T 22VAC40-61-10 Definitions Clarification is needed concerning the definition of Legal Representative. With our population in many cases the clients have not appointed a formal legal representative. Often families request admission due to safety concerns with leaving the family member alone at home while they are working. When doing an admission in this case if it is obvious that the potential participant does not understand explanation of admission paperwork. Is admission to be denied because the family does not have formal paperwork in order to sign for the person? Can the families sign the paperwork if it is documented that it is the wish of the participant for them to do so? As stated this paragraph excludes those with participants who have not made arrangements for POA or Guardian but who are living with families who are struggling to provide care. Guidance should be provided as to how accomplish admission for those who have not appointed a formal POA or Guardian, but who are unsafe to be left alone and need services. 22VAC40-61-90 Incident Reports Section C--Current regulations require that the licensing inspector be notified of any incident affecting participant safety. This paragraph requires both verbal and later written communication. Incident reports are always available at the centers for the inspectors to view and it required that they be retained at the center for two years. The requirement of both is redundant and would be a burden for staff. Section F--A clarification is needed for this paragraph-Would this include a requirement that a copy of incident reports be placed in the chart? The incident report is normally an internal document for quality assurance and should not be place in a chart. VAC40-61-120 Reports of abuse neglect or exploitation Section B--This requirement should be deleted as oft times it is the contact person or legal representative who may be the subject of a report to Adult Protective Services. This requirement could put the client or ADHC staff at risk of retaliation for the report. Notification should be left up to Adult Protective Services to protect both the client and ADHC staff.