§20

Group Home – while the circumstances are rare, preventing “live-in” staff is a significant policy decision which I think should be more carefully considered than it will be in Emergency Regulations – I would remove that phrase

§20

The definition of ICF/IDD removed the word “community” – delete the word community in the definition of “residential service”

§20

In the definition of risk management – change “prevention’ to “mitigation”

§20

In the definition of “serious incident:”

• When combined with the definition of missing – the reportability of an individual missing for “any” period of time is problematic – it suggests that a report should be filed in any circumstance when a staff member thinks “where is . . .?”  There should be a different criteria depending on the level of supervision required, the environment or circumstances
• “ a hospital admission” is overly broad and should be changed to “unplanned admission” to exclude scheduled elective surgeries, admissions for routine dental care which might include general anesthesia, and routine admissions in compliance with a physician’s protocol for the treatment of a chronic condition
• Allegations of exploitation or theft should not be included as a “serious incident” to be reported to the Office of Licensing as it would be duplicative of the report required under 12VAC35-115 to the Office of Human Rights as an allegation of abuse. This item should be removed from the Serious Incident list.
• “Disaster, fire, emergency or other condition that may jeopardize the health, safety, or welfare” this is currently required to be reported in 12VAC35-105-530 F with a focus on what steps the provider has taken to ensure the safety of the individuals and to provide for their care.  To include it as a Level 2 Serious Incident requires, among other things, a report on each individual affected (not the program location) and on the event not the provider’s implementation of their Emergency Plan.  This item should be removed from the Serious Incident list.

§160 C

Add language as follows: “ . . . shall collect, maintain and review, at least quarterly, reports, and related documentation of all Level I serious incidents . . .”

§160 D 2

Add language as follows “ . . . and by phone or other agreed upon means to anyone . . . such notice, and to the individual’s authorized representative, and to the individual’s Case Manager, as appropriate . . .”

§160 E

Completion of the specified “root cause analysis” within 30 days and then re-reviewing Level I incidents quarterly seems redundant; Level I review (as described in 160 C) is both sufficient and more comprehensive for this type of incident.  Exempt Level I incidents from this section

§400 B

The form required by DSS contains information which is not relevant to a hiring decision and may be considered inappropriate to be asked prior to employment

§400 E

This section implies that the criminal history background check and the CPS registry report will be available “prior to hiring the applicant” – the Code of Virginia §19.2-389 A 29 specifies that a criminal background check may be completed for “applicant who accepts employment in any direct care position” – it is clear that to process a criminal background check the offer of employment must have been made and accepted.

§400 E

In addition, even if the process is expedited as expected with the new DBHDS process coming on line this summer, the private sector must still wait for a letter to be prepared and mailed by DBHDS – the process will not be complete for review “prior to hiring.”  In addition, the CPS registry check takes four to six weeks from submission.  Again – cannot be reviewed “prior to hiring.” – Note that the form required to be retained in §400 C is scheduled to be eliminated by action of DBHDS in the near future.

§520 C

The “uniform risk triggers and thresholds as defined by the department” should be included as part of these regulations if they are to be expected. Providers will be subject to multiple interpretations, revisions of lists without notice, and will be unable to develop policy or consistent practice.  Alternatively, remove this expectation and use whatever the Department has developed as technical assistance if needed.

§660 C

This new language does not “fit” within the person centered process used by DD providers – the documentation from the team meeting (some of which is contained in those sections of the plan prepared by the Case Manager should be sufficient to explain the individual’s choices