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ALABAMA ASSISTED LIVING ADMINISTRATOR
LICENSING EXAM QUESTIONS AND DETAILED
SOLUTIONS JUST RELEASED
Exam Coverage Summary – Alabama Assisted Living Administrator (Point-Form)
Domain 1: Facility Licensing & Administration (20%)
• Definition of Assisted Living Facility (AAC 420-5-4-.01): provides residence, health supervision,
personal care to 3+ adults.
• Exemptions: Family ALF (2–3 adults, licensed before 10/1/2015, no relicensing if closed),
personally-related care for relatives, government-operated facilities.
• Facility capacity categories: Family (2–3), Group (4–16), Congregate (17+).
• Licensing requirements: separate license for each facility, permanent distinctive name, annual
renewal, notifies ADPH before changing name.
• Administrator licensing pathway: Category I (ALF only) vs. Category II (ALF + Specialty Care).
• Provisional license (9-month validity) issued after passing Section A; full license after completing
training (Cat I = 20 hr, Cat II = 30 hr) and passing Section B.
• Application packet: Notarized application, proof of age, test registration, character references,
diploma/transcript, work experience/internship verification, background disclosure, application
fee.
• Renewal: annual renewal, continuing education must be completed by the renewal date.
• Survey process: unannounced inspections by ADPH Bureau of Health Provider Standards;
categories include policies/procedures, resident care, medication admin, records, kitchen
sanitation, staff competencies, physical environment.
• Deficiency response: Plan of Correction required; serious/repeat violations lead to intermediate
restrictions; facility may use Informal Dispute Resolution (IDR) to contest deficiencies.
• Facility location restrictions: 1,000 ft from railroads, freight yards, or disposal plants (500 ft if
separated by 6-ft fence).
Domain 2: Resident Rights & Quality of Life (25%)
• Core rights (AAC 420-5-4-.01(d)): safe/decent environment, free from
abuse/neglect/exploitation, free from restraints, respect for dignity/privacy, unrestricted private
communication, manage own finances (unless guardian appointed), share room with spouse,
regular exercise/outdoor access, independent personal decisions, adequate health care,
participate in care planning, have a written care plan, access ombudsman.
• Admission rights notification: Rights explained prior to or at admission, posted in common area,
signed acknowledgment in resident‘s file.
• Resident funds management: individual account records for safekeeping; administrator must
maintain up-to-date transaction log when requested by resident/guardian.
• Right to refuse treatment: residents may reject medical/dental care except for communicable
disease control.
• Free access to common areas & to come and go freely: facility cannot impose unreasonable
restrictions on movement.
• Ombudsman access: residents have right to contact State Long-Term Care Ombudsman
confidentially.
• Advance directives: facility cannot require or refuse to allow resident to execute an Advance
Directive or DNAR order; records protected from unauthorized disclosure.
Domain 3: Resident Care, Assessment, & Service Plans (15%)
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• Pre-admission physician examination: medical exam ≤30 days before admission to determine if
resident meets admission criteria.
• Initial care plan: developed by facility in cooperation with resident/sponsor, based on physician
orders and identified needs.
• Activities of Daily Living (ADL) assistance: bathing, dressing, ambulation, feeding, toileting,
grooming, medication assistance, diet, personal safety.
• Reassessment: periodic (at least annually) or when significant change in condition; care plan
updated accordingly.
• Unsafe discharge: resident who cannot self-administer or protect from medication errors may
be discharged if not appropriate for ALF level of care.
• Transfer/discharge notice: written notice to resident/sponsor; discharge summary required.
• Incident reporting: incident investigations and reports maintained in resident file.
• Health supervision: monitoring for changes in condition, medication effectiveness, and safety.
Domain 4: Medication Management (20%)
• Prescribing requirements: medications must be prescribed specifically for resident by a licensed
prescriber (physician must be in good standing with Medical Licensure Commission).
• Self-management (self-administration): resident capable of maintaining possession, control,
and self-administering without unreasonable risk.
• Physician order required for self-management: written order from physician is required for
resident to manage and have custody of their own medications.
• Over-the-counter topical medications: resident may possess/self-administer with physician
approval; no separate prescription required.
• Assistance with self-administration (unlicensed staff): reminding, opening container, offering
liquids, physically bringing medication to resident.
• What unlicensed staff may NOT do: determining dosage (unless resident capable and directs
measurement), injections, “administration“ as defined in rules (i.e., placing medication in
mouth).
• Licensed nurse administration: RN or LPN may administer medications according to physician
orders and Nurse Practice Act.
• Resident requiring medication administration by licensed nurse: resident incapable of
recognizing name, understanding unit dose system, or protecting themselves from medication
error.
• Medication Administration Record (MAR): required for each resident who receives medication
administration or assistance; must be accurate, up-to-date.
• Storage: medications kept in secure location; refrigerated medications properly stored;
discontinued/expired medications disposed of according to regulations.
Domain 5: Environmental Safety & Physical Plant (10%)
• Location requirements: free from undue noise, smoke, dust, foul odors; zoning/building/fire
ordinances local compliance.
• Minimum bedroom square footage: if no sitting area, private room 80 sq ft, double room 130
sq ft.
• Bedrooms: must have outside window, not below grade; window area ≥ 1/8 of floor area unless
adequate alternative lighting/ventilation.
• Office space: administrative office(s) must be provided.
• Shared space: administrative, kitchen, service areas may be shared between regular ALF and
SCALF if specialty care unit is distinct.
• No commercial use: facility space cannot be used for commercial purpose not reasonably
necessary for residents.
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• Emergency exits & lighting: appropriate exit signs and emergency lighting in corridors.
• Handrails & grab bars: in corridors and bathrooms as needed for resident safety.
• Water temperature: regulated to prevent scalding.
• Refuse & hazardous material storage: proper storage, pest control, ventilation.
Domain 6: Fire Safety & Emergency Preparedness (15%)
• Written fire safety, relocation & evacuation plan: current plan maintained in all facilities.
• Fire alarm system: corridor smoke detection required (or smoke detectors in each room plus
open areas); connected to facility‘s fire alarm.
• Sprinkler system: must comply with currently adopted Life Safety Code.
• Fire drills: conducted at least once per month; quarterly on each shift for Group and Congregate
facilities; drills involve actual evacuation to adjacent smoke compartment or exterior.
• Night drills (9 PM – 6 AM): coded announcement instead of audible alarm; may simulate with
mannequins/empty wheelchairs.
• Outages: fire alarm/sprinkler outage >4 hours requires evacuation or continuous fire watch;
report to ADPH within 12 hours or next duty day.
• Inspection frequency: fire alarm and sprinkler systems inspected semiannually; reports kept ≥3
years.
• Alcohol-based hand rub dispensers: must minimize leaks/spills, prevent inappropriate access,
comply with Life Safety Code.
• Roller latches: prohibited on doors separating corridors from adjacent spaces.
• Emergency supplies: sufficient food, water, medications for at least 72 hours (generally
expected for emergency preparedness).
• Emergency power: emergency generator or alternative power source for life safety systems.
Domain 7: Infection Control & Sanitation (10%)
• Hand hygiene: alcohol-based hand rub allowed if dispensers meet fire safety requirements;
soap and water must be available.
• Communicable disease control: facility must have policies for isolation, reporting to ADPH, and
handling outbreaks.
• Food service sanitation: kitchen and dining areas inspected; compliance with state sanitation
codes.
• Laundry: separate handling of clean and soiled linen; adequate laundry facilities or contracted
service.
• Housekeeping: clean, sanitary, orderly environment; pest control program.
• Ventilation: adequate fresh air and temperature control.
• Waste disposal: proper handling of medical waste and general refuse.
• Reporting of reportable diseases: administrator must report to ADPH as required.
Domain 8: Personnel & Staff Training (10%)
• Administrator responsibilities: direct representative of governing authority, responsible for
proper performance of duties, compliance with regulations.
• Staff orientation: all new staff must receive orientation to facility policies, resident rights, fire
safety, infection control, emergency procedures.
• Ongoing in-service training: staff must receive regular training on assigned duties.
• Criminal background check: Level 2 background screening required for all staff who provide
direct care or have access to residents or resident funds.
• Competency verification: facility must ensure that each staff member is capable of performing
assigned tasks (e.g., medication assistance, transfer techniques).
• Minimum age for administrator: at least 19 years old.
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• Education/experience pathways: high school diploma/GED + 2 years experience (admin + direct
care), OR 60 semester college credits + 3 months experience OR 240-hour internship.
• Continuing education (CE): required for license renewal; hours determined by Board.
Domain 9: Resident Records & Documentation (10%)
• Required documents in resident file: statement of resident rights signed by resident, financial
agreement, inventory of personal effects, admission record, incident reports, advance
directives/DNAR if executed.
• Financial records: individual account ledger if facility holds resident funds.
• Medical records: must be maintained confidential, accessible to ADPH surveyors.
• Incident reporting: facility must maintain written incident investigations and reports.
• Emergency contact information: current information for each resident.
• Physician orders: must be current, signed by prescriber, and available to staff
administering/assisting with medications.
• Care plan: written, individualized, updated as needed, accessible to staff providing care.
• Record retention: records must be retained as required by law (typically at least 5 years after
discharge; varies by record type).
Domain 10: Business Operations & Governance (10%)
• Governing authority: administrator responsible to governing authority for facility operations.
• Financial agreement: written agreement between resident/sponsor and facility specifying
services provided and fees charged.
• Admissions agreement: must include rights, responsibilities, financial terms, refund policy,
discharge/transfer conditions.
• Fee setting: facility sets its own rates; must provide written notice of fee changes to
residents/sponsor.
• Resident trust funds: if facility holds funds, individual account records required, administrator
must account for all transactions.
• Billing & collections: facility may have policies for late payments, missed payments, returned
checks.
• Sales tax & exemptions: some resident services may be tax-exempt; administrator must follow
state tax laws.
• Workers’ compensation: facility must carry workers‘ compensation insurance for employees.
• Liability insurance: facility must maintain general liability insurance appropriate for its size and
services.
Domain 11: Residents‘ Rights (Rights already covered under Domain 2, but repeated for emphasis)
• Right to be free from abuse, neglect, exploitation, restraints (chemical or physical) – abuse
includes mental, physical, sexual, verbal.
• Right to privacy, dignity, and respect.
• Right to manage own financial affairs unless court-appointed guardian.
• Right to share a room with spouse if both agree.
• Right to regular exercise and being outdoors.
• Right to participate in social, religious, community activities.
• Right to access Ombudsman and file complaints without retaliation.
• Right to refuse treatment (except communicable disease control).
• Right to advance care planning (Advance Directive, DNAR).
• Right to have visitor at any reasonable time.
• Right to receive unopened mail and make private telephone calls.
ALABAMA ASSISTED LIVING ADMINISTRATOR
LICENSING EXAM QUESTIONS AND DETAILED
SOLUTIONS JUST RELEASED
Exam Coverage Summary – Alabama Assisted Living Administrator (Point-Form)
Domain 1: Facility Licensing & Administration (20%)
• Definition of Assisted Living Facility (AAC 420-5-4-.01): provides residence, health supervision,
personal care to 3+ adults.
• Exemptions: Family ALF (2–3 adults, licensed before 10/1/2015, no relicensing if closed),
personally-related care for relatives, government-operated facilities.
• Facility capacity categories: Family (2–3), Group (4–16), Congregate (17+).
• Licensing requirements: separate license for each facility, permanent distinctive name, annual
renewal, notifies ADPH before changing name.
• Administrator licensing pathway: Category I (ALF only) vs. Category II (ALF + Specialty Care).
• Provisional license (9-month validity) issued after passing Section A; full license after completing
training (Cat I = 20 hr, Cat II = 30 hr) and passing Section B.
• Application packet: Notarized application, proof of age, test registration, character references,
diploma/transcript, work experience/internship verification, background disclosure, application
fee.
• Renewal: annual renewal, continuing education must be completed by the renewal date.
• Survey process: unannounced inspections by ADPH Bureau of Health Provider Standards;
categories include policies/procedures, resident care, medication admin, records, kitchen
sanitation, staff competencies, physical environment.
• Deficiency response: Plan of Correction required; serious/repeat violations lead to intermediate
restrictions; facility may use Informal Dispute Resolution (IDR) to contest deficiencies.
• Facility location restrictions: 1,000 ft from railroads, freight yards, or disposal plants (500 ft if
separated by 6-ft fence).
Domain 2: Resident Rights & Quality of Life (25%)
• Core rights (AAC 420-5-4-.01(d)): safe/decent environment, free from
abuse/neglect/exploitation, free from restraints, respect for dignity/privacy, unrestricted private
communication, manage own finances (unless guardian appointed), share room with spouse,
regular exercise/outdoor access, independent personal decisions, adequate health care,
participate in care planning, have a written care plan, access ombudsman.
• Admission rights notification: Rights explained prior to or at admission, posted in common area,
signed acknowledgment in resident‘s file.
• Resident funds management: individual account records for safekeeping; administrator must
maintain up-to-date transaction log when requested by resident/guardian.
• Right to refuse treatment: residents may reject medical/dental care except for communicable
disease control.
• Free access to common areas & to come and go freely: facility cannot impose unreasonable
restrictions on movement.
• Ombudsman access: residents have right to contact State Long-Term Care Ombudsman
confidentially.
• Advance directives: facility cannot require or refuse to allow resident to execute an Advance
Directive or DNAR order; records protected from unauthorized disclosure.
Domain 3: Resident Care, Assessment, & Service Plans (15%)
, Page 2 of 140
• Pre-admission physician examination: medical exam ≤30 days before admission to determine if
resident meets admission criteria.
• Initial care plan: developed by facility in cooperation with resident/sponsor, based on physician
orders and identified needs.
• Activities of Daily Living (ADL) assistance: bathing, dressing, ambulation, feeding, toileting,
grooming, medication assistance, diet, personal safety.
• Reassessment: periodic (at least annually) or when significant change in condition; care plan
updated accordingly.
• Unsafe discharge: resident who cannot self-administer or protect from medication errors may
be discharged if not appropriate for ALF level of care.
• Transfer/discharge notice: written notice to resident/sponsor; discharge summary required.
• Incident reporting: incident investigations and reports maintained in resident file.
• Health supervision: monitoring for changes in condition, medication effectiveness, and safety.
Domain 4: Medication Management (20%)
• Prescribing requirements: medications must be prescribed specifically for resident by a licensed
prescriber (physician must be in good standing with Medical Licensure Commission).
• Self-management (self-administration): resident capable of maintaining possession, control,
and self-administering without unreasonable risk.
• Physician order required for self-management: written order from physician is required for
resident to manage and have custody of their own medications.
• Over-the-counter topical medications: resident may possess/self-administer with physician
approval; no separate prescription required.
• Assistance with self-administration (unlicensed staff): reminding, opening container, offering
liquids, physically bringing medication to resident.
• What unlicensed staff may NOT do: determining dosage (unless resident capable and directs
measurement), injections, “administration“ as defined in rules (i.e., placing medication in
mouth).
• Licensed nurse administration: RN or LPN may administer medications according to physician
orders and Nurse Practice Act.
• Resident requiring medication administration by licensed nurse: resident incapable of
recognizing name, understanding unit dose system, or protecting themselves from medication
error.
• Medication Administration Record (MAR): required for each resident who receives medication
administration or assistance; must be accurate, up-to-date.
• Storage: medications kept in secure location; refrigerated medications properly stored;
discontinued/expired medications disposed of according to regulations.
Domain 5: Environmental Safety & Physical Plant (10%)
• Location requirements: free from undue noise, smoke, dust, foul odors; zoning/building/fire
ordinances local compliance.
• Minimum bedroom square footage: if no sitting area, private room 80 sq ft, double room 130
sq ft.
• Bedrooms: must have outside window, not below grade; window area ≥ 1/8 of floor area unless
adequate alternative lighting/ventilation.
• Office space: administrative office(s) must be provided.
• Shared space: administrative, kitchen, service areas may be shared between regular ALF and
SCALF if specialty care unit is distinct.
• No commercial use: facility space cannot be used for commercial purpose not reasonably
necessary for residents.
, Page 3 of 140
• Emergency exits & lighting: appropriate exit signs and emergency lighting in corridors.
• Handrails & grab bars: in corridors and bathrooms as needed for resident safety.
• Water temperature: regulated to prevent scalding.
• Refuse & hazardous material storage: proper storage, pest control, ventilation.
Domain 6: Fire Safety & Emergency Preparedness (15%)
• Written fire safety, relocation & evacuation plan: current plan maintained in all facilities.
• Fire alarm system: corridor smoke detection required (or smoke detectors in each room plus
open areas); connected to facility‘s fire alarm.
• Sprinkler system: must comply with currently adopted Life Safety Code.
• Fire drills: conducted at least once per month; quarterly on each shift for Group and Congregate
facilities; drills involve actual evacuation to adjacent smoke compartment or exterior.
• Night drills (9 PM – 6 AM): coded announcement instead of audible alarm; may simulate with
mannequins/empty wheelchairs.
• Outages: fire alarm/sprinkler outage >4 hours requires evacuation or continuous fire watch;
report to ADPH within 12 hours or next duty day.
• Inspection frequency: fire alarm and sprinkler systems inspected semiannually; reports kept ≥3
years.
• Alcohol-based hand rub dispensers: must minimize leaks/spills, prevent inappropriate access,
comply with Life Safety Code.
• Roller latches: prohibited on doors separating corridors from adjacent spaces.
• Emergency supplies: sufficient food, water, medications for at least 72 hours (generally
expected for emergency preparedness).
• Emergency power: emergency generator or alternative power source for life safety systems.
Domain 7: Infection Control & Sanitation (10%)
• Hand hygiene: alcohol-based hand rub allowed if dispensers meet fire safety requirements;
soap and water must be available.
• Communicable disease control: facility must have policies for isolation, reporting to ADPH, and
handling outbreaks.
• Food service sanitation: kitchen and dining areas inspected; compliance with state sanitation
codes.
• Laundry: separate handling of clean and soiled linen; adequate laundry facilities or contracted
service.
• Housekeeping: clean, sanitary, orderly environment; pest control program.
• Ventilation: adequate fresh air and temperature control.
• Waste disposal: proper handling of medical waste and general refuse.
• Reporting of reportable diseases: administrator must report to ADPH as required.
Domain 8: Personnel & Staff Training (10%)
• Administrator responsibilities: direct representative of governing authority, responsible for
proper performance of duties, compliance with regulations.
• Staff orientation: all new staff must receive orientation to facility policies, resident rights, fire
safety, infection control, emergency procedures.
• Ongoing in-service training: staff must receive regular training on assigned duties.
• Criminal background check: Level 2 background screening required for all staff who provide
direct care or have access to residents or resident funds.
• Competency verification: facility must ensure that each staff member is capable of performing
assigned tasks (e.g., medication assistance, transfer techniques).
• Minimum age for administrator: at least 19 years old.
, Page 4 of 140
• Education/experience pathways: high school diploma/GED + 2 years experience (admin + direct
care), OR 60 semester college credits + 3 months experience OR 240-hour internship.
• Continuing education (CE): required for license renewal; hours determined by Board.
Domain 9: Resident Records & Documentation (10%)
• Required documents in resident file: statement of resident rights signed by resident, financial
agreement, inventory of personal effects, admission record, incident reports, advance
directives/DNAR if executed.
• Financial records: individual account ledger if facility holds resident funds.
• Medical records: must be maintained confidential, accessible to ADPH surveyors.
• Incident reporting: facility must maintain written incident investigations and reports.
• Emergency contact information: current information for each resident.
• Physician orders: must be current, signed by prescriber, and available to staff
administering/assisting with medications.
• Care plan: written, individualized, updated as needed, accessible to staff providing care.
• Record retention: records must be retained as required by law (typically at least 5 years after
discharge; varies by record type).
Domain 10: Business Operations & Governance (10%)
• Governing authority: administrator responsible to governing authority for facility operations.
• Financial agreement: written agreement between resident/sponsor and facility specifying
services provided and fees charged.
• Admissions agreement: must include rights, responsibilities, financial terms, refund policy,
discharge/transfer conditions.
• Fee setting: facility sets its own rates; must provide written notice of fee changes to
residents/sponsor.
• Resident trust funds: if facility holds funds, individual account records required, administrator
must account for all transactions.
• Billing & collections: facility may have policies for late payments, missed payments, returned
checks.
• Sales tax & exemptions: some resident services may be tax-exempt; administrator must follow
state tax laws.
• Workers’ compensation: facility must carry workers‘ compensation insurance for employees.
• Liability insurance: facility must maintain general liability insurance appropriate for its size and
services.
Domain 11: Residents‘ Rights (Rights already covered under Domain 2, but repeated for emphasis)
• Right to be free from abuse, neglect, exploitation, restraints (chemical or physical) – abuse
includes mental, physical, sexual, verbal.
• Right to privacy, dignity, and respect.
• Right to manage own financial affairs unless court-appointed guardian.
• Right to share a room with spouse if both agree.
• Right to regular exercise and being outdoors.
• Right to participate in social, religious, community activities.
• Right to access Ombudsman and file complaints without retaliation.
• Right to refuse treatment (except communicable disease control).
• Right to advance care planning (Advance Directive, DNAR).
• Right to have visitor at any reasonable time.
• Right to receive unopened mail and make private telephone calls.
