@Account Closed - read your state regs - a lot of your answers are there - in KS is my experience - our regs can be somewhat vague - we've found it's best to mimic some of what the regs are for SNF's to be safe. KS has had a # of SNF and AL owners expanding too quickly and letting their homes go into receivership so they've been cracking down on their survey process more recently which is actually a good thing.
IMO in 2 yrs of helping run ours - it's all people driven - have a great staff, a great reputation, keep up your marketing and most importantly TREAT people RIGHT - you can be successful. I think like in most businesses, owners do not understand the people side. Not saying I'm an expert by any means but I try to put everyone there before me and most importantly get out of their way and let them do their jobs. Residents also like it when ownership interacts with them and listens to their concerns/opinions as well. It's taken up until this point to feel better about things - had a vision for where we were going - it's just taken a while to get there as we had so many basic infrastructure things we had to fix. Chicken or the egg argument often came up in this thought process.
(If you're launching from scratch - your executive director will make or break you - find him/her - treat them very well and get the most qualified person on board - however if you're only doing a 12 or 16 room home plus there wont be much room to pay them well - if you had 2 up and going you could pay them close to market and give them profit sharing. I haven't launched one from scratch yet but was close to pulling the trigger this year however did not - My hypothesis is whomever you build out your team with to launch will make or break you. Watched an experienced owner of a larger scale facility go through the same issues from afar on a Wichita new construction build).