AGING AND DISABILITY SERVICES ADMINISTRATION

Residential Care Services
Operational Principles and Procedures for Stop Placement Orders Prohibiting Admissions

1. Purpose
   
   To implement statutes and regulations regarding the department's authority to order stop placement of 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 limits the home's capacity to provide care and/or services.
   
   
2. Authority
   
   RCW 18.20.190(1), (2), (3), (4) Boarding Homes (BH)
   WAC 388-110-260(3) BH Contract Requirements
   
   
3. Operational Principles
   
   
   1. A stop placement order prohibiting admissions may be recommended to facilitate correction of violations of statutes or regulations that demonstrate the health and safety of residents are jeopardized, and/or the home's capacity to provide care or services is seriously limited
   2. A stop placement order prohibiting admissions may be recommended when violations are serious, or, are pervasive or repeated or uncorrected, and, suspension of admissions in the home is necessary to protect residents' safety and welfare while the licensee is correcting deficiency.
   3. A stop placement order prohibiting admissions includes suspension of admission, readmission or transfer of residents into the home.
   4. Timeframes identified within this procedure to complete and process recommendations to impose a stop placement order are intended as a guide to staff and may be extended with management's approval, except as otherwise specified in statute or regulation.
   5. Licensees should be notified of a stop placement order prohibiting admissions as soon as possible by telephone; and, via personal service and/or certified mail receipt of a notice of violation letter and a Statement of Deficiencies report within ten working days of completion of data collection.
   6. Licensees will be given an opportunity to question and/or clarify the Statement of Deficiencies report and/or a stop placement order prohibiting admissions via the department's informal dispute resolution process.
   7. Licensees will be given the opportunity to contest imposition of a stop placement order prohibiting admissions through the state administrative hearing process.
   8. Imposition of a stop placement order is effective immediately upon notification and is not postponed pending completion of informal dispute resolution and/or administrative hearing processes.
   9. Recommendations to 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.
      
      
4. Procedure
   
   
   1. Imposition of A Stop Placement Order Prohibiting Admissions
      1. RCS staff should:
         1. Notify the Field Manager 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, a stop placement order prohibiting admissions to the home is necessary to protect residents while the licensee is correcting deficiencies.
         2. Document deficiencies that are serious or repeated or uncorrected, including information about pertinent deficiencies repeated in the past thirty-six months on a Statement of Deficiencies report within four working days of completion of data collection.
         3. Complete a Licensee History Memo including the home's current and significant compliance history related to the stop placement order prohibiting admissions recommendation.
         4. Forward 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 with the Field Manager and review the completed Statement of Deficiencies report and Licensee History Memo.
   2. Management Review of Stop Placement Orders Prohibiting Admissions
      1. Field Managers should:
         1. Notify the Regional Administrator and the Enforcement Officer immediately when a stop placement order prohibiting admissions may be recommended.
         2. If an emergency exists and upon approval of the Enforcement Officer, notify by telephone the licensee, HCS, DDD, and Mental Health, as appropriate, of the immediate imposition of a stop placement order prohibiting admissions.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 recommendation to impose a stop placement order prohibiting admissions.
         3. Verify:
            1. the deficiency citation(s) demonstrate that the resident's health and safety is jeopardized, or the home's capacity to provide care and/or services is seriously limited; and, a stop placement order prohibiting admissions is necessary to protect residents while the licensee is correcting the deficiencies
            2. the stop placement of admissions recommendation corresponds with the scope and severity of the deficiency citation(s) and correlates to the statute(s) or regulation(s) cited.
            3. the correct legal requirement (WAC) is identified for citations.
         4. 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 recommendation to order stop placement prohibiting admissions with RCS staff.
         5. 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.
         6. Send a copy of the acceptable Plan of Correction to the Enforcement Officer when received from the licensee.
         7. 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.
         8. Approve readmissions of residents on an exception basis.
   3. Headquarters Management Action
      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 is jeopardized or the home's capacity to provide care or services is seriously limited; and, a stop placement order prohibiting admissions to the home is necessary to protect residents while licensee is correcting deficiencies.
         2. When an emergency exists, request that the Field Manager notify the licensee, HCS, DDD, and Mental Health, as appropriate of the imposition of a stop placement order prohibiting admissions effective immediately.
         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 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's or the Assistant Director designee's final approval and determination to impose a stop placement order prohibiting admissions.
         6. Notify the Field Manager per telephone of the Assistant Director's or the Assistant Director designee's final determination and request that the Field Manager, by telephone, confirm the stop placement order prohibiting admissions with the licensee.
         7. Coordinate personal service or certified mail 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.
            AND/OR
         8. 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 and enforcement letter(s) to the Field Manager, Regional Administrator and Assistant Attorney General.
         10. Direct Headquarters support staff to notify applicable parties (i.e., HCS, DDD, MH, Ombudsman, etc…) of enforcement actions initiated via mail or e-mail distribution of the enforcement letter and the Statement of Deficiencies report.
   4. Removal of Stop Placement Orders Prohibiting Admissions
      1. RCS staff should:
         1. Re-visit the home within fifteen working days of the licensee's request to verify correction of violations that contributed to the recommendation to impose a stop placement order prohibiting admissions.
         2. Determine if findings that jeopardized the health and safety of residents or seriously limited the home's capacity to provide care or services have been removed and systems in place to ensure lasting correction.
         3. Meet with the Field Manager to recommend lifting the stop placement order prohibiting admissions.
         4. If the violations that contributed to the stop placement order have been corrected, enter the statement "no deficiencies were evident upon the conclusion of this visit" on the statement of deficiencies. If the violations remain uncorrected, re-cite the deficiencies and continue with the procedure.
      2. Field Managers should:
         1. Notify the Regional Administrator and the Enforcement Officer via e-mail when the licensee has corrected violations that necessitated the stop placement order prohibiting admissions and exhibits the capacity to maintain correction of the violations previously found deficient.
         2. Notify the licensee, by telephone, when the enforcement officer gains the approval of the assistant director or designee.
      3. Enforcement Officers should:
         1. Accept the recommendation or modify or delete the recommendation to lift the stop placement order prohibiting admissions to the home. Discuss the reason for the modification or deletion with the Field Manager who will review changes with RCS staff.
         2. Obtain the Assistant Director's or the Assistant Director designee's final approval and determination to lift the stop placement order prohibiting admissions.
         3. Send a letter via certified mail to the licensee lifting the stop placement order prohibiting admissions.
         4. Notify the field manager of the approval and request licensee be notified by telephone.
         5. Direct Headquarters support staff to send copies of the letter(s) to the Field Manager, Regional Administrator, and Assistant Attorney General.
         6. Direct Headquarters support staff to notify applicable parties (i.e., HCS, DDD, Mental Health, Ombudsman, etc…) of this action via e-mail distribution of the letter.
   5. Monitoring Visits Pending Appeal of a Stop Placement Order Prohibiting Admissions
      1. Field Managers may assign RCS staff to conduct routine monitoring visits of the home after the licensee has received a notice of a stop placement of new admissions order.
      2. RCS staff should make observations, conduct interviews, review records and document their findings related to the ongoing welfare and safety of residents in a memo to the Field Manager. 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. Information should be called in as a complaint issue, if this is a new issue.
      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