12VAC35-105-20
“Direct Care Position”: add “support” to the list of tasks.The current definition seems very clinical and not flexible to In-Home supports.
‘Missing’. Consider defining this related to an individual’s identified support needs documented in the ISP. If someone walks to the store for 5 minutes and then returns, this does not require reporting.
‘Serious Incident’. Stating that an incident is serious in nature when it is likely to lead to adverse effects is interpretable by each licensing specialist and does not allow providers to develop policy or consistent practice.
Level I:
Stating that deaths must be reported is clear. Stating that injury caused by physical restraint is clear. These regulations have provided no definition or clarity regarding Level 1 incidents. Providers will be unable to develop policy or consistent practice to meet regulation.
Level II:
The reportability of an individual missing for any period of time is problematic. Missing should be defined as related to an individual’s identified support needs documented in their ISP.
DBHDS wants to identify trends related to specific injuries and not the use of emergency rooms and urgent care facilities. The regulations should be written to require specific injuries to be reported, not use of the ER and urgent care centers.
Hospital admissions are already reported quarterly to case management utilizing the quarterly review. Remove this or state unplanned hospital visits require reporting to exclude care that is ordered by a physician and requires hospital admission.
Remove allegations of exploitation and theft as these are already required to be reported via CHRIS by the Human Rights Regulations.
Remove disaster, fire, emergency or other condition. Disaster and emergency is broad and interpretable across licensing specialists. This is already required to be reported with a focus on provider precautions and provision of care.
Remove the “diagnosis section #10.Those diagnoses should not be more reportable than others, especially in Supportive In-Home services.
Level III:
Remove “whether or not the incident occurs while in the provision of service”.
3. Who determines if a serious injury is likely to result in permanent physical or psychological impairment? This is interpretable across licensing specialists and does not allow providers to develop policy or consistent practice to meet regulation.
4. This is covered in Level II #5.
‘Serious Injury’ Medical attention that was not required but sought as a precaution and resulted in no formal treatment or diagnosis is not necessary to report.
12VAC35-105-160
D2. A provider would need to document this contact so requiring that the communication take place via phone should be removed. This should be communicated in writing to other parties if included here.
E. A root cause analysis is conducted as part of an investigation and this is redundant. Remove this.
12VAC35-105-170
E. A deadline should be included in regulation to specify DBHDS’s deadline to respond to a provider’s correction action plan.
12VAC35-105-400
B. Consent should be obtained after hire and is not relevant to a hiring decision.
E. The results of background checks takes several weeks and cannot be reviewed prior to hire. The Code of VA specifies that a criminal background check be completed for an applicant that accepts employment into a direct care position and therefore the offer of employment has to be made and accepted before processing can occur.
12VAC35-105-520
C. If this is to be required by DBHDS, the uniform risk triggers and thresholds should be defined in regulation. Otherwise, providers will be unable to develop policy and or consistent practice.
12VAC35-105-590
A.5. Adequate number of staff required to safely evacuate all individuals during an emergency.This statement should say it does not apply to Supportive In-Home.
Throughout regulation the language distinguishing between the sections do not apply to in-home or non-centered based locations was removed and not struckthrough consistently. This clarification should be highlighted and applicable sections labeled accordingly.