Thank you for providing opportunity to review and comment to improve regulations used by the Commonwealth to take care of its residents who need behavioral and developmental health and at the same time protect everyone.

1. Just for future regulatory actions, it is unclear from the document posted online as http://www.dbhds.virginia.gov/assets/QMD/licensing/Ch105.Compliance.forComment.2018.03.05.pdf as to whether all of “DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES“ “Ch 105 Rules and Regulations for Licensing Facilities and Providers” are being reviewed and revised, or just certain articles and paragraphs, as the posted document makes no mention of this.  Hopefully the review can include the full regulation.  The document posted just seems to contain certain sections http://www.dbhds.virginia.gov/quality-management/Office-of-Licensing states “Each state agency must ensure that its regulations are reviewed at least once every four years through a ‘periodic review.’ Agencies must then decide if the regulation will be amended, retained as is, or repealed. After conducting the most recent periodic review of the Licensing Regulations, the agency filed a decision to amend the regulations.”  It goes on to say “There will be additional opportunities for public comment prior to the regulation becoming permanent.”

2. Revised document for comment has term "Serious incident" which “means any happening which is not consistent with the routine operation of a service provider or the routine care of an individual that is likely to lead to adverse effects upon an individual. The term serious incident includes death and serious injury. "Level I serious incident" means a serious incident that occurs or originates during the provision of a service or on the premises of the provider and does not meet the definition of a Level II or Level III serious incident. "Level II serious incident" means a serious incident that occurs or originates during the provision of a service or on the premises of the provider that results in a threat to the health and safety of an individual that does not meet the definition of a Level III serious incident. "Level II serious incident" also includes a threat to the health or safety of others caused by an individual. "Level II serious incidents" include:

1. A serious injury of an individual caused by the use of a physical restraint;

2. A serious injury caused by another individual or person;

3. An individual who is missing for any period of time;

4. An emergency room or urgent care facility visit when not used in lieu of a primary care physician visit;

5. A hospital admission;

6. Allegation of financial exploitation of an individual or theft of their property or funds;

7. A disaster, fire, emergency, or any other condition that may jeopardize the health, safety, or welfare of individuals;

8. Choking incidents that require direct physical intervention by another person;

9. Ingestion of any hazardous material.

10. A diagnosis of: a. A decubitus ulcer or an increase in severity of level of previously diagnosed decubitus ulcer; b. A bowel obstruction; or c. Aspiration pneumonia."

Level III serious incident" means a serious incident whether or not the incident occurs while in the provision of a service or on the provider’s premises and results in:

1) Any death of an individual;

2) A sexual assault of an individual;

3) A serious injury of an individual that results in or likely will result in permanent physical or psychological impairment;

4) A suicide attempt by an individual admitted for services that results in a hospital admission”

Revised document for comment also defines “Abuse” to include “Use  of  language  that  demeans,  threatens,  intimidates,  or  humiliates  the  individual;.”

There is some confusion however, when looking at the term “adverse effects upon an individual” or  “Use  of  language  that  demeans,  threatens,  intimidates,  or  humiliates  the  individual” in that the Definitions section defines "Individual" or "individual receiving services" = “means a current direct recipient of public or private mental health, developmental, or substance abuse treatment, rehabilitation, or habilitation services, and includes the terms "consumer," "patient," "resident," "recipient," or "client." When the term is used in this chapter, the requirement applies to every individual receiving licensed services from the provider.”

12VAC35-105-325 states “Each residential service shall designate a staff person  as  a  community  liaison  responsible  for  facilitating cooperative  relationships  with  neighbors,  local  law-enforcement  personnel,  local  government officials,  and  the community at large.” So clearly neighbors (including children), local law-enforcement personnel,  emergency responders, and  the community at large are part of the environment of the license providers whereby any injury or death or abuse to any one of them needs to be covered. And so are the provider staff, the men and women who provide the services.

Request the regulations be revised before finalization to make it clear that any death, sexual assault, or serious injury of any person; any disaster, fire, emergency, or any other condition that may jeopardize the health, safety, or welfare of any person or persons; or any use  of  language  that  demeans,  threatens,  intimidates,  or  humiliates  any person; with any of the all aforementioned that results from the actions of "individual receiving services" ("patient," "resident," "recipient," or "client") are included in the “Serious incident” and ideally prevented from ever occurring through risk management and individualized  services  plan, and if they do occur, that crisis stabilization, behavior intervention, and / or corrective action occurs to prevent recurrence. The term “individual”

Unfortunately,  group home situations exist that for example included at least six calls to the police because of incidents at the home or in the street outside the home and with neighbors as young children who enjoyed playing outside and reportedly could  no longer do so while the parents worried about what could happen with the group home residents and even to the extent of frightening young children to the point of not feeling safe in their own home.  (This even seems to meet the definition of "abuse" as defined in the document for review - use of language (including screams) that demeans, threatens, intimidates, or humiliates ) So the regulations need to be clear so these situations are addressed.  Thankfully the situation I am aware of seems to have improved as a result of community and law enforcement involvement.

Our Virginia Constitution’s Article I. Bill of Rights makes it clear “That all men [human beings] are by nature equally free and independent and have certain inherent rights, of which, when they enter into a state of society, they cannot, by any compact, deprive or divest their posterity; namely, the enjoyment of life and liberty, with the means of acquiring and possessing property, and pursuing and obtaining happiness and safety.” and “That government is, or ought to be, instituted for the common benefit, protection, and security of the people, nation, or community; of all the various modes and forms of government, that is best which is capable of producing the greatest degree of happiness and safety […].” Therefore, the regulations need to ensure that the term “individual” is defined in ways that match its intended use in the regulation and not do so as it does now in a way to exclude certain persons.  Virginia’s Register of Regulations guidance “Form, Style and Procedure Manual for Publication of Virginia Regulations” as  http://register.dls.virginia.gov/documents/agency_resources/stylemanual.pdf § 3.10 says the “Definitions section” “definitions provide clarification for terms used within a regulation and allow the regulation writer to control the meaning of a word.”