1) A statement of ownership containing the following information:

(a) If the operator is an individual, his or her name, address, telephone number, business address, business telephone number, and occupation. If the operator is an association, corporation, or partnership, the business activity, address, and telephone number of the entity and the name of every person who has an ownership interest of five per cent or more in the entity;

(b) If the operator does not own the building or if he or she owns only part of the building in which the community alternative home is housed, the name of each person who has an ownership interest of five per cent or more in the building;

(c) The name and address of any community alternative home and any facility described in divisions (B)(1) to (B)(4) of section 3724.01 of the Revised Code and paragraphs (H)(1) to (H)(5) of rule 3701-16-01 of the Administrative Code in which the operator has an ownership interest of five per cent or more;

(d) The identity of the residence manager of the community alternative home, if different from the operator;

(e) The name and address of any community alternative home and any facility described in divisions (B)(1) to (B)(4) of section 3724.01 of the Revised Code and paragraphs (H)(1) to (H)(5) of rule 3701-16-01 of the Administrative Code with which either the operator or residence manager has been affiliated through ownership or employment in the five years prior to the date of application;

(f) The names, addresses, and telephone numbers of three persons not employed by or associated in business with the operator who will provide information about the character, reputation, and competence of the operator and the residence manager and the financial responsibility of the operator;

(g) Information about any conviction of the operator or residence manager for a felony or crime involving moral turpitude, or any arrest or adjudication or conviction of a criminal offense related to the provision of care, or which bears a substantial relationship to the position of operator or residence manager, in a community alternative home or any facility described in divisions (B)(1) to (B)(4) of section 3724.01 of the Revised Code and paragraphs (H)(1) to (H)(5) of rule 3701-16-01 of the Administrative Code; and

(h) Any other information the director may require regarding the operator’s ability to operate the home including, but not limited to, the names, ages, and work hours of employees, including the residence manager; the residence manager’s training and educational background and work experience, the number of residents and identification of previous or current licenses or similar approvals held;

(2) Evidence and documentation that the home meets the fire safety standards required by rule 3701-16-10 of the Administrative Code, and has been inspected and approved within the preceding year by an electrical safety inspector certified pursuant to Chapter 3783. of the Revised Code;

(3) Evidence and documentation that the home complies with local zoning regulations;

(4) If applicable, evidence and documentation that the home has a valid food service license issued under Chapter 3732. of the Revised Code;

(5) Evidence and documentation of policies developed for infection control and education of caregivers about acquired immune deficiency syndrome (AIDS) as required by division (A)(7) of section 3724.03 of the Revised Code and paragraph (H)(3) of rule 3701-16-13 of the Administrative Code;

(6) Evidence and documentation of all applicable inspections, approvals, permits, and licenses required by Chapter 3701-16 of the Administrative Code;

(B) A community alternative home applying for a permanent license at the same time as a temporary license or before its temporary license expires shall notify the director in writing of its intentions. The home also shall provide the director with any additional information necessary for review of its permanent license application, but it need not file a second application form.

(C) A person seeking renewal of a community alternative home license shall submit to the director an application for renewal, on a form prescribed and provided by the director, which shall include the following items:

(1) The name, address, and telephone number of the community alternative home;

(2) The number of residents residing in the home and the maximum occupancy of the home as of the date the applicant submits the application for renewal;

(3) Any changes to the information required by paragraph (A) of rule 3701-16-03 of the Administrative Code, unless the department was notified of the changes under paragraph (A) of rule 3701-16-09 of the Administrative Code;

(4) If alterations have been made to the structure of the building or buildings housing the community alternative home since the facility most recently was licensed, information relating to changes in that structure;

(5) If the electrical wiring has been altered, proof that the alteration has been inspected and approved by an electrical safety inspector certified pursuant to Chapter 3783. of the Revised Code;

(6) Copies of documentation of any inspections, permits, or approvals of the home’s private water system or household sewage disposal system that may be required by rule 3701-16-11 of the Administrative Code since the facility’s most recent license was issued;

(7) Any other information the director may require regarding the operator’s ability to operate the facility.

(D) An application for licensure or license renewal shall be accompanied by both of the following:

(1) A non-refundable license application fee of twenty-five dollars in the form of a cashier’s check or a postal money order payable to the “Treasurer, State of Ohio.” If a community alternative home files an application for a permanent license at the same time as a temporary license or before the temporary license expires, the home is not required to pay an additional license application fee for the permanent license application; and

(2) A statement signed by the operator, and included in the application, certifying that, to the best of his or her knowledge, the information in the application and any accompanying material is true and accurate. If a representative signs the statement, he or she shall include documentation that he or she is the authorized representative of the operator.

(E) The director may request any additional information he or she determines to be necessary to assess compliance with the applicable criteria, standards, and requirements established by Chapter 3724. of the Revised Code and Chapter 3701-16 of the Administrative Code. The applicant shall submit any additional information requested by the director within sixty days of the director’s request.

R.C. 119.032 review dates: 01/09/2009 and 01/01/2014

Promulgated Under: 119.03

Statutory Authority: 3724.05

Rule Amplifies: 3724.03

Prior Effective Dates: 8/29/1988 (Emer.), 11/27/94, 2/13/99