Residential
Care Facility
Class 2 New
Operator
Training
Presenters: Roma Barickman, Emylynn
Marhulik and Sue Tafrate
Welcome and Introductions
• Introduction of Trainers
• How many people here have owned a group home for
more than a year?
• How many people have owned a group home for less
than a year?
• How many people have a home but have not opened
yet?
• How many people are just starting out in this process?
Types of Residential
Facilities
• Class 1 – Owned/operated by a Behavioral Health
Provider
: provide accommodations, supervision, personal
care services, and mental health services for one or
more unrelated adults with mental illness or one or more
unrelated children or adolescents with severe emotional
disturbances.
• Class 2 – provides accommodations, supervision, and
personal care services to any of the following: One or
two unrelated persons with mental illness; One or two
unrelated adults who are receiving residential state
supplement payments; or, Three to sixteen unrelated
adults.
• Class 3 – provides room and board for five or more
unrelated adults with mental illness.
What is a Residential
Facility Class 2:
Residential Facility Class 2’s are residential facilities licensed
by OhioMHAS for the purpose of providing
accommodations, supervision and personal care services to
unrelated adults.
Facilities receive a two-year license to operate after
complying with the statutory requirements prescribed in the
Ohio Revised Code and the rules set forth in the Ohio
Administrative Code. Homes must have a license prior to
accepting residents.
Operators must undergo a comprehensive onsite inspection
of the home during which OhioMHAS surveyors verify the
safe and sanitary condition of the facility, the capability of
the operator and staff to meet their responsibilities in
providing supervision and personal care services and the
appropriateness of the placement of each resident.
Lawrence
7
Meigs
1
Gallia
Washington
2
Monroe
1
Scioto
3
Adams
10
Brown
1
Clermont
10
Hamilton
95
Butler
4
Warren
2
Clinton
Highland
1
Pike
2
Jackson
Ross
5
Vinton
Athens
Preble
1
Greene
1
Fayette
2
Madison
3
Clark
3
Miami
3
Darke Champaign
Franklin
46
Pickaway
4
Fairfield
10
Hocking
Mercer Auglaize
Shelby
1
Logan
Union
Hardin
Allen
Van Wert
Paulding
Putnam Hancock
Wyandot
Marion
Delaware
4
Morrow
Seneca
2
Sandusky
1
Ottawa
2
Lucas
107
Fulton
Williams
1
Henry Wood
7
Defiance
Erie
Huron
1
Lorain
17
Ashland
5
Wayne
5
Medina
6
Cuyahoga
341
Summit
51
Knox
Holmes
2
Licking
3
Coshocton
2
Muskingum
6
Tuscarawas
2
Guernsey
2
Perry
Morgan
Noble
B elmont
2
Harrison
Carroll
3
Columbiana
8
Stark
61
Portage
5
Mahoning
14
Trumbull
10
Ashtabula
6
Geauga
5
Lake
8
Number of Adult Care
Facilities in each County
As of July 2019,
951 OhioMHAS
Licensed Class 2
Residential Facilities
List of Licensed Adult Care Facilities:
http://mha.ohio.gov/Default.aspx?tabid=333
Population Who Lives in
Residential Facility Class 2
• Many of the people living in these homes have
a mental health diagnosis, or co-occurring
mental health/substance abuse histories or are
elderly.
• People who need accommodation, supervision
and personal care. Typically offer support and
assistance with daily living skills.
• Individuals who without this level of support
would be homeless, inappropriately residing in
nursing homes, extended hospital stays, or
would be incarcerated.
Assistance Required for
Residents
• Each resident must have a bed and area for personal
belongings (no more than 2 residents per room).
• Arrange transportation for those residents that need to
got for shopping and errands.
• Prepare and serve 3 nutritious, well balanced meals and
snacks (according to the dietary needs of each resident).
• Make laundry services available.
• Assistance with ADL’s. Help with walking, moving,
bathing, dressing, undressing, going to the toilet,
brushing teeth, hair care, nail care and eating.
• Provide reminders to take medication and assistance
with self administration of medication.
Administrative and
Operational Considerations
• Create a mission statement:
– What is your purpose, who are you serving, what
sets up apart from other Residential Facilities?
• Physical Property:
– Is it a safe location? Is public transportation nearby?
Are mental and medical health services nearby?
• Building and Zoning
• Average Business Startup Costs
Opening a Facility
POTENTIAL STARTUP EXPENSES
(assuming a 3-bed home)
Residential Facility Class 2 License Fee $75
Business checking account, initial deposit plus cost of checks $25-$75
Certificate of Use & Occupancy $60
Zoning or Permit applications and requirements, such as fire inspection
costs, adding smoke detectors, adding fire extinguishers
$1250-$2000
Supplies for your home and office (2 bed linens/resident, blankets, pillows,
towels, toiletries, cleaning supplies, copy paper, note pad, pens, file folders,
file cabinet)
$300-$500
Bedroom furniture (bed, nightstand, dresser) and initial food supply for 3
residents.
$1200-$1900
Mortgage or rent payments (varies greatly) $600-$1200
Utilities, gas, electric, water (varies greatly)
$175-$300
Business Plan Development
• The business plan is a roadmap for your
business growth and success. It does
not need to be long and elaborate, but
it does need to include your revenues
and expenses so that you can establish
and grow your business. The plan can
also serve as your business budget.
Business Start Up
• Select Your Business Name
• Determine Your Business Legal Structure (see page 16 in
manual)
– Sole Proprietorship
– Partnership
– Limited Liability Company (LLC)
– C-Corporation
– S-Corporation
– Nonprofit Corporation
Business Start Up
• Obtain Your Employer Identification Number (EIN)
• Register Your Business Name
• Open a Business Bank Account
• Obtain Adequate Insurance
– Automobile insurance, Homeowner’s Insurance,
General Liability Insurance, Health Insurance,
Worker’s Compensation Insurance
• Obtain OhioMHAS OAKS Vendor ID Number
Organize Your Business
• Filing System
– Financial Records: Manual Entry Booking Tool, Resident Invoices and
Payments Summary report, 12 months Income and Expense
Projections, Asset and Liability Statement, Statement of Projected
Revenues and Expenses.
– Regulatory Files: Copy of Rules and Regulations, Copy of License, Copy
of Licensure Application, Protocol of Psychiatric and Medical
Emergencies, Required Inspection Schedule (Smoke detectors, Fire
Drills, Electrical & Heating Systems), Copies of electrical, fire and
heating system inspections, Staff Qualification Form, Required training
certificates for each employee, Resident Rights and Grievance
Procedure, Certificate of Use and Occupancy (if applicable), Personnel
Policy and Job Descriptions, Employee Screening & Training, Meal
Planning Policy and Emergency Disaster Plan
Organize Your Business
– Resident Files: Resident Information Form, Resident
Agreement, Resident Personal Care Plan, Provision of
Personal Care Services Weekly Progress Notes,
Resident Medical Emergency Protocol, Resident
Psychiatric Emergency Protocol, Medication
Observation Record Form, Resident Rights, Policy,
Procedure Acknowledgement Form (signed by the
resident).
– Employee Files: Job description, Completed
Employment Application, Reference for Background
Checks, Completed BCI, Results of TB Test, 1-9 and
W-4 Tax Forms, Training Certificates.
– Your can find many of these forms as attachments to
the back of your manual.
Staffing: Essential Skills
Finding talented people with the right
skills and experience is essential. But also
consider finding people with the right
character traits, Do they have a passion
for working with this population? What
are their attitudes and beliefs? Do those
attitudes and beliefs align with your
mission statement?
Staffing
• Conduct a Background Check: Certain offenses disqualify applicants
(murder, assault and abuse crimes).
• All staff must have CPR and First Aid Certification.
• The manager and each staff person must complete a general
orientation in caring for persons diagnosed with mental illness as well
as how to access local mental health crisis and emergency services
related to mental illness.
• The manager and each staff person must complete an initial and
annual mental health training (6 hours).
• All staff must complete training in Personal Care and Self
Administration of Medication every 2 years.
• You can find more information about staffing on pages 27-29 of the
Manual.
Payroll
• Decide on a fair wage (hourly or salary)- please see Ohio
minimum wage rules.
• Payroll Taxes- FICA Taxes (Medicare and Social Security)
and Federal Unemployment Insurance Tax.
• IRS Form W-4
• I-9 Employment Eligibility Verification Form
• Other Employer Taxes: State Unemployment Tax Act
(FUTA), State/Local Income Tax, Workers
Compensation.
• When Do I Pay Myself: Typically, owners of small
businesses pay themselves after all their workers have
been paid and after all of their business expenses have
been paid.
Business Finances
• Collecting Resident Payments:
– RSS- Ohio Residential State Supplement
– SSI- Supplemental Security Income
– SSDI- Social Security Disability Income
• Monthly Expenses:
– Rent/Mortgage, Employees, Cable/Internet/Phone,
Gas/Electric/Water, Minor Repairs, Resident Food
Basics on Licensure
• What is licensure?
– Residential facilities require licensure by the Ohio
Department of Mental Health & Addiction Services
(OhioMHAS) if they operate a publicly or privately
operated home or facility serving individuals with
mental illness.
• How often do you have to renew?
– Residential facilities are licensed every two years.
• Inspection basics
– Surveyor Checklist: https://mha.ohio.gov/Health-
Professionals/Licensure-and-Certification/Residential-
Programs-non-SUD
• Trainings
Getting Your Home
Licensed
• Application: https://mha.ohio.gov/Health-Professionals/Licensure-and-
Certification/Residential-Programs-non-SUD
• License fee of $75.00
• Contact the Department of Building and Zoning Services (your local
Building and Zoning Offices)
– Obtain a certificate of zoning clearance or zoning letter (if
applicable)
– Request a certificate of use and occupancy (sometimes called a
Certificate of Use or Certificate of Appropriateness, if applicable).
• Approved inspections:
https://mha.ohio.gov/Portals/0/assets/AboutUs/Regulation/Rules/5122
-30-11.pdf
Getting Your Home
Licensed
• On-site inspection by the department.
• Required Forms and Documents.
• BCI for all staff.
• Initial and annual mental health training for all staff if
you are going to take in any resident with a mental
health diagnosis.
• Personal Care Training and Self Administration of
Medication Training.
• First Aid and CPR Certification.
• This list is not all inclusive, please refer to the surveyor
checklist to help guide you through the application
process.
Marketing
• Brochure/Flyer
• Website
• Social Media
• OACFA Housing Locator
Where Do I Find Residents?
• You are responsible for getting your own clients. There are no
referrals from OhioMHAS.
• Potential Sources: Local Alcohol, Drug Addiction and Mental
Health (ADAMH) Boards, Mental Health Service Providers,
Discharge Planners of Local Hospitals, Nursing Homes and
Healthcare Facilities, Area Agencies on Aging (AAA), Centers
for Independent Living, Departments of Social Services,
Vocational Rehabilitation Providers.
Ohio Adult Care
Facilities Association
• Help home operators to make sure they are able to provide the
best quality of care for their residents
– Provide advocacy, education, and support for home
operators
– Seek funding to help with home improvements
– Advocate on behalf of homes with the state
– Help with initial and re-certification of licensure
– $300.00 Bed Bug reimbursement
– Housing Locator (marketing tool)
• But most importantly we help give you a voice that has been
silent for too long!
Things to Consider:
• This training has focused on the Business side
of Opening an ACF, but you also have to be an
excellent Care Giver.
• Things you have to deal with on a daily basis
beyond rules. For example- client refuses
meds, preparing meals, helping solve
problems, arranging plan with case managers
and other supports, making sure the home is
clean, providing prompts when needed, and
any other issue that may arise.
Communication with a
Mentally Ill Individual
• NEVER argue: you are arguing with the illness and not
the person
• These individuals are human beings
• Make sure you give enough space when communicating
• Watch your nonverbal communication
• Always ask permission before doing something
Providing Care to Mentally
Ill Individual
• It can be difficult
• Mental illness effects mood and thoughts
• Routine is important
• Give them their autonomy
• The two most important parts of their
treatment are coffee and cigarettes (not really)
Qualities that make a Good
Operator
A good operator is physically, emotionally and mentally
capable of providing care for residents.
A good operator is responsible, mature and has a reputable
character.
A good operator has the training, education and/or
experience in the provision of care to vulnerable adults.
A good operator has the willingness to learn.
A good operator abides by the rules and regulations set
forth by the Department.
Most of all, a good operator has the capacity and
compassion to successfully provide care for residents in
their home.
Basic Principles
• Commitment to Clients – DO NO HARM
• Physical Contact
• Derogatory Language
• Clients Who Lack Decision-Making Capacity
• Right to Privacy – Confidentiality
• Disclosure of Information
• Avoid “conflict of Interest” (Appearance of…)
• Do NOT have sexual relationship with Residents
• Golden Rule should apply….
Doing What is Right
• Ethics in owning, managing and working in a Residential
Facility Class 2
• Definition:
– Ethical behavior is based on written and
unwritten codes of principles and values held in
society.
– Ethics reflect beliefs about what is right, what is
wrong, what is just, what is unjust, what is good,
and what is bad in terms of human behavior.
– Ethical principles and values serve as a guide to
behavior on a personal level, within professions, and
at the organizational level.
What do you think?
A resident overhears you say you need $25 dollars for the
grocery bill, they offer you $25 dollars as they just received
their spending money. You take the money as groceries
are costing more and they eat a lot…
Scenario #1
You are meeting your friends for a drink at a local bar. You
see one of your current residents is also there drinking at
the bar rail. They see you and come to talk with you.
Do you:
a. Ignore the resident and act like they are not there
b. Cut them off before they get to your table and tell
them to get home ASAP
c. Ask your friends if they mind going to a different place
and address concerns at a later time
d. Let them come join you and your friends to drink with
you.
Scenario #2
You have a resident with a large amount of personal spending
each month, this could affect their benefits. You are talking with
your resident about the toys your grandchildren want for
Christmas, but you are short with money due to repairs on the
facility. The resident offers you the money, and it would buy
almost everything you need.
Do you:
a. take the money as you don’t want them to lose their benefits.
b. you thank them and say that they don’t need anything anyway
c. You take them to the store and let them pay for the gifts but
put their name on the card too.
d. Thank them but do not accept the money, call their payee/
guardian to discuss options so that they are not at risk of losing
benefits.
Scenario #3
A long term resident receives a small inheritance that could
impact their benefits, the operator introduces them to life
insurance and the individual takes a policy out in which
they pay the monthly premiums leaving the operator as the
beneficiary.
Do you:
a. Thank the resident and begin planning a vacation?
b. Say nothing
c. Thank them but encourage them to explore other
options, talk with payee or family or have them talk
with an attorney? Like a funeral fund..
d. Consult with attorney, legal rights, etc.. to ensure this
is in best interest of resident.
Recommendations
Do NOT take someone else's word for it… just because
you know another operator who does something DOES
NOT MAKE it RIGHT….
Take the “higher road”
Do what minimizes harm to clients and others, and to
your person ethical values
If there are any questions, consult -consult -
consult!
Contact Us
• Susan Tafrate, OhioMHAS
– [email protected]hio.gov
• Emy-Lynn Marhulik, Ohio Adult Care
Facility Association (OACFA)
