Part I. General Provisions
22VAC40-61-10. Definitions.
The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"Activities of daily living" or "ADLs" means bathing, dressing, toileting, transferring, bowel control, bladder control, eating, and feeding. A person's degree of independence in performing these activities is a part of determining required care needs and necessary services.
"Administer medication" means to open a container of medicine or to remove the ordered dosage and to give it to the participant for whom it is ordered in such a manner as is ordered or is appropriate.
"Adult" means any person 18 years of age or older.
"Adult day center" or "center" means any facility that is either operated for profit or that desires licensure and that provides supplementary care and protection during only a part of the day to four or more adults who are aged or infirm or who have disabilities and who reside elsewhere, except (i) a facility or portion of a facility licensed by the State Board of Health or the Department of Behavioral Health and Developmental Services and (ii) the home or residence of an individual who cares for only persons related to the individual by blood or marriage. Included in this definition are any two or more places, establishments, or institutions owned, operated, or controlled by a single entity and providing such supplementary care and protection to a combined total of four or more adults who are aged or infirm or who have disabilities.
"Advance directive" means (i) a witnessed written document, voluntarily executed by the declarant in accordance with the requirements of § 54.1-2983 of the Code of Virginia or (ii) a witnessed oral statement, made by the declarant subsequent to the time the declarant is diagnosed as suffering from a terminal condition and in accordance with the provisions of § 54.1-2983 of the Code of Virginia.
"Ambulatory" means the condition of a participant who is physically and mentally capable of self-preservation by evacuating in response to an emergency to a refuge area as described in 13VAC5-63, the Virginia Uniform Statewide Building Code, without the assistance of another person, or from the structure itself without the assistance of another person if there is no such refuge area within the structure, even if such participant may require the assistance of a wheelchair, walker, cane, prosthetic device, or a single verbal command to evacuate.
"Business entity" means an individual or sole proprietor, association, partnership, limited liability company, business trust, corporation, public agency, or religious organization.
"Chapter" or "this chapter" means these regulations, that is, Standards and Regulations for Licensed Adult Day Centers, 22VAC40-61, unless noted otherwise.
"Chemical restraint" means a psychopharmacologic drug that is used for discipline or convenience and not required to treat the participant's medical symptoms or symptoms from mental illness or intellectual disability and that prohibits an individual from reaching the participant's highest level of functioning.
"Communicable disease" means an illness that spreads from one person to another or from an animal to a person.
"CPR" means cardiopulmonary resuscitation.
"Department" means the Virginia Department of Social Services.
"Dietary supplement" means a product intended for ingestion that supplements the diet, is labeled as a dietary supplement, is not represented as a sole item of a meal or diet, and contains a dietary ingredient, for example, vitamins, minerals, amino acid, herbs or other botanicals, dietary substances (such as enzymes) and concentrates, metabolites, constituents, extracts, or combinations of the preceding types of ingredients. "Dietary supplements" may be found in many forms, such as tablets, capsules, liquids, or bars.
"Direct care staff" means supervisors, assistants, aides, or other staff of a center who assist participants in the performance of personal care or ADLs.
"Director" means the qualified person who has been delegated responsibility for the programmatic and administrative functions of the adult day center.
"Electronic record" means a record created, generated, sent, communicated, received, or stored by electronic means.
"Electronic signature" means an electronic sound, symbol, or process attached to or logically associated with a record and executed or adopted by a person with the intent to sign the record.
"Good character and reputation" means findings have been established that the individual (i) maintains business or professional and community relationships that are characterized by honesty, fairness, truthfulness, and dependability and (ii) has a history or pattern of behavior that demonstrates the individual is suitable and able to administer a program for the care, supervision, and protection of adults.
"Legal representative" means a person legally responsible for representing or standing in the place of the participant for the conduct of the participant's affairs. "Legal representative" may include a guardian, conservator, attorney-in-fact under durable power of attorney, trustee, or other person expressly named by a court of competent jurisdiction or the participant as the participant's agent in a legal document that specifies the scope of the representative's authority to act. A legal representative may only represent or stand in the place of a participant for the function for which the legal representative has legal authority to act. A participant is presumed competent and is responsible for making all health care, personal care, financial, and other personal decisions that affect the participant's life unless a representative with legal authority has been appointed by a court of competent jurisdiction or has been appointed by the participant in a properly executed and signed document. A participant may have different legal representatives for different functions. For any given standard, the term "legal representative" applies solely to the legal representative with the authority to act in regard to the function relevant to that particular standard.
"Licensed health care professional" means any health care professional currently licensed by the Commonwealth of Virginia to practice within the scope of that health care professional's profession, such as a nurse practitioner, registered nurse, licensed practical nurse (nurses may be licensed or hold multistate licensure pursuant to § 54.1-3000 of the Code of Virginia), clinical social worker, dentist, occupational therapist, pharmacist, physical therapist, physician, physician assistant, psychologist, and speech-language pathologist. Responsibilities of physicians referenced in this chapter may be implemented by nurse practitioners or physician assistants in accordance with their protocols or practice agreements with their supervising physicians and in accordance with the law.
"Licensee" means the business entity to whom a license is issued and who is legally responsible for compliance with the laws and regulations related to the center. A license may not be issued in the name of more than one business entity.
"Mandated reporter" means a person specified in § 63.2-1606 of the Code of Virginia who is required to report matters giving reason to suspect abuse, neglect, or exploitation of an adult.
"Mental impairment" means a disability that reduces an individual's ability to reason logically, make appropriate decisions, or engage in purposeful behavior.
"Nonambulatory" means the condition of a participant who by reason of physical or mental impairment is not capable of self-preservation without the assistance of another person.
"Participant" means an adult who takes part in the program of care and receives services from the center.
"Physical restraint" means any manual method or physical or mechanical device, material, or equipment attached or adjacent to the participant's body that the participant cannot remove easily, which restricts freedom of movement or access to the participant's body.
"Physician" means an individual licensed to practice medicine or osteopathic medicine in any of the 50 states or the District of Columbia.
"Qualified" means having appropriate training and experience commensurate with assigned responsibilities, or if referring to a professional, possessing an appropriate degree or having documented equivalent education, training, or experience.
"Significant change" means a change in a participant's condition that is expected to last longer than 30 days. "Significant change" does not include short-term changes that resolve with or without intervention, a short-term acute illness or episodic event, or a well-established, predictive, cyclic pattern of clinical signs and symptoms associated with a previously diagnosed condition where an appropriate course of treatment is in progress.
"Staff" or "staff person" means personnel working at a center who are compensated or have a financial interest in the center, regardless of role, service, age, function, or duration of employment at the center. "Staff" or "staff person" also includes those individuals hired through a contract with the center to provide services for the center.
"Standard precautions" means a set of basic infection prevention practices intended to prevent transmission of infectious diseases from one person to another. These practices are applied to every person at every contact to ensure that transmission of disease does not occur.
"Volunteer" means a person who works at the center who is not compensated. "Volunteer" does not include a person who, either as an individual or as part of an organization, is only present at or facilitates group activities on an occasional basis or for special events.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019; amended, Virginia Register Volume 40, Issue 24, eff. August 14, 2024.
22VAC40-61-20. Requirements of law and applicability.
A. Chapter 17 (§ 63.2-1700 et seq.) of Title 63.2 of the Code of Virginia includes requirements of law relating to licensure, including licensure of adult day centers.
B. This chapter applies to adult day centers as defined in § 63.2-100 of the Code of Virginia and in 22VAC40-61-10.
C. All programs, processes, plans, policies, or procedures required by this chapter must be in writing and must be implemented.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019; amended, Virginia Register Volume 40, Issue 24, eff. August 14, 2024.
22VAC40-61-30. Program of care.
There shall be a program of care that:
1. Meets the participants' physical, intellectual, emotional, psychological, and spiritual needs;
2. Promotes the participants' highest level of functioning;
3. Provides protection, guidance, and supervision;
4. Promotes a sense of security, self-worth, and independence;
5. Promotes the participants' involvement with activities and services; and
6. Reduces risk in the caregiving environment.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019.
22VAC40-61-40. [Reserved].
Statutory Authority
§ of the Code of Virginia.
Historical Notes
Reserved, Virginia Register Volume 36, Issue 2, eff. December 29, 2019.
22VAC40-61-50. Participant rights and responsibilities.
A. All participants shall be guaranteed the following:
1. The right to be treated as an adult, with consideration, respect, and dignity, including privacy in treatment and care of personal needs.
2. The right to participate in a program of services and activities designed to interest and engage the participant and encourage independence, learning, growth, awareness, and joy in life.
3. The right to self-determination within the center setting, including the opportunity to:
a. Participate in developing or changing one's plan of care;
b. Decide whether or not to participate in any given activity;
c. Be involved to the extent possible in program planning and operation;
d. Refuse treatment and be informed of the consequences of such refusal; and
e. End participation at the center at any time.
4. The right to a thorough initial assessment, development of an individualized participant plan of care, and a determination of the required care needs and necessary services.
5. The right to be cared for in an atmosphere of sincere interest and concern in which needed support and services are provided.
6. The right to a safe, secure, and clean environment.
7. The right to receive nourishment and assistance with meals as necessary to maximize functional abilities and quality and enjoyment of life.
8. The right to confidentiality and the guarantee that no personal or medical information or photographs will be released to persons not authorized under law to receive it without the participant's written consent.
9. The right to voice or file grievances about care or treatment and to make recommendations for changes in the policies and services of the center, without coercion, discrimination, threats, or reprisal for having voiced or filed such grievances or recommendations.
10. The right to be fully informed, as documented by the participant's written acknowledgment, of all participant rights and responsibilities and of all rules and regulations regarding participant conduct and responsibilities.
11. The right to be free from harm or fear of harm, including physical or chemical restraint, isolation, excessive medication, and abuse or neglect.
12. The right to be fully informed, at the time of acceptance into the program, of services and activities available and related charges.
13. The right to communicate with others and be understood by them to the extent of the participant's capability.
B. The rights of participants shall be printed in at least 14-point type and posted conspicuously in a public place in the center.
C. The center shall make its policies and procedures available and accessible to participants, relatives, agencies, and the general public.
D. Each center shall post the name and telephone number of the appropriate regional licensing administrator of the department; the Adult Protective Services toll-free telephone number; the toll-free telephone number of the Virginia Long-Term Care Ombudsman Program and any local ombudsman program servicing the area; and the toll-free telephone number of the disAbility Law Center of Virginia.
E. The rights and responsibilities of participants shall be reviewed annually with each participant, or, if a participant is unable to fully understand and exercise his rights and responsibilities, the annual review shall include his family member or his legal representative. Evidence of this review shall include the date of the review and the signature of the participant, family member, or legal representative and shall be included in the participant's file.
F. A participant shall be assumed capable of understanding and exercising these rights and responsibilities unless a physician determines otherwise and documentation is contained in the participant's record.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019.