Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-97 - Nursing homes › Subchapter I - RESIDENT RIGHTS, CARE AND RELATED SERVICES › Definitions › Section 388-97-0001 - Definitions

Current through Register Vol. 24-14, July 15, 2024
"Abandonment"
means action or inaction by an
						individual or entity with a duty of care for a vulnerable adult that leaves the
						vulnerable individual without the means or ability to obtain necessary food,
						clothing, shelter, or health care.
"Abuse"
means the willful action or inaction
						that inflicts injury, unreasonable confinement, intimidation, or punishment of
						a vulnerable adult. In instances of abuse of a vulnerable adult who is unable
						to express or demonstrate physical harm, pain or mental anguish, the abuse is
						presumed to cause physical harm, pain, or mental anguish. Abuse includes sexual
						abuse, mental abuse, physical abuse, personal exploitation of a vulnerable
						adult, and improper use of restraint against a vulnerable adult which have the
						following meanings:
(1)
"Mental abuse"
means a willful verbal or
						nonverbal action that threatens, humiliates, harasses, coerces, intimidates,
						isolates, unreasonably confines, or punishes a vulnerable adult. Mental abuse
						may include ridiculing, yelling, or swearing.
(2)
"Physical abuse"
means the willful
						action of inflicting bodily injury or physical mistreatment. Physical abuse
						includes, but is not limited to, striking with or without an object, slapping,
						pinching, choking, kicking, shoving, or prodding.
(3)
"Sexual abuse"
means any form of
						nonconsensual sexual conduct, including, but not limited to, unwanted or
						inappropriate touching, rape, sodomy, sexual coercion, sexually explicit
						photographing, and sexual harassment. Sexual conduct may include interactions
						that do not involve touching, including but not limited to sending a resident
						sexually explicit messages, or cuing or encouraging a resident to perform
						sexual acts. Sexual abuse includes any sexual conduct between a staff person
						and a resident, whether or not it is consensual.
(4)
"Personal exploitation"
means an act of
						forcing, compelling, or exerting undue influence over a vulnerable adult
						causing the vulnerable adult to act in a way that is inconsistent with relevant
						past behavior, or causing the vulnerable adult to perform services for the
						benefit of another.
(5)
"Improper use of restraint"
means the
						inappropriate use of chemical, physical, or mechanical restraints for
						convenience or discipline or in a manner that:
(a) Is inconsistent with federal or state licensing or
						certification requirements for facilities, hospitals, or programs authorized
						under chapter 71A.12 RCW;
(b) Is not medically authorized; or
(c) Otherwise constitutes abuse under this section.
"Administrative hearing"
is a formal hearing
						proceeding before a state administrative law judge that gives:
(1) A licensee an opportunity to be heard in disputes
						about licensing actions, including the imposition of remedies, taken by the
						department; or
(2) An individual an opportunity to appeal a finding of
						abandonment, abuse, neglect, financial exploitation of a resident, or
						misappropriation of a resident's funds.
"Administrative law judge (ALJ)"
means an
						impartial decision-maker who presides over an administrative hearing. ALJs are
						employed by the office of administrative hearings (OAH), which is a separate
						state agency. ALJs are not DSHS employees or DSHS representatives.
"Administrator"
means a nursing home
						administrator, licensed under chapter 18.52 RCW, who must be in active
						administrative charge of the nursing home, as that term is defined in the board
						of nursing home administrator's regulations.
"Advanced registered nurse practitioner
						(ARNP)"
means an individual who is licensed to practice as an advanced
						registered nurse practitioner under chapter 18.79 RCW.
"Applicant"
means an individual,
						partnership, corporation, or other legal entity seeking a license to operate a
						nursing home.
"ASHRAE"
means the American Society of
						Heating, Refrigerating, and Air Conditioning Engineers, Inc.
"Attending physician"
means the doctor
						responsible for a particular individual's total medical care.
"Berm"
means a bank of earth piled against a
						wall.
"Chemical restraint"
means the
						administration of any drug to manage a vulnerable adult's behavior in a way
						that reduces the safety risk to the vulnerable adult or others, has the
						temporary effect of restricting the vulnerable adult's freedom of movement, and
						is not standard treatment for the vulnerable adult's medical or psychiatric
						condition.
"Civil adjudication proceeding"
means
						judicial or administrative adjudicative proceeding that results in a finding
						of, or upholds an agency finding of, domestic violence, abuse, sexual abuse,
						neglect, abandonment, violation of a professional licensing standard regarding
						a child or vulnerable adult, or exploitation or financial exploitation of a
						child or vulnerable adult under any provision of law, including but not limited
						to chapter 13.34, 26.44, or 74.34 RCW, or rules adopted under chapters 18.51
						and 74.42 RCW. "Civil adjudication proceeding" also includes judicial or
						administrative findings that become final due to the failure of the alleged
						perpetrator to timely exercise a legal right to administratively challenge such
						findings.
"Civil fine"
is a civil monetary penalty
						assessed against a nursing home as authorized by chapters 18.51 and 74.42 RCW.
						There are two types of civil fines, "per day" and "per instance."
(1)
"Per day fine"
means a fine imposed for
						each day that a nursing home is out of compliance with a specific requirement.
						Per day fines are assessed in accordance with WAC
						388-97-4580(1);
						and
(2)
"Per instance fine"
means a fine imposed
						for the occurrence of a deficiency.
"Condition on a license"
means that the
						department has imposed certain requirements on a license and the licensee
						cannot operate the nursing home unless the requirements are observed.
"Consent"
means express written consent
						granted after the vulnerable adult or his or her legal representative has been
						fully informed of the nature of the services to be offered and that the receipt
						of services is voluntary.
"Commuting distance radius"
means the
						one-way travel time between any two points traveling on the generally fastest
						route without any impediments such as traffic, road work, or road
						closure.
"Deficiency"
is a nursing home's failed
						practice, action or inaction that violates any or all of the following:
(1) Requirements of chapters 18.51 or 74.42 RCW, or the
						requirements of this chapter; and
(2) In the case of a medicare and medicaid contractor,
						participation requirements under Title XVIII and XIX of the Social Security Act
						and federal medicare and medicaid regulations.
"Deficiency citation"
or
"cited
						deficiency"
means written documentation by the department that describes
						a nursing home's deficiency(ies); the requirement that the deficiency(ies)
						violates; and the reasons for the determination of noncompliance.
"Deficient facility practice"
or
"failed facility practice"
means the nursing home action(s),
						error(s), or lack of action(s) that provide the basis for the
						deficiency.
"Dementia care"
means a therapeutic modality
						or modalities designed specifically for the care of persons with
						dementia.
"Denial of payment for new admissions"
is an
						action imposed on a nursing home (facility) by the department that prohibits
						payment for new medicaid admissions to the nursing home after a specified date.
						Nursing homes certified to provide medicare and medicaid services may also be
						subjected to a denial of payment for new admissions by the federal Centers for
						Medicare and Medicaid Services.
"Department"
means the state department of
						social and health services (DSHS).
"Department on-site monitoring"
means an
						optional remedy of on-site visits to a nursing home by department staff
						according to department guidelines for the purpose of monitoring resident care
						or services or both.
"Dietitian"
means a qualified dietitian. A
						qualified dietitian is one who is registered by the American Dietetic
						Association or certified by the state of Washington.
"Direct care staff"
means the staffing
						domain identified and defined in the Centers for Medicare and Medicaid
						Service's five-star quality rating system and as reported through the Centers
						for Medicare and Medicaid Service's payroll-based journal.
"Directly supervising"
means that the
						individual responsible for providing oversight to staff is on the premises and
						quickly and easily available to provide necessary assessments and other direct
						care of residents.
"Disclosure statement"
means a signed
						statement by an individual in accordance with the requirements under
						RCW
						43.43.834. The statement should include a
						disclosure of whether or not the individual has been convicted of certain
						crimes or has been found by any court, state licensing board, disciplinary
						board, or protection proceeding to have neglected, sexually abused, financially
						exploited, or physically abused any minor or adult individual.
"Drug"
means a substance:
(1) Recognized as a drug in the official
United
						States Pharmacopoeia, Official Homeopathic Pharmacopoeia of the United States,
						Official National Formulary
, or any supplement to any of them;
						or
(2) Intended for use in the diagnosis, cure, mitigation,
						treatment, or prevention of disease.
"Drug facility"
means a room or area
						designed and equipped for drug storage and the preparation of drugs for
						administration.
"Emergency closure"
is an order by the
						department to immediately close a nursing home.
"Emergency transfer"
means immediate
						transfer of residents from a nursing home to safe settings.
"Entity"
means any type of firm,
						partnership, corporation, company, association, or joint stock
						association.
"Essential community provider"
means a
						nursing home, which is the only nursing home within a commuting distance radius
						of at least forty minutes duration, traveling by automobile.
"Financial exploitation"
means the illegal
						or improper use, control over, or withholding of the property, income,
						resources, or trust funds of the vulnerable adult by any person or entity for
						any person or entity's profit or advantage other than the vulnerable adult's
						profit or advantage. Some examples of financial exploitation are given in
						RCW
						74.34.020(7).
"Geriatric behavioral health worker"
means a
						person with a bachelor's or master's degree in social work, who has received
						specialized training devoted to mental illness and treatment of older
						adults.
"Habilitative services"
means the planned
						interventions and procedures which constitute a continuing and comprehensive
						effort to teach an individual previously undeveloped skills.
"Highest practicable physical, mental, and
						psychosocial well-being"
means providing each resident with the
						necessary individualized care and services to assist the resident to achieve or
						maintain the highest possible health, functional and independence level in
						accordance with the resident's comprehensive assessment and plan of care. Care
						and services provided by the nursing home must be consistent with all
						requirements in this chapter, chapters 74.42 and 18.51 RCW, and the resident's
						informed choices. For medicaid and medicare residents, care and services must
						also be consistent with Title XVIII and XIX of the Social Security Act and
						federal medicare and medicaid regulations.
"Informal department review"
is a dispute
						resolution process that provides an opportunity for the licensee or
						administrator to informally present information to a department representative
						about disputed, cited deficiencies. Refer to WAC
						388-97-4420.
"Inspection"
or
"survey"
means
						the process by which department staff evaluates the nursing home licensee's
						compliance with applicable statutes and regulations.
"Intermediate care facility for individuals with
						intellectual disabilities (ICF/IID)"
means an institution certified
						under chapter 42 C.F.R., Part 483, Subpart I, and licensed under chapter 18.51
						RCW.
"Large nonessential community providers"
means nonessential community providers that have more than sixty licensed
						nursing home beds, even if some of those beds are not set up or are not in
						use.
"License revocation"
is an action taken by
						the department to cancel a nursing home license in accordance with
						RCW
						18.51.060 and WAC
						388-97-4220.
"License suspension"
is an action taken by
						the department to temporarily revoke a nursing home license in accordance with
						RCW
						18.51.060 and this chapter.
"Licensee"
means an individual, partnership,
						corporation, or other legal entity licensed to operate a nursing home.
"Licensed practical nurse"
means an
						individual licensed to practice practical nursing under chapter 18.79
						RCW.
"Mandated reporter"
as used in this chapter
						means any employee of a nursing home, any health care provider subject to
						chapter 18.130 RCW, the Uniform Disciplinary Act, and any licensee or operator
						of a nursing home. Under
						RCW
						74.34.020, mandated reporters also include
						any employee of the department of social and health services, law enforcement
						officers, social workers, professional school personnel, individual providers,
						employees and licensees of assisted living facilities, adult family homes,
						soldiers' homes, residential habilitation centers, or any other facility
						licensed by the department, employees of social service, welfare, mental
						health, adult day health, adult day care, home health, home care, or hospice
						agencies, county coroners or medical examiners, or Christian Science
						practitioners.
"Mechanical restraint"
means any device
						attached or adjacent to the vulnerable adult's body that he or she cannot
						easily remove that restricts freedom of movement or normal access to his or her
						body. "Mechanical restraint" does not include the use of devices, materials, or
						equipment that are:
(1) Medically authorized, as required; and
(2) Used in a manner that is consistent with federal or
						state licensing or certification requirements for facilities.
"Misappropriation of resident property"
means the deliberate misplacement, exploitation, or wrongful, temporary or
						permanent use of a resident's belongings or money.
"NFPA"
means National Fire Protection
						Association, Inc.
"Neglect"
:
(1) In a nursing home licensed under chapter 18.51 RCW,
						neglect means:
(a) A pattern of conduct or inaction by a person or
						entity with a duty of care that fails to provide the goods and services that
						maintain physical or mental health of a vulnerable adult, or that fails to
						avoid or prevent physical or mental harm or pain to a vulnerable adult;
						or
(b) An act or omission by a person or entity with a duty
						of care that demonstrates a serious disregard of consequences of such a
						magnitude as to constitute a clear and present danger to the vulnerable adult's
						health, welfare, or safety, including but not limited to conduct prohibited
						under RCW 9A.42.-100.
(2) In a skilled nursing facility or nursing facility,
						neglect also means a failure to provide a resident with the goods and services
						necessary to avoid physical harm, mental anguish, or mental illness.
"Noncompliance"
means a state of being out
						of compliance with state and/or federal requirements for nursing
						homes/facilities.
"Nonessential community provider"
means a
						nursing home located within a commuting distance radius of less than forty
						minutes duration by automobile from another nursing home.
"Nursing assistant"
means a nursing
						assistant as defined under
						RCW
						18.88A.020 or successor laws.
"Nursing facility (NF)"
or
"medicaid-certified nursing facility"
means a nursing home, or any
						portion of a hospital, veterans' home, or residential habilitation center, that
						is certified to provide nursing services to medicaid recipients under section
						1919(a) of the federal Social Security Act. All beds in a nursing facility are
						certified to provide medicaid services, even though one or more of the beds are
						also certified to provide medicare skilled nursing facility services.
"Nursing home"
means any facility licensed
						to operate under chapter 18.51 RCW.
"Officer"
means an individual serving as an
						officer of a corporation.
"Owner of five percent or more of the assets of a
						nursing home"
means:
(1) The individual, and if applicable, the individual's
						spouse, who operates, or is applying to operate, the nursing home as a sole
						proprietorship;
(2) In the case of a corporation, the owner of at least
						five percent of the shares or capital stock of the corporation; or
(3) In the case of other types of business entities, the
						owner of a beneficial interest in at least five percent of the capital assets
						of an entity.
"Partner"
means an individual in a
						partnership owning or operating a nursing home.
"Permanent restraining order"
means a
						restraining order or order of protection issued either following a hearing, or
						by stipulation of the parties. A "permanent" order may be in force for a
						specific time period (for example, one year), after which it expires.
"Person"
means any individual, firm,
						partnership, corporation, company, association or joint stock
						association.
"Pharmacist"
means an individual licensed by
						the Washington state board of pharmacy under chapter 18.64 RCW.
"Pharmacy"
means a place licensed under
						chapter 18.64 RCW where the practice of pharmacy is conducted.
"Physical restraint"
means the application
						of physical force without the use of any device for the purpose of restraining
						the free movement of a vulnerable adult's body. "Physical restraint" does not
						include briefly holding without undue force a vulnerable adult in order to calm
						or comfort him or her, or holding a vulnerable adult's hand to safely escort
						him or her from one area to another.
"Physician's assistant (PA)"
means a
						physician's assistant as defined under chapter 18.57A or 18.71A RCW or
						successor laws.
"Plan of correction"
is a nursing home's
						written response to cited deficiencies that explains how it will correct the
						deficiencies and how it will prevent their reoccurrence.
"Reasonable accommodation"
and
"reasonably accommodate"
has the meaning given in federal and
						state antidiscrimination laws and regulations. For the purpose of this
						chapter:
(1) Reasonable accommodation means that the nursing home
						must:
(a) Not impose admission criteria that excludes
						individuals unless the criteria is necessary for the provision of nursing home
						services;
(b) Make reasonable modification to its policies,
						practices or procedures if the modifications are necessary to accommodate the
						needs of the resident;
(c) Provide additional aids and services to the
						resident.
(2) Reasonable accommodations are not required if:
(a) The resident or individual applying for admission
						presents a significant risk to the health or safety of others that cannot be
						eliminated by the reasonable accommodation;
(b) The reasonable accommodations would fundamentally
						alter the nature of the services provided by the nursing home; or
(c) The reasonable accommodations would cause an undue
						burden, meaning a significant financial or administrative burden.
"Receivership"
is established by a court
						action and results in the removal of a nursing home's current licensee and the
						appointment of a substitute licensee to temporarily operate the nursing
						home.
"Recurring deficiency"
means a deficiency
						that was cited by the department, corrected by the nursing home, and then cited
						again within fifteen months of the initial deficiency citation.
"Registered nurse"
means an individual
						licensed to practice as a registered nurse under chapter 18.79 RCW.
"Rehabilitative services"
means the planned
						interventions and procedures which constitute a continuing and comprehensive
						effort to restore an individual to the individual's former functional and
						environmental status, or alternatively, to maintain or maximize remaining
						function.
"Resident"
generally means an individual
						residing in a nursing home. Except as specified elsewhere in this chapter, for
						decision-making purposes, the term "resident" includes the resident's surrogate
						decision maker acting under state law. The term resident excludes outpatients
						and individuals receiving adult day or night care, or respite care.
"Resident care unit"
means a functionally
						separate unit including resident rooms, toilets, bathing facilities, and basic
						service facilities.
"Respiratory isolation"
is a technique or
						techniques instituted to prevent the transmission of pathogenic organisms by
						means of droplets and droplet nuclei coughed, sneezed, or breathed into the
						environment.
"Siphon jet clinic service sink"
means a
						plumbing fixture of adequate size and proper design for waste disposal with
						siphon jet or similar action sufficient to flush solid matter of at least two
						and one-eighth inches in diameter.
"Skilled nursing facility (SNF)"
or
"medicare-certified skilled nursing facility"
means a nursing
						home, a portion of a nursing home, or a long-term care wing or unit of a
						hospital that has been certified to provide nursing services to medicare
						recipients under section 1819(a) of the federal Social Security Act.
"Small nonessential community providers"
means nonessential community providers that have sixty or fewer nursing home
						licensed beds, even if some of those beds are not set up or are not in
						use.
"Social/therapeutic leave"
means leave which
						is for the resident's social, emotional, or psychological well-being; it does
						not include medical leave.
"Staff work station"
means a location at
						which nursing and other staff perform charting and related activities
						throughout the day.
"Stop placement"
or
"stop placement
						order"
is an action taken by the department prohibiting nursing home
						admissions, readmissions, and transfers of patients into the nursing home from
						the outside.
"Substantial compliance"
means the nursing
						home has no deficiencies higher than severity level 1 as described in WAC
						388-97-4500,
						or for medicaid certified facility, no deficiencies higher than a scope and
						severity "C."
"Surrogate decision maker"
means a resident
						representative or representatives as outlined in WAC
						388-97-0240,
						and as authorized by
						RCW
						7.70.065.
"Survey"
means the same as
"inspection"
as defined in this section.
"Temporary manager"
means an individual or
						entity appointed by the department to oversee the operation of the nursing home
						to ensure the health and safety of its residents, pending correction of
						deficiencies or closure of the facility.
"Temporary restraining order"
means
						restraining order or order of protection that expired without a hearing, was
						dismissed following an initial hearing, or was dismissed by stipulation of the
						parties before an initial hearing.
"Termination"
means an action taken
						by:
(1) The department, or the nursing home, to cancel a
						nursing home's medicaid certification and contract; or
(2) The department of health and human services Centers
						for Medicare and Medicaid Services, or the nursing home, to cancel a nursing
						home's provider agreement to provide services to medicaid or medicare
						recipients, or both.
"Toilet room"
means a room containing at
						least one toilet fixture.
"Uncorrected deficiency"
is a deficiency
						that has been cited by the department and that is not corrected by the licensee
						by the time the department does a revisit.
"Violation"
means the same as
"deficiency"
as defined in this section.
"Volunteer"
means an individual who is a
						regularly scheduled individual not receiving payment for services and having
						unsupervised access to a nursing home resident.
"Vulnerable adult"
includes a person:
(1) Sixty years of age or older who has the functional,
						mental, or physical inability to care for himself or herself;
(2) Found incapacitated under chapter 11.88 RCW;
(3) Who has a developmental disability as defined under
						RCW
						71A.10.020;
(4) Admitted to any facility;
(5) Receiving services from home health, hospice, or home
						care agencies licensed or required to be licensed under chapter 70.127
						RCW;
(6) Receiving services from an individual provider;
						or
(7) Who self directs his or her own care and receives
						services from a personal aide under chapter 74.39 RCW.
"Whistle blower"
means a resident, employee
						of a nursing home, or any person licensed under Title 18 RCW, who in good faith
						reports alleged abandonment, abuse, financial exploitation, or neglect to the
						department, the department of health or to a law enforcement
						agency.
Statutory Authority:
						  Chapters
						  18.51 and
						  74.42 RCW. 13-04-093, §
						  388-97-0001, filed 2/6/13, effective 3/9/13; 11-22-077, § 388-97-0001,
						  filed 11/1/11, effective 12/2/11; 10-02-021, § 388-97-0001, filed
						  12/29/09, effective 1/29/10. Statutory Authority:
						  Chapters
						  18.51 and
						  74.42 RCW and 42 C.F.R. 489.52.
						  08-20-062, § 388-97-0001, filed 9/24/08, effective 11/1/08.
Reviser's note:
The spelling error in the
						  above section occurred in the copy filed by the agency and appears in the
						  Register pursuant to the requirements of
						  RCW
						  34.08.040.