PURPOSE: This rule defines terms and explains usage rules for terms used in licensure procedures and rules developed under sections 630.705–630.760, RSMo for all licensed community residential facilities and day programs.

1. (1) Unless the context clearly indicates otherwise, the terms defined in sections 630.005, 632.005 and 633.005, RSMo and as used in 9 CSR 40 are incorporated by reference as if set out in this rule.

2. (2) The following additional words and terms, as used in 9 CSR 40, mean:

   1. (A) Administrative agent, as set forth in 9 CSR 30-4.031, an agency and its approved designee(s) authorized by the Division of Comprehensive Psychiatric Services as an entry and exit point into the state mental health service delivery system of a geographic service area defined by the division;
   2. (B) Applicant, an individual, partnership, association, corporation or governmental entity which has applied to the department for a license or program license;
   3. (C) Aversive stimulus, an object or event, excluding restraint, protective devices and time-out, that is identified as punitive, painful or degrading;
   4. (D) Board of inquiry, one (1) or more employees of a state hospital or regional center assigned to investigate allegations of abuse or neglect in a licensed community residential facility or day program;
   5. (E) Central investigative unit, department staff in the Office of Departmental Affairs assigned to investigate allegations of abuse and neglect under special circumstances;

   6. (F) Chemical restraints, as defined in section 630.005, RSMo, are drugs which are prescribed or administered to temporarily restrain a client or resident who presents a

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likelihood of serious physical harm to him/herself or others;

1. (G) Class I neglect, failure of an employee to provide reasonable and necessary services to maintain the physical and mental health of any client or resident when that failure presents either imminent danger to the health, safety or welfare of a client or resident, or a substantial probability that death or physical injury would result;
2. (H) Class II neglect, failure of an employee to provide reasonable or necessary services to a client or resident according to the individualized treatment or habilitation plan, if feasible, or according to acceptable standards of care;
3. (I) Community residential facility, any premises where residential prevention, evaluation, care, treatment or habilitation are provided for persons affected by mental retardation, developmental disabilities, mental illness or mental disorders, except for a person's dwelling;
4. (J) Day program, a place providing a series of interventions, activities and instruction delivered by qualified staff for the purpose of evaluation, treatment, habilitation or rehabilitation for persons with mental disorders, mental illness, mental retardation or developmental disabilities. These interventions, activities and instruction occur on a regularly scheduled basis at least two (2) days a week for three (3) hours or more but less than twenty-four (24) hours in each daily period. The provision of evaluation, treatment, habilitation and rehabilitation does not include the following types of services and facilities: summer camps; on-site job training programs; professional service facilities, such as offices of physicians, physical therapists; and occupational therapists and programs operating solely for social welfare functions including, but not limited to, nutrition and meal sites, food or clothing distribution or provision of temporary safe shelter. Also excluded is any adult day care program, day care home or day nursery licensed by the Department of Social Services or the Department of Health or exempt from licensing under section 660.405 or 210.211, RSMo which provides only day care and does not offer nor holds itself out as offering services normally subject to licensing by the Department of Mental Health;
5. (K) Department facility, a facility operated by the department or designated by the department as a department facility;
6. (L) Dual diagnosis, a person who has both a diagnosis of mental retardation and mental illness. A facility serving a person with a dual diagnosis is subject to the rules regulating 9 CSR 40-1

mental retardation, regardless of which diagnosis is primary;

1. (M) Family living arrangement, a residential facility operating in the owned or leased permanent residence of the licensee, serving no more than three (3) residents who are integrated into the licensee’s family unit. The facility does not normally use direct-care staff other than members of the household. However, volunteer or paid staff may be used to provide direct-supervisory care in the facility for occasional weekends, evenings, vacations, and the like, as relief for the licensee;
2. (N) Group home, a residential facility serving nine (9) or fewer residents, similar in appearance to a single-family dwelling and providing basic health supervision, habilitation training in skills of daily and independent living and community integration, and social support. Group homes do not include family living arrangements or individualized supported living;
3. (O) Head of supervising facility, the superintendent of a state hospital or regional center director in whose region an allegation of abuse or neglect is under investigation;
4. (P) Individualized habilitation plan (IHP), a document which sets forth habilitation goals and objectives for clients or residents, and which details the habilitation program as required by 9 CSR 40-3.135, 9 CSR 40- 4.135 and 9 CSR 40-9.135;
5. (Q) Individualized program plan, a document which sets forth program goals and objectives for clients or residents and which details the program objectives as required by 9 CSR 40-3.135, 9 CSR 40-4.135 and 9 CSR 40-9.135;
6. (R) Individualized treatment plan (ITP), a document which sets forth treatment goals and objectives for clients or residents, and which details the treatment program as required by 9 CSR 40-3.135, 9 CSR 40- 4.135 and 9 CSR 40-9.135;
7. (S) Isolation, removing an individual from a social setting to prevent spread of contagious disease;
8. (T) Latch-key program, day care supervisory services to persons who are mentally retarded before and after school or day program activities but is not designed to pursue objectives within an IHP;
9. (U) License, written notification that a residential facility or day program complies with licensing requirements to serve clients;
10. (V) Licensee, an individual, partnership, association, corporation or governmental entity which has received from the department a license or program license for the operation of a community residential facility or day program;
11. (W) Mechanical restraints, any device, instrument or physical object used to confine or otherwise limit a client’s or resident’s freedom of movement except when necessary for orthopedic, surgical and other medical purposes;
12. (X) Mechanical supports, supportive devices used in normative situations to achieve proper body position and balance; these are not restraints;
13. (Y) Medical treatment, any activity for curing or healing, or for relieving pain, including physical therapy;

14. (Z) Mental health professional (MHP)—

    1. 1. A physician licensed under Missouri

law to practice medicine or osteopathy and with training in mental health services or one (1) year of experience, under supervision, in treating problems related to mental illness or specialized training;

1. 2. A psychiatrist, a physician licensed

under Missouri law who has successfully completed a training program in psychiatry approved by the American Medical Association, the American Osteopathic Association or other training program identified as equivalent by the department;

1. 3. A psychologist licensed under

Missouri law to practice psychology with specialized training in mental health services;

1. 4. A professional counselor licensed

under Missouri law to practice counseling and with specialized training in mental health services;

1. 5. A licensed clinical social worker with

a master's degree in social work from an accredited program and with specialized training in mental health services;

1. 6. A psychiatric nurse, a registered pro-

fessional nurse licensed under Chapter 335, RSMo with at least two (2) years of experience as a registered nurse in a psychiatric setting or a master's degree in psychiatric nursing;

1. 7. An individual possessing a master's

or doctorate degree in counseling and guidance, rehabilitation counseling, vocational counseling, psychology, pastoral counseling or family therapy or related field who has successfully completed a practicum or has one (1) year of experience under the supervision of a mental health professional; and

1. 8. An occupational therapist certified by

the American Occupational Therapy Certification Board, registered in Missouri, has a bachelor’s degree and has completed a practicum in a psychiatric setting and has one (1) year of experience in a psychiatric setting, or has a master’s degree and has completed either a practicum in a psychiatric setting or has one (1) year of experience in a psychiatric setting;

1. (AA) Nonambulatory, unable to walk independently without assistance of a mechanical device or another person;
2. (BB) Occupant, any person excluding staff, who lives at a community residential facility. This includes, but is not limited to, residents, the children of staff, friends and relatives;
3. (CC) Person’s dwelling, the private home of a person providing care, treatment and habilitation or rehabilitation to a relative or a home occupied by a client or resident who functions independently of protective oversight services;

4. (DD) Physical abuse—

   1. 1. Purposefully beating, striking,

wounding or injuring any client or resident; or

1. 2. In any manner whatsoever mistreating

or maltreating a client or resident in a brutal or inhumane manner. Physical abuse includes handling a client or resident with any more force than is reasonable or apparently necessary for a client’s or resident’s proper control, treatment or management;

1. (EE) Physical restraint, physical holding involving a restriction on an individual’s voluntary movement to temporarily restrain an agitated, violent or aggressive client or resident who presents a likelihood of serious physical harm to him/herself or others;
2. (FF) Probationary license, written authorization to continue service delivery for a specified period of time to enable a licensee to achieve compliance with the department’s licensing requirements as set forth in a consent agreement between the department and the licensee;
3. (GG) Program license, written notification that a community residential facility or day program which already has a license, temporary operating permit or probationary license from the Department of Social Services under sections 198.006—198.096, RSMo also meets the department’s licensing requirements relative to admission criteria, care, treatment and habilitation or rehabilitation needs of residents or clients;
4. (HH) Protective device, mitts, helmets, bed rails, splints, wheelchairs and crib nets;
5. (II) Protective oversight, continuous awareness of a resident’s functioning, the resident’s whereabouts, the ability to intervene if a crisis arises for the resident, supervision in nutrition or medication or actual provision of care and a twenty-four (24)-hour responsibility for the welfare of the resident;
6. (JJ) Psychiatric group home, a community residential facility with less than sixteen (16) residents providing twenty-four (24)-hour accommodations, psychiatric supervision, board, storage and distribution of medications, protective oversight and psychosocial rehabilitation for residents who can benefit from an intense, highly structured treatment setting;
7. (KK) Psychiatric Group Home II, a residential treatment program for young adults who are mentally ill, between the ages of eighteen to twenty-one (18–21), inclusive, licensed by the Department of Mental Health for eight to ten (8–10) residents;

8. (LL) Qualified mental retardation professional (QMRP). The following represents the minimum requirements for individuals to be considered QMRPs:

   1. 1. Psychologist, a person with at least a

master’s degree in psychology from an accredited school with at least one (1) year of experience in working directly with persons with mental retardation or other developmental disabilities;

1. 2. Physician, a doctor of medicine or

osteopathy, who has at least one (1) year of experience in working directly with persons with mental retardation or other developmental disabilities;

1. 3. Social worker, a person who holds a

graduate degree from a school of social work accredited or approved by the Council on Social Work Education (CSWE) or another comparable body, or a person who holds a bachelor of social work degree from a college or university accredited or approved by the CSWE or another comparable body. The social worker must also have at least one (1) year of experience in working directly with persons with mental retardation or other developmental disabilities;

1. 4. Occupational therapist, a person eli-

gible for certification by the American Occupational Therapy Association or another comparable body who has at least one (1) year of experience in working directly with persons with mental retardation or other developmental disabilities;

1. 5. Physical therapist, a person who is

eligible for certification by the American Physical Therapy Association or another comparable body and who has at least one (1) year of experience in working directly with persons with mental retardation or other developmental disabilities;

1. 6. Speech pathologist or audiologist, a

person who is eligible for a certificate of clinical competence in speech-language pathology or audiology granted by the Speech- Language-Hearing Association or another comparable body; or a person who meets the educational requirements for certification and who is in the process of accumulating the supervised experience required for certification. A speech pathologist or audiologist must also have at least one (1) year of experience in working directly with persons with

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mental retardation or other developmental disabilities;

1. 7. Registered nurse, a person who is a

registered nurse and who has at least one (1) year of experience in working directly with persons with mental retardation or other developmental disabilities;

1. 8. Professional recreation staff member,

a person who has a bachelor’s degree in recreation or in a specialty area such as art, dance, music or physical education and who has at least one (1) year of experience in working directly with persons with mental retardation or other developmental disabilities; and

1. 9. Human services professional, a per-

son who has at least a bachelor’s degree in a human services field (including, but not limited to, psychology, sociology, rehabilitation counseling and special education) and who has at least one (1) year of experience in working directly with persons with mental retardation or other developmental disabilities;

1. (MM) Research, intervention or interaction on clients or residents to test hypotheses, derive generalizations to test new interventions classified as experimental whether behavioral, psychological, biomedical or pharmacological and shall include the review of current or past client or resident personally identifiable records, surveying clients or residents, and use of client or resident personally identifiable statistics;
2. (NN) Residential center, a residential facility serving ten (10) or more residents and providing social support, health supervision and habilitation training in skills of daily living;
3. (OO) Seclusion, placement alone in a locked room;
4. (PP) Semi-independent living arrangement, a community residential facility composed of individual living units or apartments each of which provides bedroom space, living space and a kitchen for up to three (3) residents and where protective oversight is provided by staff living on-site or in close proximity, normally in the same building, but not in the same living unit as residents;

5. (QQ) Sexual abuse, any touching, directly or through clothing, of the genitals, anus or breasts of a client or resident for sexual purpose. Sexual purpose means for the arousing or gratifying of anyone’s sexual desires. This definition includes the employee touching a resident and the employee causing the client or resident to touch the employee. It includes fondling through clothing. It also includes aiding and abetting sexual abuse between clients or residents or failing to exercise duty

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to stop or prevent sexual abuse between clients or residents;

1. (RR) Substantial compliance, a facility may be found in substantial compliance when deficiencies do not involve:

   1. 1. Abuse or neglect—Any instance of

abuse/neglect in which corrective action has not been taken;

1. 2. Life endangering conditions—Any

single life-endangering item or combination of minor deficiencies which collectively are life endangering or which become perilous contingent upon an event such as the outbreak of fire;

1. 3. Legally required items—Deficiencies

related to statutory requirements for DMH- licensed facilities, such as consumers rights and licensure procedures;

1. 4. Repeated deficiencies—Items which

may or may not be serious in and of themselves, but which become significant when left uncorrected according to agreed upon schedules over a period of time;

1. 5. Numerous deficiencies—Deficiencies

which may or may not be serious themselves, but become significant collectively because they indicate an ineffective maintenance plan, deficient housekeeping standards, inadequate orientation or training of staff, poor nursing care practice, inadequate diet, lack of habilitation or rehabilitation, ineffective policy and procedures, inadequate staffing, poor recordkeeping, or other problems which may affect the consumers’ well being; or

1. 6. Minimum physical plant require-

ments—Quantitative requirements under physical plant and fire safety relating to minimum dimensions for hallways, doors, ceiling heights, window space, floor space, number of bathrooms, and occupants per bedroom;

1. (SS) Temporary operating permit, written authorization permitting licensee seeking licensing for a new licensing period or a new owner applying for the license to continue service delivery pending completion of the licensing survey process;
2. (TT) Time-out, temporary exclusion or removal of a client or resident from positive reinforcement as part of a formal behavior modification procedure in which, contingent upon the client’s or resident’s emission of undesired behavior, the client or resident is removed from the situation that affords positive reinforcement; and
3. (UU) Verbal abuse, referring to a client or resident in the client’s or resident’s presence with profanity or in a demeaning, undignified or derogatory manner.

1. (3) Unless the context clearly indicates otherwise, certain terms shall be used in 9 CSR 40 as follows: 9 CSR 40-1

   1. (A) Parent, the parent of a minor client or resident unless his/her parental rights have been terminated, or the parent of an adult client or resident who consents to having the parent have access to or participate in the record or activity subject of a particular rule. The term should be disregarded if the client’s or resident’s parents are deceased or have had their parental rights terminated; and
   2. (B) Guardian, the person appointed by a Missouri court of competent jurisdiction to have the care, custody and control of the client or resident. The term should be disregarded if the client or resident has not had a guardian appointed.

2. (4) Unless the context clearly indicates otherwise in 9 CSR 40—

   1. (A) The use of any words in the plural includes the use in the singular and vice versa;
   2. (B) The use of terms in the masculine gender includes the use in feminine gender and vice versa; and
   3. (C) Time to perform an act required under this rule shall be computed by excluding the first day and including the last day, unless the last day is a holiday recognized by the state, a Saturday or Sunday, in which case the last day shall include the first day following the state holiday, Saturday or Sunday.

AUTHORITY: sections 630.050, and 630.705, RSMo 1994.* Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed March 14, 1984, effective Aug. 15, 1984. Amended: Filed July 15, 1985, effective Feb. 1, 1986. Amended: Filed Jan. 2, 1990, effective June 11, 1990. Amended: Filed Jan. 31, 1991, effective July 8, 1991. Amended: Filed July 17, 1995, effective March 30, 1996. **Original authority: 630.050, RSMo (1980), amended 1993, 1995 and 630.705, RSMo (1980), amended 1982, 1984, 1985, 1990.