Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-107 - Licensing requirements for enhanced services facilities › DEFINITIONS › Section 388-107-0001 - Definitions

Current through Register Vol. 24-14, July 15, 2024
The definitions in this section apply throughout this
					 chapter unless the context clearly requires otherwise.
"Abandonment"
means action or inaction by a
					 person with a duty of care for a vulnerable adult that leaves the vulnerable
					 person 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 on
					 a resident. In instances of abuse of a resident 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 is also defined in
					 RCW
					 74.34.020. Abuse includes sexual abuse,
					 mental abuse, physical abuse, and exploitation of a resident, which have the
					 following meanings:
(1)
"Mental abuse"
means any willful action or
					 inaction of mental or verbal abuse. Mental abuse includes, but is not limited
					 to, coercion, harassment, inappropriately isolating a resident from family,
					 friends, or regular activity, and verbal assault that includes ridiculing,
					 intimidating, 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, prodding, or the use of chemical restraints or
					 physical restraints except as described in section 388-107-0420;
(3)
"Sexual abuse"
means any form of
					 nonconsensual sexual contact, including, but not limited to, unwanted or
					 inappropriate touching, rape, sodomy, sexual coercion, sexually explicit
					 photographing, and sexual harassment. Sexual contact 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 contact between a staff person
					 and a resident, whether or not it is consensual;
(4)
"Exploitation"
means an act of forcing,
					 compelling, or exerting undue influence over a resident causing the resident to
					 act in a way that is inconsistent with relevant past behavior, or causing the
					 resident to perform services for the benefit of another.
"Activities of daily living"
means the
					 following tasks related to basic personal care: Bathing; toileting; dressing;
					 personal hygiene; mobility; transferring; and eating.
"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.
"Administrator"
means an enhanced services
					 facility administrator who must be in active administrative charge of the
					 enhanced services facility as required in this chapter. Unless exempt under
					 RCW
					 18.88B.041, the administrator must complete
					 long-term care worker training and home care aide certification.
"Advance directive,"
as used in this chapter,
					 means any document indicating a resident's choice with regard to a specific
					 service, treatment, medication or medical procedure option that may be
					 implemented in the future such as power of attorney health care directive,
					 limited or restricted treatment cardiopulmonary resuscitation (CPR), do not
					 resuscitate (DNR), and organ tissue donation.
"Aggressive behavior"
means actions by the
					 individual that constitute a threat to the individual's health and safety or
					 the health and safety of others in the environment.
"Antipsychotic medications"
means that class
					 of medications primarily used to treat serious manifestations of mental illness
					 associated with thought disorders, which includes but is not limited to
					 atypical antipsychotic medications.
"Applicant"
means the individual or entity, as
					 defined in this section that has submitted, or is in the process of submitting,
					 an application for an enhanced services facility license.
"Capacity"
means the maximum amount an
					 enhanced services facility can serve is sixteen residents.
"Caregiver"
means the same as "long-term care
					 worker" as defined in
					 RCW
					 74.39A.009, as follows: "Long-term care
					 workers" include all persons who provide paid, hands-on personal care services
					 for the elderly or persons with disabilities, including but not limited to
					 individual providers of home care services, direct care workers employed by
					 home care agencies, providers of home care agencies to persons with
					 developmental disabilities under Title 71A RCW, all direct care workers in
					 state-licensed enhanced services facilities, assisted living facilities, and
					 adult family homes, respite care providers, direct care workers employed by
					 community residential service businesses, and any other direct care worker
					 providing home or community-based services to the elderly or persons with
					 functional disabilities or developmental disabilities.
"Challenging behavior"
means a persistent
					 pattern of behaviors that inhibit the individual's functioning in public
					 places, in the facility and integration within the community, or uncontrolled
					 symptoms of a physical or mental condition. These behaviors may have been
					 present for long periods of time or have manifested as an acute onset.
"Chemical dependency"
means alcoholism,
					 medication addiction, or dependence on alcohol and one or more other
					 psychoactive chemicals, as the context requires and as those terms are defined
					 in chapter 70.96A RCW.
"Chemical dependency professional"
means a
					 person certified as a chemical dependency professional by the department of
					 health under chapter 18.205 RCW.
"Deficiency"
means an enhanced services
					 facility's practice, action, or inaction that violates any or all of the
					 requirements of chapter 70.97 RCW or this chapter.
"Department"
means the department of social
					 and health services.
"Direct supervision"
means oversight by a
					 person on behalf of the enhanced services facility who has met training
					 requirements, demonstrated competency in core areas, or has been fully exempted
					 from the training requirements, is on the premises, and is quickly and easily
					 available to the caregiver.
"Enhanced services facility"
or
"ESF"
means a facility licensed under chapter 70.97 RCW that
					 provides treatment and services to persons for whom acute inpatient treatment
					 is not medically necessary and who have been determined by the department to be
					 inappropriate for placement in other licensed facilities due to the complex
					 needs that result in behavioral and security issues. For the purposes of this
					 chapter, an enhanced services facility is not an evaluation and treatment
					 facility certified under chapter 71.05 RCW.
"Facility"
means an enhanced services
					 facility.
"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's
					 or entity's profit or advantage other than for the vulnerable adult's profit or
					 advantage. Some examples of financial exploitation are given in
					 RCW
					 74.34.020(6).
"Holding technique"
means using the least
					 amount of force necessary to manually hold all or part of a person's body in a
					 way that restricts the person's free movement; also includes any approved
					 controlling maneuvers identified in the person-centered service plan. Examples
					 include holds taught in approved training for deescalation techniques and
					 control of self-harm or aggressive behavior. This definition does not apply to
					 briefly holding, without force, a person in order to calm the person, or
					 holding a person's hand to escort the person safely from one area to
					 another.
"Infectious"
means capable of causing
					 infection or disease by entrance of organisms into the body, which grow and
					 multiply there, including, but not limited to, bacteria, viruses, protozoans,
					 and fungi.
"Inspection"
means the process by which
					 department staff evaluates the enhanced services facility licensee's compliance
					 with applicable statutes and regulations.
"License suspension"
is an action taken by the
					 department to temporarily revoke an enhanced services facility license in
					 accordance with
					 RCW
					 70.97.120 and this chapter.
"Licensee"
means the individual or entity, as
					 defined in this chapter, to whom the department issues the enhanced services
					 facility license.
"Licensed physician"
means a person licensed
					 to practice medicine or osteopathic medicine and surgery in the state of
					 Washington.
"Likelihood of serious harm"
means a
					 substantial risk that:
(1) Physical harm will be inflicted by an individual upon
					 his or her own person, as evidenced by threats or attempts to commit suicide or
					 inflict physical harm on oneself;
(2) Physical harm will be inflicted by an individual upon
					 another, as evidenced by behavior that has caused such harm or that places
					 another person or persons in reasonable fear of sustaining such harm; or
(3) Physical harm will be inflicted by an individual upon
					 the property of others, as evidenced by behavior that has caused substantial
					 loss or damage to the property of others.
"Long-term care worker"
as defined in
					 RCW
					 74.39A.009, has the same meaning as the term
					 "caregiver."
"Management agreement"
means a written,
					 executed agreement between the licensee and the manager regarding the provision
					 of certain services on behalf of the licensee.
"Mandated reporter":
(1) Is an employee of the department, law enforcement
					 officer, social worker, professional school personnel, individual provider, an
					 employee of a facility, an operator of a facility, an employee of a social
					 service, welfare, mental health, adult day health, adult day care, home health,
					 home care, or hospice agency, county coroner or medical examiner, Christian
					 Science practitioner, or health care provider subject to chapter 18.130 RCW;
					 and
(2) For the purpose of the definition of mandated reporter,
					 "facility" means a residence licensed or required to be licensed under chapter
					 18.20 RCW, Assisted living facility; chapter 18.51 RCW, Nursing homes; chapter
					 70.128 RCW, Adult family homes; chapter 72.36 RCW, Soldiers' homes; chapter
					 71A.20 RCW, Residential habilitation centers; chapter 70.97 RCW, Enhanced
					 services facility or any other facility licensed by the department.
"Medically fragile"
means a chronic and
					 complex physical condition which results in prolonged dependency on specialized
					 medical care that requires frequent daily skilled nursing interventions. If
					 these medically necessary interventions are interrupted or denied, the resident
					 may experience irreversible damage or death. Examples of specialized medical
					 care and treatment for medically fragile residents include but are not limited
					 to: IV therapies requiring monitoring of vital signs and dose titration
					 dependent on lab values; wound care requiring external vacuum or other
					 mechanical devices for debridement; complicated wound care requiring other
					 specialized or extensive interventions and treatment; ventilator or other
					 respiratory device dependence and monitoring; dependence on licensed staff for
					 complex respiratory support; and peritoneal or hemodialysis (on-site).
"
Medication administration
" means the direct
					 application of a prescribed medication whether by injection, inhalation,
					 ingestion, or other means, to the body of the resident by an individual legally
					 authorized to do so.
"
Medication service
" means any service
					 provided either directly or indirectly by an enhanced services facility related
					 to medication administration medication assistance, or resident
					 self-administration of medication.
"Mental disorder"
means any organic, mental,
					 or emotional impairment that has substantial adverse effects on an individual's
					 cognitive or volitional functions.
"Mental health professional"
means a
					 psychiatrist, psychologist, psychiatric nurse, licensed mental health
					 counselor, licensed mental health counselor-associate, licensed marriage and
					 family therapist, licensed marriage and family therapist-associate, licensed
					 independent clinical social worker, licensed independent clinical social
					 worker-associate, licensed advanced social worker, or licensed advanced social
					 worker-associate and such other mental health professionals as may be defined
					 by rules adopted by the secretary under the authority of chapter 71.05
					 RCW.
"Misappropriation of resident property"
means
					 the deliberate misplacement, exploitation, or wrongful, temporary or permanent
					 use of a resident's belongings or money.
"Neglect"
means:
(1) 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 resident, or that fails to avoid or prevent
					 physical or mental harm or pain to a resident; or
(2) 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 resident's health, welfare,
					 or safety, including but not limited to conduct prohibited under
					 RCW
					 9A.42.100.
"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 (e.g. 5 years), after which it expires.
"Prescriber"
means a health care practitioner
					 authorized by Washington state law to prescribe medications.
"Professional person"
means a mental health
					 professional and also means a physician, registered nurse, and such others as
					 may be defined in rules adopted by the secretary pursuant to the provisions of
					 this chapter.
"
Psychopharmacologic medications
" means a
					 class of prescription medications that affect the mind, emotions, and behavior,
					 including but not limited to antipsychotics, antianx-iety medication, and
					 antidepressants.
"Reasonable accommodation" and "reasonably
					 accommodate"
have the meaning given in federal and state
					 antidiscrimination laws and regulations which include, but are not limited to,
					 the following:
(1) Reasonable accommodation means that the enhanced
					 services facility must:
(a) Not impose an admission criterion that excludes
					 individuals unless the criterion is necessary for the provision of enhanced
					 services facility 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 enhanced services facility;
					 or
(c) The reasonable accommodations would cause an undue
					 burden, meaning a significant financial or administrative burden.
"RCW"
means Revised Code of Washington.
"Records"
means:
(1)
"Active records"
means the current,
					 relevant documentation regarding residents necessary to provide care and
					 services to residents; or
(2)
"Inactive records"
means historical
					 documentation regarding the provision of care and services to residents that is
					 no longer relevant to the current delivery of services and has been thinned
					 from the active record.
"Registration records"
include all the records
					 of the department, regional support networks, treatment facilities, and other
					 persons providing services to the department, county departments, or facilities
					 which identify individuals who are receiving or who at any time have received
					 services for mental illness.
"Resident"
means a person admitted to an
					 enhanced services facility.
"Resident's representative"
means:
(1) The legal representative who is the person or persons
					 identified in
					 RCW
					 7.70.065 and who may act on behalf of the
					 resident pursuant to the scope of their legal authority. The legal
					 representative shall not be affiliated with the licensee, enhanced services
					 facility, or management company, unless the affiliated person is a family
					 member of the resident; or
(2) If there is no legal representative, a person
					 designated voluntarily by a competent resident in writing, to act in the
					 resident's behalf concerning the care and services provided by the enhanced
					 services facility and to receive information from the enhanced services
					 facility if there is no legal representative. The resident's representative may
					 not be affiliated with the licensee, enhanced services facility, or management
					 company, unless the affiliated person is a family member of the resident. The
					 resident's representative under this subsection shall not have authority to act
					 on behalf of the resident once the resident is no longer competent. The
					 resident's competence shall be determined using the criteria in
					 RCW
					 11.88.010(1)(e).
"Secretary"
means the secretary of the
					 department or the secretary's designee.
"Significant change"
means:
(1) A deterioration in a resident's physical, mental, or
					 psychosocial condition that has caused or is likely to cause clinical
					 complications or life-threatening conditions; or
(2) An improvement in the resident's physical, mental, or
					 psychosocial condition that may make the resident eligible for discharge or for
					 treatment in a less intensive or less secure setting.
"Significant medication error"
includes any
					 failure to administer or receive a medication according to an authorized health
					 care provider's order, or according to the manufacturer's directions for
					 nonprescription medications, that results in an error involving the wrong
					 medication, wrong dose, wrong patient, wrong time, wrong rate, wrong
					 preparation, or wrong route of administration.
"Social worker"
means a person with a master's
					 or further advanced degree from a social work educational program accredited
					 and approved as provided in
					 RCW
					 18.320.010.
"Staff" or "staff person"
means any person
					 who:
(1) Is employed or used by an enhanced services facility,
					 directly or by contract, to provide care and services to any resident.
(2) Staff must meet all of the requirements of chapter
					 388-112A WAC.
"Stop placement" or "stop placement order"
is
					 an action taken by the department prohibiting enhanced services facility
					 admissions, readmissions, and transfers of patients into the enhanced services
					 facility from the outside.
"Temporary restraining order"
means
					 restraining order or order of protection that expired without a hearing, was
					 terminated following an initial hearing, or was terminated by stipulation of
					 the parties in lieu of an initial hearing.
"Treatment"
means the broad range of
					 emergency, detoxification, residential, inpatient, and outpatient services and
					 care, including diagnostic evaluation, mental health or chemical dependency
					 education and counseling, medical, physical therapy, restorative nursing,
					 psychiatric, psychological, and social service care, vocational rehabilitation,
					 and career counseling.
"Violation"
means the same as "deficiency" as
					 defined in this section.
"Volunteer"
means an individual who interacts
					 with residents without reimbursement.
"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; or
(2) Found incapacitated under chapter 11.88 RCW; or
(3) Who has a developmental disability as defined under
					 RCW 71A.10.020;
					 or
(4) Admitted to any facility, including any enhanced
					 services facility; or
(5) Receiving services from home health, hospice, or home
					 care agencies licensed or required to be licensed under chapter 70.127 RCW;
					 or
(6) Receiving services from an individual provider.
(7) Who self-directs his or her own care and receives
					 services from a personal aide under chapter 74.39 RCW.
(8) For the purposes of requesting and receiving background
					 checks pursuant to
					 RCW
					 43.43.832, it shall also include adults of
					 any age who lack the functional, mental, or physical ability to care for
					 themselves.
"WAC"
means Washington Administrative
					 Code.
Reviser's note:
The unnecessary underscoring
						and strike through 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.