AGING AND DISABILITY SERVICES ADMINISTRATION

Residential Care Services
Operational Principles and Procedures for License Revocation / Stop Placement Order Prohibiting Admissions

1. Purpose
   
   To implement statutes and regulations regarding the Department of Social and Health Services' (the department's) authority to revoke a license and impose a stop placement order prohibiting resident admissions in a consistent and uniform manner throughout the state subsequent to a Boarding Home's failure or refusal to comply with regulations that jeopardizes the health and safety of residents, or, seriously limit the home's capacity to provide care and/or services.
   
   
2. Authority
   
   RCW 18.20.190(1), (2), (3), (4) Boarding Homes (BH)
   WAC 388-78A-030(4) BH Minimum Licensing Requirements
   WAC 388-110-260(1), (2), (3) BH Contract Requirements
   RCW Chapter 34.05 Notice of Hearing Rights
   
   
3. Operational Principles
   
   
   1. Revocation of a license and a stop placement order prohibiting admissions may be recommended as authorized by law including, but not limited to, the licensee's:
      1. Failure or refusal to comply with statutes and regulations that result in demonstrating the health and safety of residents is jeopardized and the homes ability to provide care and services is seriously limited.
      2. Operation of a home without a license or under a revoked or suspended license;
      3. Knowingly, or with reason to know, making a false statement of a material fact on an application for license or in any matter under investigation by the department; or,
      4. Willful prevention, interference with, or attempt to impede in any way any inspection or investigation conducted by the department.
   2. Licensee's history of repeated and/or uncorrected violations of statutes and regulations that are similar to the current violations will be considered in the recommendation to revoke the license and to impose a stop placement order prohibiting resident admissions.
   3. Timeframes identified within this procedure to complete and process recommendations to revoke a license and to impose a stop placement order prohibiting admissions are intended as a guide to staff and may be extended with management's approval, except as otherwise specified in statute or regulation.
   4. Licensees will be notified of the department's initiation of a revocation of a license and stop placement order prohibiting admissions as soon as possible by telephone, and via personal service and/or certified mail receipt of a Statement of Deficiencies report and enforcement letter within ten working days of completion of data collection.
   5. Licensees will be given an opportunity to question and/or clarify the Statement of Deficiencies report and/or revocation of a license and stop placement order prohibiting admissions via the department's informal dispute resolution process.
   6. Licensees will be given an opportunity to contest revocation of a license and a stop placement order prohibiting admissions via the administrative hearing process.
   7. A stop placement order prohibiting admissions is effective immediately upon notification and is not postponed pending completion of informal dispute resolution and/or administrative hearing processes.
   8. The license revocation will be final 29 days after the licensee's receipt of the written notice of revocation, unless the home files an appeal before the effective date. If an appeal is filed within the allowed time, the revocation of a license will not take effect until the appeal is dismissed or a final order has been entered in the administrative hearing process.
   9. Recommendations to revoke a license and impose a stop placement order prohibiting admissions may be reviewed by Regional Administrators for any purpose including, but not limited to, quality assurance activities and information sharing within RCS' management structure.
   10. A plan of Correction is not requested when a decision has been made to do a License Revocation.
       
       
4. Procedure
   1. On-site Data Analysis Related to Recommendations to Revoke a License and Impose a Stop Placement Order Prohibiting Admissions
      1. RCS staff should:
         1. Notify the Field Manager immediately if findings jeopardize the health and safety of residents or seriously limit the home's capacity to provide care and/or services.
         2. Complete the inspection.
         3. Critically analyze documented findings to verify completion of thorough data collection. Staff will confirm that the documentation answers pertinent questions (i.e., who, what, when, where, how and why) regarding possible failed (deficient) practices and related findings.
         4. Determine the scope and severity of failed (deficient) practice(s).
         5. With Field Manager approval, advise the licensee of findings that demonstrate that residents' health and safety are jeopardized and/or represent pervasive noncompliance with statutes or regulations.
         6. Obtain a list of resident, family/legal representative and attending physician names, addresses and telephone numbers to facilitate timely notification of possible departmental action.
   2. Off-site Data Analysis / Process Related to Recommendations to Revoke a License and Impose a Stop Placement Order Prohibiting Admission.
      1. RCS staff should:
         1. Consult with the Field Manager immediately if there are findings that demonstrate the residents' health and safety are jeopardized and that the homes capacity to provide care or services is seriously jeopardized, and, revocation of a license and a stop placement order prohibiting admissions to the home are necessary to protect residents.
         2. Document deficiencies that jeopardize the health and safety of residents or seriously limit the home's capacity to provide care including pertinent repeated or uncorrected violations since the date of initial licensure on a Statement of Deficiencies report.
         3. Complete a Licensee History Memo including the home's current and significant compliance history related to the recommendation to revoke a license and impose a stop placement order prohibiting admissions.
         4. Forward the Licensee History Memo, original Statement of Deficiencies report and resident and staff (when warranted) sample list to the Field Manager within four working days of completion of data collection.
         5. Meet and review the completed Statement of Deficiencies report and Licensee History Memo with the Field Manager.
   3. Regional Management Action Related to Recommendations to Revoke a License and Impose a Stop Placement Order Prohibiting Admissions
      1. Field Managers should:
         1. Consult with RCS staff immediately if there are findings that demonstrate that residents' health and safety is jeopardized or that the home's capacity to provide care or services is seriously limited, and, revocation of a license and a stop placement order prohibiting admissions to the home is necessary to protect residents.
         2. Notify the Regional Administrator and the Enforcement Officer immediately when revocation of the license and a stop placement order prohibiting admissions may be recommended.
         3. When an emergency exists and upon approval of the Enforcement Officer, notify the licensee, HCS, DDD, & Mental Health, as appropriate, of the imposition of a stop placement order prohibiting admissions effective immediately and possible revocation of the license recommendation.
         4. Review, edit and approve the Statement of Deficiencies report and Licensee History Memo to determine accuracy, adequacy, clarity, thoroughness and timeliness of the submission of the revocation of a license and stop placement order recommendations.
         5. Verify:
            1. the deficiency citation(s) demonstrate that resident health and safety are jeopardized, or, that the home's capacity to provide care or services is seriously limited; and, revocation of a license and a stop placement order prohibiting admissions are necessary to protect residents.
            2. the recommendations to revoke a license and impose a stop placement order prohibiting admissions correspond with the scope and severity of the deficiency citation(s) and correlate with statute(s) or regulation(s) cited.
            3. The correct legal requirement (Washington Administrative Code or WAC) is identified for each citation.
         6. Accept the Statement of Deficiencies report and Licensee History Memo as submitted or modify or delete any portion. Field Managers will review changes in the license revocation and stop placement order recommendations with RCS staff.
         7. Review Statement of Deficiencies report to ensure the documents do not contain
            a request for a plan of correction
         8. E-mail the approved Statement of Deficiencies report, resident and staff (when
            warranted) sample list and Licensee History Memo to the Enforcement Officer
            for review and approval within six working days of completion of data
            collection. Fax the signed front page of the Statement of Deficiencies.
         9. Notify the Enforcement Officer of proposed changes in the Statement of
            Deficiencies report subsequent to completion of an informal dispute resolution
            meeting with the licensee.
         10. Following the Assistant Director or Assistant Director's designee's decision
             to revoke a license, coordinate with the Enforcement Officer to personally
             serve the Statement of Deficiencies report, resident and staff (when warranted)
             list and enforcement letter to the licensee.
         11. Coordinate with HCS, DDD, Mental Health, as appropriate, and the Washington State Ombudsman's office to notify residents, family members/legal representatives, and attending physicians of the initiation of the enforcement action(s).
         12. Coordinate with HCS, DDD, Mental Health, as appropriate, and the
             Washington State Ombudsman's office to notify residents, family
             members/legal representatives, and attending physicians of the initiation of the
             enforcement action(s).
   4. Headquarters Management Action Related to Recommendations to Revoke a License and Impose a Stop Placement Order Prohibiting Admissions
      1. Enforcement Officers should:
         1. Notify the Assistant Director or the Assistant Director's designee immediately when findings demonstrate the health and safety of residents are jeopardized or the home's capacity to provide care or services is seriously limited; and, license revocation and a stop placement order prohibiting admissions to the home are necessary to protect residents.
         2. If an emergency exists, request that the Field Manager notify by telephone the licensee, HCS, and DDD of the stop placement order prohibiting admissions effective immediately and possible revocation of a license recommendation.
         3. Review the Statement of Deficiencies report and Licensee History Memo to determine if a sufficient basis exists to approve the enforcement action recommendation.
         4. Accept the recommendation to revoke a license and impose a stop placement order prohibiting admissions, or modify or delete any portion. Discuss the reason for the modification or deletion with the Field Manager who will review changes with RCS staff.
         5. Obtain the Assistant Director or the Assistant Director designee's final approval and decision to revoke a license and impose a stop placement order prohibiting admissions within ten working days of completion of data collection.
         6. Notify the Field Manager per telephone of the Assistant Director or Assistant Director designee's final decision and request that the Field Manager confirm by telephone, the initiation of the revocation of a license and stop placement order prohibiting admissions with the licensee, HCS, DDD, and Mental Health, as appropriate.
         7. Coordinate personal service delivery of the Statement of Deficiencies report, resident and staff (when warranted) sample list and enforcement letter (if completed) to the licensee within ten working days of completion of data collection. The letter should include the initiation of the license revocation, imposition of a stop placement order prohibiting admissions, the effective date of both actions, and information regarding the licensee's informal dispute resolution and hearing rights.
            AND/OR
            
         8. Direct Headquarters support staff to send a copy of the Statement of Deficiencies report, resident and staff (when warranted) sample list and, enforcement letter via certified mail to the licensee within ten working days of completion of data collection.
         9. Direct Headquarters support staff to send copies of the final Statement of Deficiencies report with applicable enforcement letter(s) to the Field Manager, Regional Administrator and Assistant Attorney General.
         10. Direct Headquarters support staff to notify applicable parties (i.e., AAG, HCS, DDD, Mental Health, Ombudsman, etc…) of enforcement actions initiated, via mail or e-mail distribution of applicable enforcement letter(s) and the Statement of Deficiencies report.
         11. Request Vendor Services terminate the licensee's Medicaid contract unless a hearing is requested within twenty-eight days.
   5. Monitoring Visits Pending Appeal of a Revocation of License and a Stop Placement Order Prohibiting Admissions
      1. Field Managers should assign RCS staff to conduct routine monitoring visits of the home after the licensee has received a notice of revocation of a license and, pending any administrative appeal and final decision.
      2. RCS staff should make observations, conduct interviews, review records and document their findings related to the ongoing welfare and safety of residents. RCS staff should not make a determination of compliance with cited statutes and regulations during these visits.
      3. RCS staff should immediately notify the Field Manager if findings represent a diminished welfare and safety of residents since the last inspection and/or, represent imminent threat of harm to residents. For serious new issues, RCS staff should call in a complaint to the CRU.
      4. Field Managers should immediately consult with the Enforcement Officer regarding findings obtained during monitoring visits if additional enforcement action may be warranted.
      5. Enforcement Officer should inform the Assistant Director or the Assistant Director's designee of additional findings related to the licensee's noncompliance and risks related to resident safety and welfare.
      6. The Assistant Director or the Assistant Director's designee will determine additional enforcement action required.
      7. The Enforcement Officer should coordinate with the Field Manager and the Assistant Attorney General to facilitate initiation of additional actions subsequent to a licensee's ongoing failure or refusal to meet regulations that jeopardize the health and safety of residents or, that seriously limit the home's capacity to provide care or services.

Date: 02-28-02
Patricia K. Lashway, Director
Residential Care Services