216 R.I. Code R. 216-RICR-40-10-2.3

Current through June 12, 2024

Section 216-RICR-40-10-2.3 - Definitions

A. Whenever used in these Regulations, the following terms shall be construed as follows:

1. "Abuse" means any assault as defined in R.I. Gen. Laws Chapter 11-5 including, but not limited to hitting, kicking, pinching, slapping or the pulling of hair, provided however, unless such is required as an element of offense, it shall not be necessary to prove that the patient or resident was injured thereby, or any assault as defined in R.I. Gen. Laws Chapter 11-37 or any offense under R.I. Gen. Laws Chapter 11-10; or

a. Any conduct which harms or is likely to physically harm the resident except where the conduct is a part of the care and treatment, and in furtherance of the health and safety of the resident; or

b. Intentionally engaging in a pattern of harassing conduct which causes or is likely to cause emotional or psychological harm to the resident, including but not limited to ridiculing or demeaning a patient or resident, making derogatory remarks to a patient or resident or cursing directed towards a patient or resident, or threatening to inflict physical or emotional harm on a patient.

2. "Act" means R.I. Gen. Laws Chapter 23-17.4, entitled "Assisted Living Residence Licensing Act."

3. "Activities of daily living" means bathing, dressing, eating, toileting, mobility and transfer.

4. "Administrator" means the person who has responsibility for day to day administration or operation of an assisted living residence.

5. "Alzheimer Dementia Special Care Unit/Program" means a distinct living environment within an assisted living residence that has been physically adapted to accommodate the particular needs and behaviors of those with dementia. The unit provides increased staffing, therapeutic activities designed specifically for those with dementia and trains its staff on an ongoing basis on the effective management of the physical and behavioral problems of those with dementia. The residents of the unit or program have had a standard medical diagnostic evaluation and have been determined to have a diagnosis of Alzheimer's dementia or another dementia.

6. "Assisted living residence" means a publicly or privately operated residence that provides directly or indirectly by means of contracts or arrangements personal assistance and may include the delivery of limited health services, as defined under R.I. Gen. Laws § 23-17.4-2(12), to meet the resident's changing needs and preferences, lodging, and meals to six (6) or more adults who are unrelated to the licensee or administrator, excluding however, any privately operated establishment or facility licensed pursuant to R.I. Gen. Laws Chapter 23-17 and those facilities licensed by or under the jurisdiction of the Department of Behavioral Healthcare, Development Disabilities and Hospitals, the Department of Children, Youth, and Families, or any other State agency.

7. "Capable of self-preservation" means the physical mobility and judgmental ability of the individual to take appropriate action in emergency situations. Residents not capable of self-preservation are limited to facilities that meet more stringent Life Safety Code requirements as provided under R.I. Gen. Laws § 23-17.4-6(b)(3).

8. "Center for Acute Infectious Diseases Epidemiology" means Center for Acute Infectious Diseases Epidemiology (CAIDE); Division of Emergency Preparedness, and Infectious Disease; Rhode Island Department of Health.

9. "Center for Food Protection" means the Center for Food Protection, Division of Environmental Health, Rhode Island Department of Health.

10. "Center for Health Facilities Regulation" means the Center for Health Facilities Regulation, Division of Healthcare Quality and Safety, Rhode Island Department of Health.

11. "Change in operator" means a transfer by the licensee or operator of an assisted living residence to any other person (excluding delegations of authority to the administrative employees of the residence) of the licensee's authority to:

a. Hire or fire the Chief Executive Officer of the assisted living residence;

b. Maintain and control the books and records of assisted living residence;

c. Dispose of assets and incur liabilities on behalf of the assisted living residence; or

d. Adopt and enforce policies regarding operation of the assisted living residence.

e. This definition is not applicable to circumstances wherein the licensee of an assisted living residence for adults retains the immediate authority and jurisdiction over the activities enumerated in §§ 2.3(A)(11)(a) through (d) of this Part above.

12. "Change in owner" means:

a. In the case of an assisted living residence which is a partnership, the removal, addition or substitution of a partner which results in a new partner acquiring a controlling interest in such partnership;

b. In the case of an assisted living residence which is an unincorporated solo proprietorship, the transfer of the title and property to another person;

c. In the case of an assisted living residence which is a corporation:

(1) A sale, lease, exchange or other disposition of all, or substantially all of the property and assets of the corporation; or

(2) A merger of the corporation into another corporation; or

(3) The consolidation of two or more corporations, resulting in the creation of a new corporation; or

(4) In the case of an assisted living residence which is a business corporation, any transfer of corporate stock which results in a new person acquiring a controlling interest in such corporation; or

(5) In the case of an assisted living residence which is a non-business corporation, any change in membership which results in a new person acquiring a controlling vote in such corporation.

13. "Declaration of disaster emergency" means a disaster emergency declared by the Governor pursuant to R.I. Gen. Laws § 30-15-9.

14. "Department" means the Rhode Island Department of Health. The Department is also the "licensing agency" designated pursuant to R.I. Gen. Laws Chapter 23-17.

15. "Director" means the Director of the Rhode Island Department of Health.

16. "Elopement," means leaving the premises without notice when the residence has assumed responsibility for the resident's whereabouts.

17. "Employee" means any individual, whether paid or unpaid, directly employed by or under contract with the residence, who provides or delivers direct care services to residents and/or who has routine contact with residents without the presence of other employees.

18. "Essential caregiver" means an individual, whether a family member or friend of a resident of a nursing home or long-term care facility, who is designated by the resident or appointed by an individual with decision-making authority for the resident to provide physical or emotional support to the resident during a declaration of disaster emergency.

19. "Fiduciary agent" means one who holds a fiduciary relation or acts in a fiduciary capacity.

20. "Health oversight agency" means a public authority or other agency or organization authorized by law to investigate or otherwise oversee the reporting of allegations of failure to meet professional practice standards or misconduct.

21. "High managerial agent" means an officer of a residence, the administrator and assistant administrator of the residence, the director and assistant director of nursing services, or any other agent in a position of comparable authority with respect to the formulation of policies of the residence or the supervision in a managerial capacity of subordinate employees.

22. "Level of licensure" means the licensed authority to admit residents according to the following classifications: [Note that residences must have both an "F" (fire) and an "M" (medication) classification].

23. "Licensee" means any person who holds an assisted living residence license from the Department.

24. "Life Safety Code" means the current applicable Rhode Island Fire Safety Code, R.I. Gen. Laws Chapter 23-28.1.

25. "Limited health services" means health services provided by a licensed assisted living residence, as ordered by a resident's physician or other authorized health care provider acting within his/her scope of practice, and provided by qualified licensed assisted living staff members under supervision. Limited health services includes the following:

a. Stage I and stage II pressure ulcer treatment and prevention;

b. Simple wound care including postoperative suture care/removal and stasis ulcer care;

c. Ostomy care including appliance changes for residents with established stomas;

d. Urinary catheter care.

26. "Medication aide" means a nursing assistant who has had additional training in the administration of medications and is licensed with the Department pursuant to R.I. Gen. Laws Chapter 23-17.9 and Subchapter 05, Part 22 of this Chapter, Nursing Assistants, Medication Aides, and the Approval of Nursing Assistant and Medication Aide Training Programs.

27. "Mistreatment" means the inappropriate use of medications, isolation, or use of physical or chemical restraints as punishment, for employee convenience, as a substitute for treatment or care, in conflict with a physician's order, or in quantities which inhibit effective care of treatment, which harms or is likely to harm the patient or resident.

28. "Neglect" means the intentional failure to provide treatment, care, goods and services necessary to maintain the health and safety of the patient or resident, or the intentional failure to carry out a plan of treatment or care prescribed by the physician of the patient or resident, or the intentional failure to report patient or resident health problems or changes in health conditions to an immediate supervisor or nurse, or the intentional lack of attention to the physical needs of a patient or resident including, but not limited to toileting, bathing, meals and safety.

a. "Neglect" also means failure to promptly act upon any change in a resident's condition that would disqualify that resident from admission to the residence pursuant to § 2.4.14(A)of this Part, including but not limited to, the transfer of the resident to a health care facility. Provided, however, no person shall be considered to be neglected for the sole reason that he or she relies or is being furnished treatment in accordance with the tenets and teachings or a well-recognized church or denomination by a duly-accredited practitioner thereof.

29. "Person" means any individual, trust or estate, partnership, corporation (including associations, joint stock companies, or limited liability companies) State or political subdivision or instrumentality of a State.

30. "Personal assistance" means the provision of one (1) or more of the following services, as required by the resident or as reasonably requested by the resident, on a scheduled or unscheduled basis, including:

a. Assisting the resident with personal needs, including activities of daily living;

b. Assisting the resident with self-administration of medication; or administration of medications by appropriately licensed staff;

c. Providing or assisting the resident in arranging for health and supportive services as may be reasonably required;

d. Monitoring the activities of the resident while on the premises of the residence to ensure his/her health, safety, and well-being; and

e. Reasonable recreational, social and personal services.

31. "Qualified designee" means a licensed registered nurse, licensed practical nurse, or licensed medication aide.

32. "Qualified licensed assisted living staff members" means a nursing assistant as provided under R.I. Gen. Laws § 23-17.9-2(a)(3), a licensed practical nurse as provided under R.I. Gen. Laws § 5-34-3(13) and/or a registered nurse as provided under R.I. Gen. Laws § 5-34-3(14).

33. "Resident" means an individual not requiring medical or nursing care as provided in a health care facility but who as a result of choice and/or physical or mental limitation requires personal assistance, lodging and meals and may require the administration of medication and/or limited health services. A resident must be capable of self-preservation in emergency situations, unless the facility meets a more stringent Life Safety Code as required under R.I. Gen. Laws § 23-17.4-6(b)(3).

a. Persons needing medical or skilled nursing care, including daily professional observation and evaluation, as provided in a health care facility, and/or persons who are bedbound or in need of the assistance of more than one (1) person for ambulation are not appropriate to reside in assisted living residences. However, a resident may receive daily skilled nursing care or therapy from a licensed health care provider for a condition that results from a temporary illness or injury for up to forty-five (45) days subject to an extension of additional days as approved by the Department, or if the resident is under the care of a Rhode Island licensed hospice agency provided the assisted living residence assumes responsibility for ensuring that the required care is received.

b. Residents who are bed bound or in need of assistance of more than one (1) staff person for ambulation may reside in a residence if they are receiving hospice care in accordance with these Regulations. "Resident" shall also mean the resident's agent as designated in writing or legal guardian.

34. "Significant change" means an improvement or decline in the resident's health status, behavior, or cognitive and/or functional abilities that results in a change in the resident's independence or quality of life, including but not limited to:

a. Resident's ability to perform activities of daily living;

b. A change in the resident's behavior or mood resulting in behavioral symptoms that present a threat to the resident's self or others;

c. The elimination of problematic behavior on a sustained basis;

d. Requirements for resident's level of service.

35. "State Fire Marshal" means the Division of the State Fire Marshal, Department of Public Safety, State of Rhode Island.

36. "Supervision" means the supervision requirements of qualified licensed assisted living staff delivering limited health services.

216 R.I. Code R. 216-RICR-40-10-2.3

Amended effective 7/3/2022
Amended effective 8/25/2022
Amended effective 3/18/2024