Aging and Disability Services Information for Professionals

AGING AND DISABILITY SERVICES ADMINISTRATION

Residential Care Services
Operational Principles and Procedures for
Summary Suspension of a License, License Revocation, and
Stop Placement Order Prohibiting Admissions

Purpose

To implement statutes and regulations regarding the department's authority to summarily suspend a license, revoke a license and impose a stop placement order prohibiting admissions in a consistent and uniform manner throughout the state subsequent to a Boarding Home's failure or refusal to comply with regulations that place residents in imminent threat of harm.
Authority

RCW 18.20.190(1), (2), (3), (4) Boarding Homes (BH)
WAC 388-78A-030(4), (5) BH Minimum Licensing Requirements
WAC 388-110-260(1), (2), (3) BH Contract Requirements
RCW Chapter 34.05 Notice of Hearing Rights
Operational Principles
1. Summary suspension of a license, revocation of a license and a stop placement order prohibiting admissions may be recommended if the department finds that serious physical harm to or death of a resident has occurred; or, a serious threat to the life, health or safety of a resident exists.
2. Licensee's history of repeated 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 impose a stop placement order prohibiting resident admissions.
3. Timeframes identified within this procedure to complete and process recommendations to suspend and 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 that the department has initiated a summary suspension of a license, revocation of a license and a 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 three working days of completion of data collection. There may be an emergency where an initial notification letter may be hand-delivered to the licensee to enable immediate removal of the residents.
5. Licensees will be given an opportunity to question and/or clarify a Statement of Deficiencies report, or, suspension of a license, revocation of a license or a stop placement order via the department's informal dispute resolution process.
6. Licensees will be given an opportunity to contest suspension of a license, revocation of a license and a stop placement order prohibiting admissions via the administrative hearing process.
7. A stop placement order prohibiting admissions and a summary suspension of a license are effective immediately upon notification and are not postponed pending completion of informal dispute resolution 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 suspend a license, 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.
Procedure
1. On-site Data Analysis Related to Recommendations to Impose Summary Suspension/Revocation of a License and a Stop Placement Order Prohibiting Admissions
  1. RCS staff should:
    1. Notify the Field Manager immediately when there are findings that serious physical harm to or death of a resident has occurred; or, that a serious threat to the life, health or safety of a resident exists.
    2. 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 failed (deficient) practices and related findings.
    3. Determine the scope and severity of failed (deficient) practice(s).
    4. With Field Manager's approval, advise the licensee of findings of serious physical harm to or death of a resident; or, a serious threat to the life, health or safety of a resident. Licensees will be informed that the home's failure or refusal to comply with regulations has placed residents in imminent threat of harm.
    5. Complete the inspection.
    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 Impose Summary Suspension/Revocation of a License and a Stop Placement Order Prohibiting Admissions
  1. RCS staff should:
    1. Consult with the Field Manager immediately if serious physical harm to or death of a resident has occurred; or; a serious threat to the life, health or safety of a resident exists; and, summary suspension of a license, revocation of a license and a stop placement order prohibiting admissions to the home may be necessary to protect residents.
    2. Document deficiencies that demonstrate serious physical harm to or death of a resident has occurred; or, that a serious threat to the life, health or safety of a resident exists including information about pertinent repeated or uncorrected deficiencies on a Statement of Deficiencies report within two working days of completion of data collection. Include repeated or uncorrected violations since the date of initial licensure that are related to the enforcement actions recommended.
    3. Complete a Licensee History Memo including the home's current and significant compliance history related to the summary suspension, revocation of a license and stop placement order prohibiting admissions recommendations.
    4. Forward the Licensee History Memo, original Statement of Deficiencies report, and resident and staff (when warranted) sample list to the Field Manager within two 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 Impose Summary Suspension/Revocation of a License and a Stop Placement Order Prohibiting Admissions
  1. Field Managers should:
    1. Consult with RCS staff immediately if there are findings that serious physical harm to or death of a resident has occurred; or, that a serious threat to the life, health or safety of a resident exists; and, summary suspension, revocation of a license and a stop placement order prohibiting admissions to the home may necessary to protect residents.
    2. Notify the Regional Administrator and the Enforcement Officer immediately if summary suspension, revocation of a license and a stop placement order prohibiting admissions may be recommended.
    3. If an emergency exists and upon Enforcement Officer approval, notify the licensee, HCS, DDD or Mental Health, as appropriate, of the stop placement order prohibiting admissions effective immediately and possible summary suspension/revocation of the license recommendations.
      In an emergency situation, upon Enforcement Officer direction, the initial letter of summary suspension shall be hand delivered to the licensee to enable immediate removal of the residents. An amended notice of summary suspension, license revocation and stop placement shall follow within three working days.
    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 summary suspension, revocation of a license and stop placement order recommendations. Review the Statement of Deficiencies to determine the document does not contain a request for a plan of correction.
    5. Verify:
      1. the deficiency citation(s) demonstrates serious physical harm to or death of a resident has occurred; or, that a serious threat to the life, health or safety of a resident exists; and, summary suspension, revocation of a license and a stop placement order prohibiting admissions are necessary to protect residents.
      2. the recommendations to impose summary suspension, license revocation and 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 (WAC) is identified for the enforcement actions recommended.
    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 summary suspension, license revocation and stop placement order recommendations with RCS staff.
    7. 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 two working days of completion of data collection unless, the Assistant Director or the Assistant Director's designee has determined the imminent threat of harm to residents has been removed.
    8. 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.
    9. Following the Assistant Director or Assistant Director designee's decision to suspend and revoke a license, coordinate with the Enforcement Officer to personally serve the Statement of Deficiencies report, resident and staff sample list (when warranted), and enforcement letter to the licensee.
    10. 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 initiation of enforcement action(s).
    11. Upon direction by the enforcement officer, send licensing or complaint investigation staff to verify status of compliance of licensee's other licensed homes not subject of the current actions, in or out of the region.
4. Headquarters Management Action Related to Recommendations to Impose Summary Suspension/Revocation of a License and a Stop Placement Order Prohibiting Admissions
  1. Enforcement Officers should:
    1. Notify the Assistant Director or the Assistant Director's designee immediately if there are findings that serious physical harm to or death of a resident has occurred; or, that a serious threat to the life, health or safety of a resident exists; and, summary suspension, license revocation and a stop placement order prohibiting admissions to the home may be 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 summary suspension/revocation of the license recommendations.
      There may be an emergency, where, with approval of the Assistant Director or designee, it is necessary to instruct the Field Manager to deliver an initial summary suspension letter to enable immediate removal of residents. An amended letter of summary suspension, license revocation and stop placement letter will follow within 3 working days.
    3. Review the Statement of Deficiencies report and Licensee History Memo to determine if a sufficient basis exists to approve the enforcement action recommendations.
    4. Accept the recommendation to suspend a license, revoke a license and impose a stop placement order prohibiting admissions, or modify or delete any portion. The reason for the modification or deletion will be discussed 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 suspend a license, revoke a license and impose a stop placement order prohibiting admissions within three working days of completion of data collection.
    6. Notify the Field Manager per telephone of the Assistant Director or the Assistant Director designee's final decision and request that the Field Manager confirm the initiation of suspension and revocation of a license and immediate stop placement order prohibiting admissions with the licensee, HCS and 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 three working days of completion of data collection. The letter should include the initiation of the summary suspension, license revocation, imposition of a stop placement order prohibiting admissions, the effective date of all actions, and information regarding the licensee's informal dispute resolution and hearing rights.
    8. May direct Field Manager to send staff out to licensee's other homes, in or out of region, to determine compliance.
      AND/OR
    9. Direct Headquarters support staff to send a copy of the Statement of Deficiencies report, resident and staff sample list (when warranted), and enforcement letter via certified mail to the licensee within three working days of completion of data collection.
    10. Direct Headquarters support staff to send copies of the Statement of Deficiencies report with applicable enforcement letter(s) to the Field Manager, Regional Administrator and Assistant Attorney General.
    11. Direct Headquarters support staff to notify applicable parties (i.e., AAG, HCS, DDD, Ombudsman, etc…) of enforcement actions initiated, via mail or e-mail distribution of enforcement letter(s) and the Statement of Deficiencies report.
    12. Request Vendor Services terminate the licensee's Medicaid contract unless a hearing is requested within twenty-eight (28) days.
    13. When the License History Memo is reviewed, (with approval by the assistant Director or designee), notify CRU of other regions where the Boarding Family Home licensee has homes and request a complaint visit by staff to determine compliance status.
5. Monitoring Visits Pending a Stay of a Summary Suspension of a License and/or Appeal of Revocation of License and a Stop Placement Order Prohibiting Admissions
  1. Field Manager should assign RCS staff to conduct routine monitoring visits of the home after the licensee has received a formal notice of summary suspension and revocation of a license pending any injunction, stay or motion to stay summary suspension action, administrative appeal and final decision; and, until all residents have relocated from the home.
  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 new issues, RCS staff should call information to the Complaint Resolution Unit (CRU).
  4. Field Manager should immediately consult with the Enforcement Officer regarding findings obtained during monitoring visits if additional enforcement action may be warranted.
  5. The 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