The following terms shall have the meanings specified:
1. Abuse - The willful, reckless or negligent infliction of injury, unreasonable confinement, intimidation or cruel punishment with resulting physical harm or pain or mental anguish; sexual abuse or exploitation; or the willful deprivation of essential needs. A person may commit abuse by willfully, recklessly or negligently inflicting injury by responding to the actions of a client, if the person's response was excessive or unwarranted under the circumstances. Intimidation, for purposes of this definition, shall include verbal interaction between a person and a client receiving care that is either intended to inflict mental anguish or could reasonably be expected to inflict mental anguish upon the person subjected to such verbal interaction. a. Willful conduct, for purposes of this definition, means intentional or knowing conduct.b. Reckless conduct, for purposes of this definition, means a conscious disregard of a substantial and unjustifiable risk.c. Negligent conduct, for purposes of this definition, means a failure to exercise that degree of care which a reasonable person would exercise in the same situation.2. Active Treatment - A continuous aggressive and consistent program of specialized and generic training, treatment, health services and related services that is directed toward 1) the clients' acquisition of behaviors necessary to function with as much self-determination and independence as possible; and 2) the prevention or deceleration of regression or loss of current optimal functional status. 3. Activities Coordinator - A person who has training and experience with clients with developmental disabilities, and who is responsible for the integration of recreation and leisure activities as part of the clients' active treatment program. 4. Adult - Means any person who has attained eighteen (18) years of age and who is a legally emancipated minor. 5. Advocate - A member of the Office of Advocacy, who is responsible to advise, assist, and protect the personal, legal and financial rights of persons with mental retardation. 6. Ambulatory - Able to walk without assistance from a mechanical device or another human. 7. Annual Plan - See Individual Program Plan. 8. Behavioral Program - A structured program established for a client by the Interdisciplinary Team and written by a qualified professional to develop or enhance desired behaviors or to modify or eliminate inappropriate behaviors. 9. Certified Nursing Assistant (CNA) - A person whose duties are assigned by a registered professional nurse and who has successfully completed a training program or course with a curriculum prescribed by the Maine State Board of Nursing, holds a certificate of training from that program or course and is listed on the Maine Registry of Certified Nursing Assistants 10. Certified Nursing Assistant/Medications (CNA/M) - An experienced certified nursing assistant who has satisfactorily completed the Board of Nursing's standardized medication course for certified nursing assistants. The CNA/M may perform this complex nursing task only under the director onsite supervision of a licensed nurse and only in long term care nursing facilities and state mental health institutions. 11. Client - A person who 1) has been diagnosed with mental retardation or other related developmental disabilities; and 2) is in need of, and is receiving active treatment in an Intermediate Care Facility for Persons with 876 Mental Retardation. 12. Competent Client - A client eighteen (18) years old or older, not under legal guardianship. 13. Department - The Department of Health and Human Services (DHHS). 14. Developmental Disability - A severe chronic disability of a person which: A. Is attributable to a mental or physical impairment or a combination of the two;B. Is manifested before the person reaches age 22;C. Is likely to continue indefinitely;D. Results in substantial functional limitations in three (3) or more of the following areas of major life activity:(2) Receptive and expressive language;(6) Capacity for independent living;(7) Economic self-sufficiency; andE. Reflects the person's need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services, which are individually planned and coordinated. 15. Developmental Trainer - A person in the ICF/MR facility who, during active treatment hours, is responsible for directing and coordinating of direct services employees on their assigned shift. This person must have the required education and/or experience as outlined in Chapter 6. 16. Developmental Training Assistant - A person providing direct services in an ICF/MR facility who has had at least three (3) months experience in working with persons with developmental disabilities. 17. Developmental Training Coordinator - The person who develops and monitors habilitation plans for clients in an ICF/MR facility. He/she may act as assistant to the Qualified Mental Retardation Professional. 18. Director of Food Services - A person who:A. Is a licensed dietitian; orB. Is a licensed dietetic technician or dietary manager or who is certified by the Dietary Managers Association; orC. Is a graduate of a State-approved course that provided at least 90 hours of classroom instruction in food service supervision and has experience as a supervisor in a health care facility with consultation from a licensed dietitian; orD. Has training and experience in food service supervision or management in a military service. The training shall be equivalent in content to the program in paragraph B or C, above, as determined by the Department. 19. Director of Nursing (DON) - A registered professional nurse who has the responsibility for nursing services in a facility. 20. Direct Services Staff - Staff whose primary daily responsibility is to manage, supervise and provide hands-on care to clients in their residential living units. 21. Discharge - The permanent transfer of a client to another residence. 22. Distinct Part - A physically separate unit that is clearly identifiable in the facility, such as an entire ward or contiguous wards, wing, floor or buildings. 23. Division of Licensing and Regulatory Services - The State Agency responsible for licensure and Medicaid certification of ICFs/MR. 24. External or Day Programs - An external program means employment for pay, vocational or pre-vocational activity away from the person's residence, or other habilitative support services that are provided outside of the person's residence. 25. Habilitation - The process by which a person is assisted to acquire and maintain those life skills which: -Enable the person to cope more effectively with the demands of his/her own person and of the environment;
-Raise the level of his/her physical, mental and social ability; and
-Improve his/her sense of well-being.
26. Incident or Accident - Any occurrence which threatens the safety, health or well-being of any person residing in the facility. 27. Individual Program Plan (IPP) - A detailed annual written plan developed by the person and an Interdisciplinary Team, outlining the person's specific needs for training, treatment, education and habilitation services along with the methods to be utilized in providing them. This includes the Person Centered Plan (PCP). 28. Informed Consent - A specific written approval by or on behalf of a resident which is given by the person or the person's legal guardian who is able to evaluate the risks and alternatives of the treatment, program or proposal. 29. Interdisciplinary Team (IDT) - A team of professionals, paraprofessionals and nonprofessionals who represent the disciplines or service areas that are relevant to the identification of the client's needs as described in the comprehensive functional assessment, and who have the expertise to design effective programs to meet those needs. 30. Intermediate Care Facility for Persons with Mental Retardation - Group (ICF/MR Group) - A facility that provides for clients with a diagnosis of mental retardation, or related conditions, who require less than eight (8) hours of licensed nurse supervision per day. 31. Intermediate Care Facility for Persons with Mental Retardation - Nursing (ICF/MR Nursing) - A facility that provides for clients with a diagnosis of mental retardation whose medical/nursing needs require the presence of a licensed nurse at least eight (8) hours per day seven (7) days per week. The facility must, therefore, have nursing coverage twenty-four (24) hours per day to provide adequate services to clients.
32. Institution - Means a facility, a health care facility or an ICF/MR. 33. Laboratory Services - For the purposes of this regulation, "laboratory" means an entity whose work is the microbiological, serological, chemical, hematological, radiobioassay, cytological, immunohematological, pathological or other examination of materials derived from the human body, for the purpose of providing information for the diagnosis, prevention, treatment or assessment of any disease or medical condition. 34. Licensee - Any person, partnership, association or corporation to whom a license to operate an ICF/MR is issued. 35. Medication Error - The incorrect administration of any medication as related to selection of drug, dosage, form, route and time of administration, omission of prescribed medication and unauthorized drug without a physician order. Errors in documentation or charting are considered medication errors. 36. Mistreatment - Behavior or facility practices that result in any type of individual exploitation such as financial, sexual or criminal. 37. Mobile - Ability to move independently from place to place. 38. Mobile Nonambulatory - Unable to walk without assistance, but able to move from place to place with the use of a mechanical device such as a walker, crutches, a wheelchair or a wheeled platform. 39. Neglect - A threat to an individual's health or welfare by physical or mental injury or impairment, deprivation of essential needs or lack of protection from these. 40. Nonambulatory - Unable to walk without assistance and unable to move from place to place without the assistance of another person. 41. Normalization - Means the principle of assisting the person with mental retardation or autism to obtain an existence as close to normal as possible and making available to that person patterns and conditions of everyday life that are as close as possible to the norms and patterns of the mainstream of society. [See Wolfensberger 1980 in Normalization, Integration and Community Services; R.J. Flynn and K.E. Nitsch (eds.). Baltimore, University Park Press] "The use of culturally valued means in order to enable people to lead culturally valued lives." 42. Person - Any individual, corporation, partnership, association, governmental subdivision or any other entity. 43. Person Centered Plan (PCP) - A process where the needs and desires of the person are articulated and identified with as much involvement of the person him/herself as possible. (See IPP). 44. Prescription Drugs - Means those drugs that may be dispensed only on the written prescription of a physician, psychiatrist, dentist, physician assistant and nurse practitioner. 45. Program - Refers to any and all activities that are specified in the individual program plan (IPP)/Annual Plan, and is designed to increase physical, social, emotional or intellectual growth and development. 46. Psychotropic Drug - Those drugs which exert an effect upon the mind and which include anti-depressants, anti-anxiety agents, anti-psychotics and hypnotics. 47. Qualified Mental Retardation Professional (QMRP) - A person who has at least one (1) year of experience working directly with persons with mental retardation or other developmental disabilities; and: A. Has a bachelor's degree in human services; orC. Is a registered nurse. 48. Recreation Therapist - A person who has at least a bachelor's degree in therapeutic recreation. 49. Rehabilitation - The restoration of a client to an optimal functional state through the establishment and implementation of an individually designed program. 50. Resident Assistant - A person in an entry level position who provides, under supervision, direct services to clients in an ICF/MR facility. 51. Residential Living Unit - (Same as Client Living Unit) Those rooms and/or areas clients can be expected to use on a daily basis. The rooms include the living room, dining room, recreation or family room, bathroom and the individual's bedroom. 52. Restraint - Any procedure, equipment or medication used for the purpose of restricting the activity of a client. Examples of restraint include, but are not limited to, the following:A. Time-out room - The use of a room to isolate a client for a limited time and only under limited circumstances;B. Physical Restraint - Any manual method or physical or mechanical device that the client cannot remove easily, and which restricts the free movement of, normal functioning of, or normal access to a portion or portions of a client's body;C. Drugs to Manage Inappropriate Behavior - Medications prescribed and administered for modifying the maladaptive behavior of a client; and D. Chemical Restraint - Chemical restraint is the emergency use of a prescribed medicine, administered involuntarily, when all of the following conditions exist (emergency means a situation in which the use of the restraint is absolutely necessary to prevent imminent harm or danger to the person or others, and is a situation that could not be reasonably anticipated): 1. The medication is used primarily in response to a behavioral incident rather than a medical incident;2. The prescribed medicine represents a dosage which would not otherwise be administered to the client as part of a regular medication regime; and 3. The prescribed medicine impairs the client's ability to do or accomplish his or her usual activities of daily living. 53. Social Role Valorization - "The enablement, establishment, enhancement, maintenance and/or defense of valued social roles for people - particularly for those at value risk - by using, as much as possible, culturally valued means". (A Brief Introduction to Social Role Valorization (2nd ed.) 1992 by Wolf Wolfensberger; Training Institute for Human Service Planning, Leadership and Change Agentry (Syracuse University) (See Normalization) 54. Transfer - The movement of a client between facilities. C.M.R. 10, 144, ch. 118, 2