AN ACT Relating to residential care facilities; adding a new chapter to Title 18 RCW; and prescribing penalties.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. The purpose of this chapter is to provide for the establishment and licensing of residential care facilities as an important segment in the delivery of long-term care, and to provide standards which will promote adequate and safe care for those individuals residing therein.

NEW SECTION. Sec. 2. Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Abuse" means the sexual use or sexual mistreatment of an individual resident by any person, or damaging or potentially damaging nonaccidental acts or incidents which may result in bodily injury or death under circumstances which indicate the health, welfare, and safety of the resident was harmed thereby.

(2) "Administrator" means the person licensed by the state to operate a residential care facility and is responsible for the day-to-day operations of the facility. An administrator may also be a licensee.

(3) "Aged person" means a person sixty-five years of age or more, or a person less than sixty-five who by reason of infirmity requires domiciliary care.

(4) "Ambulatory" means a resident who is physically and mentally capable of walking unaided or is capable of independent mobility with the use of a cane, crutches, a walkerette, a walker, a wheelchair, or an artificial limb. It means an individual who is able to walk or traverse a normal path to safety unaided by another individual. This definition does not include an individual who needs the assistance of another individual in order to get into and out of bed, to transfer to a chair or toilet, or to move from place to place.

(5) "Assistance in obtaining" means providing residents with help in arranging to use and to participate in community support services available in the area in which the residential care facility is located.

(6) "Department" means the department of social and health services.

(7) "Domiciliary care" means the care offered an individual in his or her living accommodation which includes the assumption of a general responsibility for the safety and well-being of the individual and provision of assistance in the activities of daily living, as needed.

(8) "Functional abilities" means the physical, mental, emotional, and social abilities to cope with the affairs and activities of daily living.

(9) "Health care practitioner" means any individual, group, or organization that provides health care as legally authorized by law, including but not limited to, physicians, chiropractors, naturopaths, certified registered nurses, and physicians assistants.

(10) "Home health care services" means any nursing service or other service provided by licensed nurses, other practitioners, or aides on a periodic or short-term basis that does not include continuous nursing care.

(11) "Licensee" means a person who has been issued a license to operate a residential care facility under this chapter and is the person ultimately responsible for the operations of the residential care facility. A licensee may also be an administrator.

(12) "Person" means any individual, firm, partnership, corporation (for profit and not-for-profit), company, association, or joint stock association, and the legal successors thereto.

(13) "Residential care facility" means a publicly or privately operated living arrangement in which domiciliary care, lodging and meals are provided for three or more aged persons not related by blood or marriage to the operator.

(14) "Resident" means an aged person living in a licensed residential care facility.

NEW SECTION. Sec. 3. (1) No person may operate or maintain a residential care facility within this state without a license under this chapter.

(2) An application for a license shall be made to the department upon forms provided by the department and shall contain such information as the department reasonably requires to establish evidence of ability to comply with this chapter and the rules promulgated hereunder.

(3) Upon receipt of an application for license, if the applicant and the residential care facility meet the requirements established under this chapter, the department shall issue a license. At the time of the application for or renewal of a license, the licensee shall pay a license fee as established by the department under RCW 43.24.086. Licenses issued under this chapter shall expire on a date to be set by the department, but licenses issued under this chapter shall not exceed twelve months in duration. However, if a residential care facility has been in continuous operation under the same license and operator for a period of at least two years and has had at least two yearly inspections that resulted in no significant violations of this chapter or the rules promulgated thereunder, the licensee shall be granted a license of twenty-four months' duration. Application for renewal of a license shall be made not later than thirty days prior to the date of expiration of the license. Each license shall be issued only for the premises and the persons named in the application, and no license is transferable or assignable except as specifically authorized under this chapter. Licenses shall be posted in a conspicuous place on the licensed premises.

NEW SECTION. Sec. 4. All license applications shall be investigated by the department and if any of the following are found, the license shall be denied:

(1) Any licensed applicant found engaging in drug or alcohol abuse or convicted of a felony shall be disqualified even though the residential care facility premises are adequate if the abuse or conviction is reasonably related to the competency of the person to exercise responsibilities of ownership, operation, or administration of the residential care facility and the department determines, after investigation, that the person has not been sufficiently rehabilitated to warrant public trust.

(2) License applicants convicted of a felony, child abuse, or any crime involving physical harm to another person, and individuals who have been identified as perpetrators of substantiated child abuse pursuant to chapter 26.44 RCW shall be disqualified by reason of such conviction if such conviction is reasonably related to the competency of the person to exercise responsibilities for ownership, operation, or administration of a residential care facility and the department determines, after investigation, that such person has not been sufficiently rehabilitated subsequent to such conviction or abuse registry listing to warrant public trust.

(3) License applicants who, in this state or elsewhere, have been denied a license to operate a hospital, nursing home, boarding home, or other facility for the care of children or ill, aged, or infirm persons, or who have had a license to operate such a facility suspended or revoked, shall not be granted a license until they establish to the department by clear, cogent, and convincing evidence their ability to operate the residential care facility for which the license is sought in full conformity with all applicable laws and rules.

NEW SECTION. Sec. 5. A residential care facility license shall be denied, suspended, or revoked for failure to comply with the provisions of this chapter or any of the following:

(1) Obtaining or attempting to obtain a license by fraudulent means or representation;

(2) Committing, permitting, aiding, or abetting the commission of any illegal act on the residential care facility premises;

(3) Committing, permitting, aiding, or abetting, cruelty, assault, abuse, neglect, or indifference to the welfare of any resident;

(4) Failure to care properly for the number and types of residents in the facility;

(5) Misappropriation of the property of the residents; or

(6) Failure or inability to exercise fiscal responsibility and accountability in respect to an individual resident, the department, or the business community.

NEW SECTION. Sec. 6. (1) If a transfer of a residential care facility license is planned, the licensee shall notify the department at least thirty days prior to the proposed date of transfer. Notification shall be in writing and shall contain the following information:

(a) The full names of the present licensee and the prospective licensee;

(b) The name and address of the residential care facility concerned;

(d) The type of transfer which is to be made, such as sale, lease, or rental.

(2) The prospective licensee shall submit a new residential care facility license application at least thirty days prior to the proposed transfer date.

(3) A new residential care facility license shall be issued to the prospective licensee only following approval of the license application by the department.

NEW SECTION. Sec. 7. Upon a denial of a license application or upon a determination by the department that grounds exist to suspend or revoke a license, and the license applicant or the license holder wishes to contest the department's determination, the department shall first pursue administrative review as set forth in this section.

(1) Within thirty days after a license applicant or license holder is notified of an action or a determination it wishes to challenge, the applicant or license holder shall request in writing that the department review such determination. The request shall be signed by the applicant or license holder and shall identify the challenged determination and the date thereof, and shall state as specifically as practicable the grounds for it's contention that the determination was erroneous. Copies of any documentation on which the applicant or license holder intends to rely to support it's position shall be included with request.

(2) After receiving a request for review, the department shall contact the applicant or license holder to schedule a conference for the earliest mutually convenient time. The conference shall be scheduled for no later than sixty days after a properly completed request was received unless both parties agree in writing to a specified later date.

(3) The applicant or license holder and appropriate representatives of the department shall attend the conference. In addition, representatives selected by the applicant or license holder may attend and participate. The applicant or license holder shall provide to the department in advance of the conference any documentation on which it intends to rely to support it's contentions. The parties shall clarify and attempt to resolve the issues at the conference. If additional documentation is needed to resolve the issues, a second session of the conference shall be scheduled for not later than thirty days after the initial session unless both parties agree in writing to a specific later date.

(4) A written decision by the department will be furnished to the applicant or license holder within thirty days after the conclusion of the conference.

(5) If the applicant or license holder desires review of an adverse decision of the department, it shall within thirty days following receipt of such decision request a fair hearing in writing in accordance with chapter 34.04 RCW. Request for fair hearing shall satisfy the criteria for review request as set forth in subsection (1) of this section.

NEW SECTION. Sec. 8. (1) The department shall establish and maintain a state-wide registry of all licensed residential care facilities. This registry shall contain the following information:

(a) The name of the facility;

(b) The name of the licensee of the facility;

(d) The number of residents the facility is licensed to serve; and

(e) If the facility limits the population it serves, the populations served in the facility.

(2) The department shall make copies of the registry of licensed residential care facilities available upon request.

NEW SECTION. Sec. 9. (1) Residential care facilities shall not be located where excessive noise, odor, dust, smoke, or traffic would adversely affect the health or safety of the residents.

(2) The department is subject to local land use planning and zoning codes when determining whether a new residential care facility is properly located or when determining whether an existing facility meets the standards as specified.

NEW SECTION. Sec. 10. (1) When the new construction in a residential care facility is planned, the following shall be submitted to the department for review:

(a) Preliminary documents as follows:

(i) Review containing, at a minimum, information concerning services to be provided and operational methods to be used which will affect the extent of facilities required by this chapter;

(ii) Scale drawings for modifications to rooms or areas;

(iii) Drawings descriptive of proposed modifications including impact upon physical plan operations and services;

(iv) Two sets of preliminary plans drawn to scale and including a plot plan showing streets, driveways, the water supply and the sewage disposal systems, grade and location of buildings, existing and proposed, the designated function of each room and all fixed equipment. The preliminary plan shall be accompanied by a general description of the construction and materials; and

(v) Final construction drawings are not required at the preliminary document stage.

(b) Final construction documents shall include two sets of specifications and final plans drawn to scale. The plans shall be submitted to and approved by the department before construction is started. Final plans and specifications shall show complete details to be furnished to contractors for construction of buildings. These shall include:

(i)Plot plan;

(ii) Plans of each floor of the buildings which designate the function of each room and show all fixed equipments;

(iii) Interior and exterior elevations, building sections, and construction detail;

(iv) A schedule for floor, wall, and ceiling finishes, and the types and sizes of doors and windows;

(v) Plumbing, heating, ventilating, and electrical systems; and

(vi) Specifications which fully describe workmanship and finishes.

(2) Adequate provision shall be made for the safety and comfort of residents if construction work takes place in or near occupied areas.

(3) All construction shall take place in accordance with approved final plans and specifications. The department shall be consulted prior to making any significant changes from the approved plans and specifications. When indicated by the nature or extent of proposed changes, the department may require the submission of modified plans or addenda for review. Only those changes that have been approved by the department may be incorporated into the construction project.

(4) Prior to occupancy and use of the building or any room or other portion of a building which constitutes the whole or part of a new construction project, the licensee shall submit a statement to the department indicating the date the construction project was completed and that it met requirements of this chapter. Authorization by the department is required prior to occupancy.

(5) Department approval of plans and occupancy does not exempt a licensee from compliance with other applicable codes.

NEW SECTION. Sec. 11. (1) There shall be an administrator who manages the residential care facility who is at least twenty-one years of age and is not a resident of the facility.

(2) The administrator shall have at least a high school diploma or equivalent unless the administrator was operating a boarding home in this state prior to January 1, 1958.

(3) The administrator shall either be on duty or readily available at all times, except when an alternate administrator, who meets the administrator qualifications of this section, is designated in writing by the administrator, and is on duty or readily available.

(4) Any change of administrator shall be reported to the department.

NEW SECTION. Sec. 12. (1) There shall be sufficient staff to provide the services needed by residents and to maintain the residential care facility properly. Residents may be employed to perform supportive functions under the on-premises supervision of responsible staff.

(2) At least one readily accessible staff member of at least eighteen years of age who is capable of assisting residents shall be available on the premises at all times when residents are present in the facility.

(3) An orientation shall be provided to each new employee to acquaint the employee with the organization of the boarding home, the physical plant layout, particular duties and responsibilities, and the policies, procedures, and equipment which are pertinent to those duties and responsibilities including emergencies, abuse, neglect, and prevention of transmission of infection. The orientation shall be documented.

(4) Each staff member shall be provided with needed training for the performance of the specific functions, duties, and procedures for which the staff member is responsible. The training shall be documented.

(5) Upon employment, each person shall have or provide documented evidence of a tuberculin test by the Mantoux method, unless medically contraindicated. When this skin test is negative (less than ten millimeters of induration), no further tuberculin skin testing is required. A positive test will consist of ten millimeters or more of induration, read at forty-eight to seventy-two hours. Positive reactors shall have chest x-ray within ninety days of the first day of employment. Health records, including skin test results, reports of x-ray findings, and exemptions to such, shall be maintained in the facility. Those with positive skin tests who have competed a recommended course of preventative or curative treatment, as determined by the local health officer, are exempt from testing.

(6) Staff members with a communicable disease in an infectious state shall not be on duty.

(7) Documentation of requirements for each staff member, as described in this chapter, shall be available on the premises.

(8) Nonresidents living on the premises and staff shall not have been convicted of child abuse or any crime involving physical harm to another person and shall not be a perpetrator of substantiated child abuse, as described in chapter 26.44 RCW, until such staff member or nonresident demonstrates sufficient rehabilitation, subsequent to such conviction or listing on abuse registry, to warrant public trust.

NEW SECTION. Sec. 13. (1) The department shall adopt, amend, and promulgate such rules with respect to all residential care facilities to be licensed under this chapter as may be reasonably required to further the accomplishment of the purposes of this chapter in promoting safe and adequate care of individuals in residential care facilities and the sanitary, hygienic, and safe conditions of the residential care facility in the interest of public health, safety, and welfare.

(2) In developing proposed rules, the department shall solicit comments from or consult with resident councils, resident advocacy groups, and representatives of residential care facilities. The department shall attempt to reasonably accommodate the objections of any of these groups to proposed rules prior to submission of the final draft for formal review and adoption.

NEW SECTION. Sec. 14. (1) The department shall make or cause to be made a yearly inspection of all residential care facilities except as otherwise provided in this section. Every inspection may include an inspection of every part of the premises in an examination of all records (other than financial records), methods of administration, the general and special dietary, and the stores and methods of supply. An inspector shall contact the facility administrator, or person designated by the administrator as in charge of the facility in their absence, upon arrival at the facility for an inspection. An inspector must have the permission of the administrator prior to interviewing staff. Routing yearly inspections shall be conducted during normal business hours.

(2) If a residential care facility has two consecutive yearly inspections by the department that do not disclose any significant violations of this chapter or the rules promulgated under this chapter, the department may waive the yearly inspection requirement and inspect that residential care facility every other year. If any subsequent inspection discloses significant violations of this chapter or the rules promulgated under this chapter, then the department shall return to yearly inspections.

(3) Following an inspection, written notice of any violations of this chapter or the rules promulgated under this chapter shall be given to the administrator and licensee.

NEW SECTION. Sec. 15. (1) Standards for fire protection and the enforcement thereof, with respect to residential care facilities, are the responsibility of the state fire marshal, who shall adopt reasonable standards as may be necessary for the protection of life against the cause and spread of fire and fire hazards.

(2) The department, upon a receipt of an application for a license, shall submit to the state fire marshal in writing a request for an inspection, giving the applicant's name and the location of the premises to be licensed. Upon receipt of a request, the state fire marshal or deputy shall make an inspection of the residential care facility to be licensed and, if it is found that the premises do not comply with the fire regulations as promulgated by the state fire marshal, the fire marshal shall promptly make a written report to the residential care facility and the department as to the manner and the time allowed in which the premises must qualify for a license and set forth the conditions to be remedied with respect to fire regulations. The licensee shall notify the state fire marshal upon completion of any requirements made by the state fire marshal, who shall make a reinspection of such premises. If the residential care facility to be licensed meets with the approval of the state fire marshal, the fire marshal shall submit to the department a written report approving same with respect to fire protection before a license can be issued. However, if the prelicense inspection violations found by the state fire marshal do not pose a risk to the safety of the residents of the facility, then the state fire marshal shall authorize the department to issue the applicant's license while the corrections required by the state fire marshal are being made. The state fire marshal shall make or cause to be made inspections of the residential care facilities annually.

NEW SECTION. Sec. 16. (1) Prior to the admission of an applicant for residency in a residential care facility, the facility shall obtain sufficient information about the applicant's current ability to function to determine if the applicant can be properly housed in the residential care facility.

(2) Admission of individuals as residents shall be limited to those who can be accommodated by the physical plant facilities, space, furniture, equipment, staff, and programs of domiciliary care.

(3) Only individuals who are ambulatory shall be admitted and retained as residents unless the state fire marshal approves the residential care facility for acceptance of nonambulatory individuals. No aged person requiring nursing or medical care of a type provided by institutions licensed under chapter 18.51, 70.41, or 71.112 RCW may be admitted unless registered nurses are available from a visiting nurse service or home health agency of an adjacent or nearby skilled nursing facility or one located in the facility, and upon a doctors order that a supervised medication service is needed. Such medication service shall be provided only to ambulatory residents who otherwise meet all requirements for residency in a residential care facility.

(4) Accommodations for individuals who, though capable of independent mobility with the use of a cane, crutches, a walkerette, a walker, a wheelchair, or an artificial limb, are not capable of walking unaided, shall be restricted to sections or areas of the residential care facility that have been specifically approved for occupancy by such individuals by the state fire marshal, unless the state fire marshal has approved the entire residential care facility for occupancy by such individuals.

(5) The following shall not be admitted or retained as residents:

(a) Individuals who are manifesting overt behavior which is dangerous to others or self; or

(b) Individuals who need nursing care over and above the following:

(i) Simple nursing care of a type ordinarily given in a private home by a lay person to one who has a mild temporary illness which does not exceed fourteen days in duration; or

(ii) Service from a community home health care agency.

(6) At the time of admission, the residential care facility administrator shall make definite arrangements with the resident regarding the health care practitioner or individual to be called in case the resident becomes ill.

NEW SECTION. Sec. 17. (1) Each resident shall have, in addition to any rights not specifically withheld by law, the following rights:

(a) To be informed, or to have an agent designated by the resident informed, of the resident's rights and the policies of the facility at the time of admission. The written copy of rights and policies shall be provided to each resident or designated agent;

(b) To be treated in a manner that respects the resident's individual identity and human dignity and fosters constructive self-esteem;

(c) To be notified thirty days in advance if the resident requires transfer for medical or nursing care or for his or her own welfare or that of other residents, except as prohibited by Titles XVIII, XIX, or XX of the federal social security act. This requirement does not apply if the resident needs routine services not supplied by the facility or an emergency condition requiring immediate transfer exists. The notice of transfer or discharge and discharge plans shall be documented in the residents records;

(d) To associate and communicate privately with persons of the resident's own choice; to send and receive uncensored correspondence through the mail; and to have reasonable access to a telephone booth to make and receive personal calls;

(e) To managed personal financial affairs unless the resident has been adjudicated to be incompetent in a court proceeding directed to that particular issue or pursuant to law;

(f) To retain and use personal clothing and possessions unless to do so would infringe upon the rights of other residents;

(g) To refuse to perform services for the facility unless these services are included in their plan care;

(h) To be assured privacy for visits with relatives or guests;

(i) To voice grievances and recommend changes in policies and services to the facility staff and to outside representatives of his or her choice, free from restraint, interference, coercion, discrimination, or reprisal;

(j) To be informed of phone numbers and addresses of the department and appropriate advocacy groups;

(k) To meet with and participate in activities of social, religious, and community groups at his or her own discretion;

(l) To be free from physical, chemical, and psychological restraints unless authorized by law;

(m) To be free from exploitation, assault, abuse, and neglect;

(n) To have information contained in residential health records kept confidential, with access only to authorized personnel and the department; and

(o) To be given timely notice of changes in admission or retention policy and procedures.

(2) Each resident shall have at least one comfortable pillow and adequate, clean bedding. Clean sheets, pillowcase, towels, and washcloths shall be provided as needed and at least once each week.

(3) A resident shall be regularly observed for changes in physical, mental, and emotional functioning. When observations reveal the resident has need for services unavailable in the residential care facility, the administrator or designee shall arrange for the transfer of the resident.

(4) Basic domiciliary services shall be conducted so as to obtain or maintain each residents highest degree of functioning possible compatible with individual safety and welfare. The following services shall be provided when a resident requires such services:

(a) General health supervision, which means provisions of the following services in accordance with a resident's particular needs, including:

(i) To encourage a resident to self-administer medically prescribed drugs and treatments;

(ii) To encourage a resident to follow any medically prescribed modified diet, rest, or activity regimen;

(iii) To encourage and assist a resident to keep appointments for health care services such as physicians, dentists, home health services, or clinics; and

(iv) To encourage and assist a resident to see his or her health care practitioner if the resident manifests signs or symptoms of an illness or abnormality for which medical diagnosis and treatment seem indicated.

(b) Reminding and guidance, supervision, or assistance to a resident in:

(i) Personal hygienic care, dressing, grooming, and other activities;

(ii) Maintenance of functional aids or equipments, such as glasses, hearing aids, canes, crutches, walkers, or wheelchairs;

(iii) Maintenance of clothing and other personal effects; and

(iv) Maintenance of personal living quarters in a manner conducive to safety and comfort.

(c) Encouraging, guiding, or assisting a resident to participate in social, recreational, diversional, vocational, church, or other activities within the residential care facility and the community in accordance with his or her interests, tolerance, and abilities.

(5) If a resident is believed to be ill or injured, the health care practitioner or other individual designated by the resident shall be notified immediately.

NEW SECTION. Sec. 18. (1) There shall be a permanent, current book or register of all individuals admitted as residents of the facility. The register shall contain the date of admission, full name, and date of discharge.

(2) The facility shall maintain a health record in the residential care facility for each resident to include the following:

(a) The full name, date of birth, and former address of the resident;

(b) The date of admission, and date of discharge;

(d) The name, address, and telephone number of the resident's personal physician or health care practitioner;

(e) The dates and descriptions of all illnesses or accidents and changes in functional abilities of the individual while a resident of the residential care facility, including actions taken, with entries signed by staff; and

(f) A signed written prescription by the resident's physician or health care practitioner for any modified diet, concentrate, or supplement provided by the residential care facility for the resident.

(2) A systematic, secure method of identifying and filing residential health records shall be provided so each record can be located readily.

(3) Each resident's health record shall be retained for a minimum of five years after the resident's discharge.

NEW SECTION. Sec. 19. (1) Any person operating or maintaining a residential care facility without a license under this chapter is guilty of a misdemeanor and each day of a continuing violation shall be a separate offense.

(2) Notwithstanding the existence or use of any other remedy, the department may, in the manner provided by law, upon the advise of the attorney general, who shall represent the department in the proceeding, maintain an action in the name of the state for injunction or other process against any person to restrain or prevent the operation or maintenance of a residential care facility without a license under this chapter.

NEW SECTION. Sec. 20. Nothing in this chapter or the rules adopted thereunder shall be construed as authorizing the supervision, regulation, or control of the remedial care or treatment in any boarding home conducted for those who rely upon treatment by prayer or spiritual means in accordance with the creed or tenets of any well-recognized church or religious denomination.

NEW SECTION. Sec. 21. Sections 1 through 20 of this act shall constitute a new chapter in Title 18 RCW.

NEW SECTION. Sec. 22. If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.