6 Colo. Code Regs. § 1011-1 Chapter 07, pt. 2

Current through Register Vol. 47, No. 24, December 25, 2024

Part 2 - DEFINITIONS

For purposes of this chapter, the following definitions shall apply, unless the context requires otherwise:

2.1 "Abuse" means any of the following acts or omissions:

(A) The non-accidental infliction of bodily injury, serious bodily injury or death,

(B) Confinement or restraint that is unreasonable under generally accepted caretaking standards, or

(C) Subjection to sexual conduct or contact that is classified as a crime.

2.2 "Administrator" means a person who is responsible for the overall operation, daily administration, management and maintenance of the assisted living residence. The term "administrator" is synonymous with "operator" as that term is used in Title 25, Article 27, Part 1. The term "administrator" includes individuals appointed as an interim administrator in accordance with Part 4.5(A) unless otherwise indicated.

2.3 "Activities of daily living (ADLs)" means those personal functional activities required by an individual for continued well-being, health and safety. As used in this Chapter 7, activities of daily living include, but are not limited to, accompaniment, eating, dressing, grooming, bathing, personal hygiene (hair care, nail care, mouth care, positioning, shaving, skin care), mobility (ambulation, positioning, transfer), elimination (using the toilet) and respiratory care.

2.4 "Advance medical directive" means a written instruction, as defined in Section 15-18.7-102(2), C.R.S., concerning medical treatment decisions to be made on behalf of the resident who provided the instruction in the event that the individual becomes incapacitated.

2.5 "Alternative care facility" means an assisted living residence certified by the Colorado Department of Health Care Policy and Financing to receive Medicaid reimbursement for the services provided pursuant to 10 CCR 2505-10, Section 8.495.

2.6 "Appropriately skilled professional" means an individual that has the necessary qualifications and/or training to perform the medical procedures prescribed by a practitioner. This includes, but is not limited to, registered nurse, licensed practical nurse, physical therapist, occupational therapist, respiratory therapist, and dietitian.

2.7 "Assisted living residence" or "ALR" means:

(A) A residential facility that makes available to three or more adults not related to the owner of such facility, either directly or indirectly through a resident agreement with the resident, room and board and at least the following services: personal services; protective oversight; social care due to impaired capacity to live independently; and regular supervision that shall be available on a twenty-four-hour basis, but not to the extent that regular twenty-four hour medical or nursing care is required, or

(B) A Supportive Living Program residence that, in addition to the criteria specified in the above paragraph, is certified by the Colorado Department of Health Care Policy and Financing to also provide health maintenance activities, behavioral management and education, independent living skills training and other related services as set forth in the supportive living program regulations at 10 CCR 2505-10, Section 8.515.

(C) Unless otherwise indicated, the term "assisted living residence" is synonymous with the terms "health care entity," "health facility," or "facility" as used elsewhere in 6 CCR 1011-1, Standards for Hospitals and Health Facilities.

2.8 "At-risk person" means any person who is 70 years of age or older, or any person who is 18 years of age or older and meets one or more of the following criteria:

(A) Is impaired by the loss (or permanent loss of use) of a hand or foot, blindness or permanent impairment of vision sufficient to constitute virtual blindness;

(B) Is unable to walk, see, hear or speak;

(C) Is unable to breathe without mechanical assistance;

(D) Is a person with an intellectual and developmental disability as defined in Section 25.5-10-202, C.R.S.;

(E) Is a person with a mental health disorder as defined in Section 27-65-102 (11.5), C.R.S.;

(F) Is mentally impaired as defined in Section 24-34-501 (1.3)(b)(II), C.R.S.;

(G) Is blind as defined in Section 26-2-103(3), C.R.S.; or

(H) Is receiving care and treatment for a developmental disability under Article 10.5 of Title 27, C.R.S.

2.9 "Auxiliary aid" means any device used by persons to overcome a physical disability and includes but is not limited to a wheelchair, walker or orthopedic appliance.

2.10 "Care plan" means a written description, in lay terminology, of the functional capabilities of an individual, the individual's need for personal assistance, service received from external providers, and the services to be provided by the facility in order to meet the individual's needs. In order to deliver person-centered care, the care plan shall take into account the resident's preferences and desired outcomes. "Care plan" may also mean a service plan for those facilities which are licensed to provide services specifically for the mentally ill.

2.11 "Caregiver" means a parent, spouse, or other family member or friend of a resident who provides care to the resident.

2.12 "Caretaker neglect" means neglect that occurs when adequate food, clothing, shelter, psychological care, physical care, medical care, habilitation, supervision or any other service necessary for the health or safety of an at-risk person is not secured for that person or is not provided by a caretaker in a timely manner and with the degree of care that a reasonable person in the same situation would exercise, or a caretaker knowingly uses harassment, undue influence or intimidation to create a hostile or fearful environment for an at-risk person.

2.13 "Certified nurse medication aide (CNA-Med)" means a certified nurse aide who meets the qualifications specified in 3 CCR 716-1, Rule 1.19, and who is currently certified as a nurse aide with medication aide authority by the State Board of Nursing.

2.14 "Communicable disease" means the same as the definition set forth in Section 25-1.5-102(l)(a)(IV), C.R.S.

2.15 "Compassionate care visit" means a visit with a friend or family member that is necessary to meet the physical or mental needs of a resident when the resident is exhibiting signs of physical or mental distress, including:

(A) End-of-life situations;

(B) Adjustment support after moving to a new facility or environment;

(C) Emotional support after the loss of a friend or family member;

(D) Physical support after eating or drinking issues, including weight loss or dehydration; or

(E) Social support after frequent crying, distress, or depression.

A compassionate care visit includes a visit from a clergy member or layperson offering religious or spiritual support or other persons requested by the resident for the purpose of a compassionate care visit.

2.16 "Controlled substance" means any medication that is regulated and classified by the Controlled Substances Act at 21 U.S.C., § 812 as being schedule II through V.

2.17 "Deficiency" means a failure to fully comply with any statutory and/or regulatory requirements applicable to a licensed assisted living residence.

2.18 "Deficiency list" means a listing of deficiency citations which contains a statement of the statute or regulation violated, and a statement of the findings, with evidence to support the deficiency.

2.19 "Dementia diseases and related disabilities" means a condition where mental ability declines and is severe enough to interfere with an individual's ability to perform everyday tasks. Dementia diseases and related disabilities includes Alzheimer's disease, mixed dementia, Lewy body dementia, vascular dementia, frontotemporal dementia, and other types of dementia.

2.20 "Department" means the Colorado Department of Public Health and Environment or its designee.

2.21 "Disproportionate share facilities" means facilities that serve a disproportionate share of low income residents as evidenced by having qualified for federal or state low income housing assistance; planning to serve low income residents with incomes at or below 80 percent of the area median income; and submitting evidence of such qualification, as required by the Department.

2.22 "Discharge" means termination of the resident agreement and the resident's permanent departure from the facility.

2.23 "Egress alert device" means a device that is affixed to a structure or worn by a resident that triggers a visual or auditory alarm when a resident leaves the building or grounds. Such devices shall only be used to assist staff in redirecting residents back into the facility when staff are alerted to a resident's departure from the facility as opposed to restricting the free movement of residents.

2.24 "Emergency contact" means one of the individuals identified on the face sheet of the resident record to be contacted in the case of an emergency.

2.25 "Essential caregiver" means a designated individual that meets an essential need for the resident by assisting with activities of daily living or positively influencing the behavior of the resident. The goal of such a designation is to help ensure residents continue to receive individualized, person-centered care when limitations on general visitors are in place. Each resident's care plan should include services provided by the essential caregiver.

2.26 "Exploitation" means an act or omission committed by a person who:

(A) Uses deception, harassment, intimidation or undue influence to permanently or temporarily deprive an at-risk person of the use, benefit or possession of anything of value;

(B) Employs the services of a third party for the profit or advantage of the person or another person to the detriment of the at-risk person;

(C) Forces, compels, coerces or entices an at-risk person to perform services for the profit or advantage of the person or another person against the will of the at-risk person; or

(D) Misuses the property of an at-risk person in a manner that adversely affects the at-risk person's ability to receive health care, health care benefits, or to pay bills for basic needs or obligations.

2.27 "External services" means personal services and protective oversight services provided to a resident by family members or healthcare professionals who are not employees, contractors, or volunteers of the facility. External service providers include, but are not limited to, home health, hospice, private pay care providers, caregivers as defined in Part 2.11, and essential caregivers as defined in Part 2.25.

2.28 "High Medicaid utilization facility" means a facility that has no less than 35 percent of its licensed beds occupied by Medicaid enrollees as indicated by complete and accurate fiscal year claims data; and served Medicaid clients and submitted claims data for a minimum of nine (9) months of the relevant fiscal year.

2.29 "Hospice care" means a comprehensive set of services identified and coordinated by an external service provider in collaboration with the resident, family and assisted living residence to provide for the physical, psychosocial, spiritual and emotional needs of a terminally ill resident as delineated in a care plan. Hospice care services shall be available 24 hours a day, seven days a week pursuant to the requirements for hospice providers set forth in 6 CCR 1011-1, Chapter 21, Hospices.

2.30 "Interim administrator" means an individual meeting the requirements at Parts 6.3 and 6.5(A), who is appointed in accordance with Part 4.5(A) to fulfill the responsibilities of the administrator position while the assisted living residence does not have an individual in the administrator position.

2.31 "Involuntary discharge" means any discharge initiated by the assisted living residence.

2.32 "Licensee" means the person or entity to whom a license is issued by the Department pursuant to Section 25-1.5-103 (1) (a), C.R.S., to operate an assisted living residence within the definition herein provided. For the purposes of this Chapter 7, the term "licensee" is synonymous with the term "owner."

2.33 "Local ombudsman" means the same as the definition set forth in Section 25-27-102 (6.5), C.R.S.

2.34 "Medical waste" means waste that may contain disease causing organisms or chemicals that present potential health hazards such as discarded surgical gloves, sharps, blood, human tissue, prescription or over-the-counter pharmaceutical waste, and laboratory waste.

2.35 "Medication administration" means assisting a person in the ingestion, application, inhalation, or, using universal precautions, rectal or vaginal insertion of medication, including prescription drugs, according to the legibly written or printed directions of the attending physician or other authorized practitioner, or as written on the prescription label, and making a written record thereof with regard to each medication administered, including the time and the amount taken.

(A) Medication administration does not include:

(1) Medication monitoring; or

(2) Self-administration of prescription drugs or the self-injection of medication by a resident.

(B) Medication administration by a qualified medication administration person (QMAP) does not include judgement, evaluation, assessments, or injecting medication (unless otherwise authorized by law in response to an emergent situation.)

2.36 "Medication monitoring" means:

(A) Reminding the resident to take medication(s) at the time ordered by the authorized practitioner;

(B) Handing to a resident a container or package of medication that was lawfully labeled previously by an authorized practitioner for the individual resident;

(C) Visual observation of the resident to ensure compliance;

(D) Making a written record of the resident's compliance with regard to each medication, including the time taken; and

(E) Notifying the authorized practitioner if the resident refuses or is unable to comply with the practitioner's instructions regarding the medication.

2.37 "Mistreatment" means abuse, caretaker neglect, or exploitation.

2.38 "Name-based judicial record check" means a background check performed using judicial department records that includes an individual's conviction and final disposition of case records.

2.39 "Nurse" means an individual who holds a current unrestricted license to practice pursuant to Article 255 of Title 12, C.R.S., and is acting within the scope of such authority.

2.40 "Nursing services" means support for activities of daily living, the administration of medications, and the provision of treatment by a nurse in accordance with orders from the resident's practitioner.

2.41 "Owner" means the person or business entity that applies for assisted living residence licensure and/or in whose name the license is issued.

2.42 "Palliative care" means specialized medical care for people with serious illnesses. This type of care is focused on providing residents with relief from the symptoms, pain and stress of serious illness, whatever the diagnosis. The goal is to improve quality of life for both the resident and the family. Palliative care is provided by a team of physicians, nurses and other specialists who work with a resident's other health care providers to provide an extra layer of support. Palliative care is appropriate at any age and at any stage in a serious illness and can be provided together with curative treatment. Unless otherwise indicated, the term "palliative care" is synonymous with the terms "comfort care," "supportive care," and similar designations.

2.43 "Patient or resident with a disability" means an individual who needs assistance to effectively communicate with assisted living residence staff, make health-care decisions, or engage in activities of daily living due to a disability such as:

(A) A physical, intellectual, behavioral, or cognitive disability;

(B) Deafness, being hard of hearing, or other communication barriers;

(C) Blindness;

(D) Autism spectrum disorder; or

(E) Dementia.

2.44 "Personal care worker" means an individual who:

(A) Provides personal services for any resident; and

(B) Is not acting in his or her capacity as a health care professional under Articles 240, 255, 270, or 285 of Title 12 of the Colorado Revised Statutes.

2.45 "Personal services" means those services that an assisted living residence and its staff provide for each resident including, but not limited to:

(A) An environment that is sanitary and safe from physical harm,

(B) Individualized social supervision,

(C) Assistance with transportation, and

(D) Assistance with activities of daily living.

2.46 "Plan of correction" means a written plan to be submitted by an assisted living residence to the Department for approval, detailing the measures that shall be taken to correct all cited deficiencies.

2.47 "Practitioner" means a physician, physician assistant or advance practice nurse (i.e., nurse practitioner or clinical nurse specialist) who has a current, unrestricted license to practice and is acting within the scope of such authority.

2.48 "Pressure sore" (also called pressure ulcer, decubitus ulcer, bed-sore or skin breakdown) means an area of the skin or underlying tissue (muscle, bone) that is damaged due to loss of blood flow to the area. Symptoms and medical treatment of pressure sores are based upon the level of severity or "stage" of the pressure sore.

(A) Stage 1 affects only the upper layer of skin. Symptoms include pain, burning, or itching and the affected area may look or feel different from the surrounding skin.

(B) Stage 2 goes below the upper surface of the skin. Symptoms include pain, broken skin, or open wound that is swollen, warm, and/or red, and may be oozing fluid or pus.

(C) Stage 3 involves a sore that looks like a crater and may have a bad odor. It may show signs of infection such as red edges, pus, odor, heat, and/or drainage.

(D) Stage 4 is a deep, large sore. The skin may have turned black and show signs of infection such as red edges, pus, odor, heat and/or drainage. Tendons, muscles, and bone may be visible.

2.49 "Protective oversight" means guidance of a resident as required by the needs of the resident or as reasonably requested by the resident, including the following:

(A) Being aware of a resident's general whereabouts, although the resident may travel independently in the community; and

(B) Monitoring the activities of the resident while on the premises to ensure the resident's health, safety and well-being, including monitoring the resident's needs and ensuring that the resident receives the services and care necessary to protect the resident's health, safety, and well-being.

2.50 "Qualified medication administration person" or "QMAP" means an individual who passed a competency evaluation administered by the Department before July 1, 2017, or passed a competency evaluation administered by an approved training entity on or after July 1, 2017, and whose name appears on the Department's list of persons who have passed the requisite competency evaluation.

2.51 "Renovation" means the moving of walls and reconfiguring of existing floor plans. It includes the rebuilding or upgrading of major systems, including but not limited to: heating, ventilation, and electrical systems. It also means the changing of the functional operation of the space.

(A) Renovations do not include "minor alterations," which are building construction projects which are not additions, which do not affect the structural integrity of the building, which do not change functional operation, and/or which do not add beds or capacity above what the facility is limited to under the existing license.

2.52 "Resident's legal representative" means one of the following:

(A) The legal guardian of the resident, where proof is offered that such guardian has been duly appointed by a court of law, acting within the scope of such guardianship;

(B) An individual named as the agent in a power of attorney (POA) that authorizes the individual to act on the resident's behalf, as enumerated in the POA;

(C) An individual selected as a proxy decision-maker pursuant to Section 15-18.5-101, C.R.S., et seq., to make medical treatment decisions. For the purposes of this regulation, the proxy decision-maker serves as the resident's legal representative for the purposes of medical treatment decisions only; or

(D) A conservator, where proof is offered that such conservator has been duly appointed by a court of law, acting within the scope of such conservatorship.

2.53 "Restraint" means any method or device used to involuntarily limit freedom of movement including, but not limited to, bodily physical force, mechanical devices, chemicals, or confinement.

2.54 "Secure environment" means any grounds, building or part thereof, method, or device that prohibits free egress of residents. An environment is secure when the right of any resident thereof to move outside the environment during any hours is limited.

2.55 "Self-administration" means the ability of a resident to take medication independently without any assistance from another person.

2.56 "Staff" means employees and contracted individuals intended to substitute for or supplement employees who provide personal services. "Staff" does not include individuals providing external services, as defined herein.

2.57 "State long-term care ombudsman" means the same as the definition set forth in Section 25-27-102(12), C.R.S.

2.58 "Therapeutic diet" means a diet ordered by a practitioner or registered dietician as part of a treatment of disease or clinical condition, or to eliminate, decrease, or increase specific nutrients in the diet. Examples include, but are not limited to, a calorie counted diet; a specific sodium gram diet; and a cardiac diet.

2.59 "Transfer" means being able to move from one body position to another. This includes, but is not limited to, moving from a bed to a chair or standing up from a chair to grasp an auxiliary aid.

2.60 "Volunteer" means an unpaid individual providing personal services on behalf of and/or under the control of the assisted living residence. "Volunteer" does not include individuals visiting the assisted living residence for the purposes of resident engagement.

6 CCR 1011-1 Chapter 07, pt. 2

46 CR 24, December 25, 2023, effective 11/15/2023, exp. 3/14/2024 (Emergency)

46 CR 24, December 25, 2023, effective 1/14/2024