DAL#: 18-13: Adult Care Facilities Resident Safety Plan Checklist DOH-5265

June 5, 2018

DAL#: 18-13: Adult Care Facilities Resident Safety Plan Checklist DOH-5265

Dear Administrator:

This Dear Administrator Letter (DAL) replaces HCBS 08-11, "Renovations" previously issued February 12, 2008". As such, Adult Care Facilities are required to notify their regional office of any renovations to their facility that may disrupt services or potentially impact the safety of their residents and are required to submit a safety plan for review and approval by the Regional Office prior to the start of those renovations. These requirements are outlined in regulations found at 18 NYCRR Section 485.5(f), and specifically state, "No operator shall change or modify a facility, or the services originally approved and stipulated by the operating certificate, without prior written approval of the department", and 487.11(b) "An operator seeking certification to operate an adult home, or an operator of a certified facility planning renovation or remodeling, must: (1) submit to the department, in duplicate, plans and specifications for construction, renovation or building addition; and (2) proceed with implementation of such plan only after obtaining written approval of the department".

To streamline the process, the Division of Adult Care Facility and Assisted Living Surveillance has developed a standardized Resident Safety Plan Checklist for use by adult care facilities. The form, which must be completed in its entirety, will allow operators to submit the required information through the use of an electronic fillable form. To access the new Resident Safety Plan Checklist, please visit the Department's website at the following address at https://www.health.ny.gov/facilities/adult_care/forms.htm

Once completed, the Resident Safety Plan Checklist should be submitted to your Regional Office using the addresses below.

Patricia Hasan
Capital District Regional Office
875 Central Avenue
Albany, NY 12206
(518) 408-5287
John VanDyke
Central New York Regional Office
217 South Salina Street, 4th floor
Syracuse, NY 13202
(315) 477-8472
Bobbie Barrington
Metropolitan Area Regional Office
90 Church Street, 15th floor
New York, NY 10007
(212) 417-4440
Norine Nickason
Western Regional Office
335 East Main Street, 1st floor
Rochester, NY 14604
(585) 423-8185

Thank you for your ongoing cooperation with our efforts to protect the safety of residents in adult care facilities across New York State.


Valerie A. Deetz, Director
Division of Adult Care Facility and Assisted Living Surveillance


cc: B. Barrington
J. Pinto
J. VanDyke
P. Hasan
N. Nickason
H. Seney
L. O'Connell