What department must provide approval for construction changes during a facility's development?

The correct answer is that the Department of Health Services Regulation must provide approval for construction changes during a facility's development. This department is responsible for overseeing and ensuring that healthcare facilities, including nursing homes, meet state and federal regulations related to construction and operational standards. Their review process often involves assessing plans to ensure that they comply with health and safety codes, which are essential for the protection and welfare of residents.

While other departments, such as the local health department or the fire safety department, might play roles in the overall development process, their functions are typically more focused on specific areas rather than comprehensive oversight of facility construction. The environmental health department may address aspects of sanitation and public health, but the ultimate authority regarding the approval of changes in construction falls under the jurisdiction of the Department of Health Services Regulation. This aligns with their responsibility to maintain standards that impact the quality of care provided in these facilities.