WSR 97-18-087

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Aging and Adult Services Administration)

(Public Assistance)

[Filed September 3, 1997, 11:32 a.m.]

Original Notice.

Preproposal statement of inquiry was filed as WSR 96-18-089.

Title of Rule: Revisions to the adult family home minimum licensing requirements, WAC 388-76-540 through 388-76-795.

Purpose: To make the adult family home regulations clearer, more easily understood, and more reflective of practices that are currently in place.

Statutory Authority for Adoption: RCW 70.128.040.

Statute Being Implemented: Chapters 70.128 and 70.129 RCW.

Summary: Due to laws passed in the 1995 legislative session, rules governing adult family homes were completely revised and became effective in July 1996. In the past year, internal and external stakeholders have provided input and feedback concerning their experience implementing these rules. This feedback made it evident that changes to the regulations were needed to: (1) Eliminate faulty and/or confusing language; (2) make the regulations clearer and more easily understood; and (3) make the regulations more reflective of current practice. In addition, some changes are necessary to ensure department expectations are clearly defined and easily understood.

Reasons Supporting Proposal: See Summary above.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Stacy Winokur, P.O. Box 45600, Olympia, WA 98504-5600, 1-800-422-3263 or (360) 407-0505.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: See Purpose and Summary above.

Proposal Changes the Following Existing Rules: These changes will: (1) Eliminate faulty and/or confusing language; (2) make the regulations clearer and more easily understood; (3) make the regulations more reflective of current practice; and (4) ensure department expectations are clearly defined and easily understood.

No small business economic impact statement has been prepared under chapter 19.85 RCW. An analysis of the economic impact to small businesses will be included in the detailed written analysis required by RCW 34.05.328.

RCW 34.05.328 applies to this rule adoption.

Hearing Location: Lacey Government Center (behind Tokyo Bento restaurant), 1009 College Street S.E., Room 102, Lacey, WA 98503, on October 21, 1997, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Leslie Baldwin by October 14, 1997, phone (360) 902-7540, TTY (360) 902-8324, e-mail lbaldwin@dshs.wa.gov.

Submit Written Comments to and Identify WAC Numbers: Leslie Baldwin, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, FAX (360) 902-8292, by October 21, 1997.

Date of Intended Adoption: No sooner than October 22, 1997.

September 3, 1997

Merry A. Kogut, Manager

Rules and Policies Assistance Unit

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-540 Definitions. (((1))) "Abandonment" means action or inaction by a person or entity with a duty of care for a frail elder or vulnerable adult that leaves the vulnerable person without the means or ability to obtain necessary food, clothing, shelter, or health care.

(((2))) "Abuse" means a nonaccidental act of physical or mental mistreatment or injury, or sexual mistreatment, which harms a person through action or inaction by another individual.

(((3))) "Adult family home" means the same as the definition in RCW 70.128.010.

(((4))) "Applicant" means an individual, partnership, corporation, or other entity seeking a license to operate an adult family home.

(((5))) "Capacity" means the maximum number of persons in need of personal or special care permitted in an adult family home at a given time. This number shall include related children or adults in the home who receive special care.

(((6))) "Caregiver" means any person eighteen years of age or older responsible for providing direct personal care to a resident and may include but is not limited to the provider, resident manager, employee, relief caregiver, volunteer, student, entity responsible individual or household member.

(((7))) "Case Manager" means the department staff person or designee assigned to negotiate, monitor, and facilitate a service plan for residents receiving services fully or partially paid for by the department.

(((8))) "Chemical restraint" means a psychopharmacologic drug that is used for discipline or convenience and not required to treat the resident's medical symptoms.

(((9))) "Department" means the Washington state department of social and health services.

(((10))) "Entity provider" means any corporation, partnership, association, or limited liability company that is licensed under this chapter to operate an adult family home.

(((11))) "Entity responsible individual" means the individual an entity provider designates who is ultimately responsible for the daily operation of the adult family home.

"Exploitation" means the illegal or improper use of a frail elder or vulnerable adult or that person's income or resources, including trust funds, for another person's profit or advantage.

(((12))) "Frail elder or vulnerable adult" means the same as the definition in RCW 74.34.020 or RCW 43.43.830.

(((13))) "Individual provider" means a natural person who is licensed to operate an adult family home.

(((14))) "Inspection" means an on-site visit by department personnel to determine the adult family home's compliance with this chapter and chapter 70.128 RCW, Adult family homes.

(((15))) "Multiple facility provider" means an individual or entity provider who is licensed to operate more than one adult family home.

(((16))) "Neglect" means a pattern of conduct or inaction resulting in deprivation of care necessary to maintain a resident's physical or mental health.

(((17))) "Nursing assistant" means the same as the definition in chapter 18.88A RCW.

(((18))) "Personal care services" means both physical assistance and/or prompting and supervising the performance of direct personal care tasks as determined by the resident's needs as defined in WAC 388-15-202(((38))), Long-term care services--Definitions. Personal care services do not include assistance with tasks which must be performed by a licensed health professional.

(((19))) "Physical restraint" means a manual method, obstacle, or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that restricts freedom of movement or access to his or her body, is used for discipline or convenience, and not required to treat the resident's medical symptoms.

(((20))) "Provider" means any person or entity that is licensed under this chapter to operate an adult family home.

(((21))) "Resident" means any adult unrelated to the provider who lives in the adult family home and who is in need of care. "Resident" includes former residents when examining complaints about admissions, readmissions, transfers or discharges. For decision-making purposes, the term "resident" includes the resident's surrogate decision maker in accordance with state law or at the resident's request.

(((22))) "Resident manager" means a person employed or designated by the provider to manage the adult family home.

(((23))) "Special Care" means care beyond personal care services as defined by ((subsection (18) of)) "personal care services" in this section.

(((24))) "Unsupervised" means the same as the definition in RCW 43.43.830(8).

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-540, filed 6/19/96, effective 7/20/96.]

Reviser's note: RCW 34.05.395 requires the use of underlining and deletion marks to indicate amendments to existing rules. The rule published above varies from its predecessor in certain respects not indicated by the use of these markings.

Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-550 License application--Initial and renewal. (1) All applications for adult family home licensure or renewal are subject to review under this chapter.

(2) ((To apply for an adult family home license, an applicant shall complete and submit a license application on department provided forms at least sixty days before the requested effective date of that license)) First time adult family home applicants must attend department orientation to receive an initial adult family home application.

(3) To apply for an initial adult family home license, an applicant shall complete and submit the department designated application form providing all information necessary, including information regarding any facilities and homes for the care or provision of services to children or vulnerable adults that the applicant is or has been affiliated with in the last ten years, so the department can determine whether the applicant meets all applicable qualifications and requirements. An entity shall provide this information with regard to any partner, officer, director, managerial employee, or owner of five percent or more of the entity applicant.

(4) For renewal of an adult family home license, the provider shall complete and submit a renewal application on department provided forms at least sixty days before the current license's expiration date. The license must be renewed annually to remain valid.

(((4) The applicant shall complete the department designated application form providing all information necessary, including information regarding any facilities and homes for the care or provision of services to children or vulnerable adults that the applicant is or has been affiliated with in the last ten years, so the department can determine whether the applicant meets all applicable qualifications and requirements. An entity shall provide this information with regard to any partner, officer, director, managerial employee, or owner of five percent or more of the entity applicant.))

(5) All entity providers shall include their Unified Business Identifier (UBI) and Federal Employer Identification (FEI) numbers on the application.

(6) Married couples may not apply for separate adult family home licenses for each spouse.

(7) Couples legally married under Washington state law are the only individuals who may apply jointly for an adult family home license as co-providers. Two unmarried individuals applying for an adult family home license must be an entity provider by having legally formed a corporation, partnership, association, or limited liability company.

(8) The license applicant shall be the person or entity ultimately responsible for the daily operation of the adult family home. The license applicant or the applicant's authorized representative shall sign the adult family home license or renewal application.

(((8))) (9) All entity providers shall designate an individual on their initial adult family home application who is ultimately responsible for the operation of the adult family home, this person will hereafter be referred to as the entity responsible individual. Entity providers shall notify their licensor when there is a change in the entity responsible individual.

(10) An applicant who enters into a lease or contractual agreement with a landlord who takes an active interest in the operation of the adult family home, shall include the landlord's name and address on the license or renewal application. Active interest includes but is not limited to:

(a) The charging of rent as a percentage of the business;

(b) Assistance with start up and operational expenses;

(c) Collection of resident fees;

(d) Recruitment of residents;

(e) Management oversight;

(f) Assessment and negotiated service plan development for residents; or

(g) The provision of personal or special care to residents.

(((9))) (11) The department shall not commence review of an incomplete license or renewal application, and incomplete applications shall become void sixty days following the department's written request for additional documentation or information to complete the application.

(((10))) (12) An adult family home license shall be valid for up to one year.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-550, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-560 License eligibility--Initial and renewal. (1) The department shall consider separately and jointly as applicants each person and entity named in an application for an adult family home license. If the department finds any person or entity unqualified, the department shall deny the license.

(2) In making a determination whether to grant an adult family home license, the department shall review:

(a) The information in the application; and

(b) Other documents and information the department deems relevant, including inspection and complaint investigation findings in each facility or home for the care or provision of services to children or vulnerable adults with which the applicant or any partner, officer, director, managerial employee, or owner of five percent or more of the entity applicant is or has been affiliated.

(3) The applicant and the home for which the license is sought shall comply with all requirements established by chapter 70.128 RCW and this chapter. The department may deny a license for noncompliance with any such requirements.

(4) An individual provider shall be twenty-one years of age or older ((and)).

(5) All providers shall be registered with the department of health as required by RCW 70.128.120, prior to licensure.

(((5))) (6) All resident managers shall be registered with the department of health as required by RCW 70.128.120, prior to being designated as an adult family home resident manager.

(7) A provider shall have the understanding, ability, emotional stability and physical health suited to meet the emotional and care needs of vulnerable adults.

(8) An adult family home shall not be licensed as a boarding home.

(9) The department shall deny a license if an applicant or any partner, officer, director, managerial employee, entity responsible individual, resident manager or owner of five percent or more of the entity applicant has a history of significant noncompliance with federal or state regulations in providing care or services to vulnerable adults or children. The department shall consider, at a minimum, the following as a history of significant noncompliance requiring denial of a license:

(a) Revocation or suspension of a license for the care of children or vulnerable adults;

(b) Enjoined from operating a facility for the care of children or adults; or

(c) Revocation, cancellation, suspension, or nonrenewal of a Medicaid or Medicare provider agreement, or any other agreement with a public agency for the care or treatment of children or vulnerable adults.

(((6))) (10) The department may deny, suspend, revoke, or refuse to renew a license if any person who is a caregiver, any person who has unsupervised access to residents, or any person who lives in the home but who is not a resident, meets any of the criteria defined under subsection (9) of this section.

(11) The department shall deny, suspend, revoke, or refuse to renew a license if an applicant, any person who is a caregiver, any person who has unsupervised access to residents, or any person who lives in the home but who is not a resident or any partner, officer, director, managerial employee, entity responsible individual, resident manager, an owner of fifty percent or more of the entity applicant, or an owner who exercises control over daily operations has been:

(a) Convicted of a crime against a person as defined under RCW 43.43.830 or RCW 43.43.842;

(b) Convicted of a crime relating to financial exploitation as defined under RCW 43.43.830 or RCW 43.43.842;

(c) Found by a court in a protection proceeding under chapter 74.34 RCW to have abused or financially exploited a vulnerable adult;

(d) Found in any final decision issued by a disciplinary board to have sexually or physically abused or exploited any minor or a person with a developmental disability or to have abused or financially exploited any vulnerable adult;

(e) Found in any dependency action under RCW 13.34.030 (2)(b) to have sexually ((assaulted)) abused or exploited any minor or to have physically abused any minor; or

(f) Found by a court in a domestic relations proceeding under Title 26 RCW to have sexually abused or exploited any minor or to have physically abused any minor.

(((7) The department shall deny, suspend, revoke, or refuse to renew a license if any person who lives in the home or who has unsupervised access to residents meets any of the criteria defined under subsection (6) of this section.

(8))) (12) The department may deny, suspend, revoke, or refuse to renew a license if an applicant, any person who is a caregiver, any person who has unsupervised access to residents, or any person who lives in the home but who is not a resident, or any partner, officer, director, managerial employee, entity responsible individual, resident manager, an owner of fifty percent or more of the entity applicant, or an owner who exercises control over daily operations has:

(a) Obtained or attempted to obtain a license by fraudulent means or misrepresentation;

(b) Permitted, aided, or abetted the commission of any illegal act on the adult family home premises;

(c) Been convicted of a felony or a crime against a person if the conviction reasonably relates to the competency of the person to own or operate an adult family home;

(d) Had sanction, corrective, or remedial action taken by federal, state, county, or municipal health or safety officials related to the care or treatment of children or vulnerable adults;

(e) Engaged in or been convicted of the illegal use of or illegal selling or distribution of drugs, or the excessive use of alcohol;

(f) Been convicted of any crime involving a firearm;

(g) Operated a facility for the care of children or adults without a license;

(((g))) (h) Failed to meet financial obligations as the obligations fell due in the normal course of business;

(((h))) (i) Misappropriated property of residents;

(((i))) (j) Been denied a license or license renewal to operate a facility that was licensed for the care of children or vulnerable adults;

(((j))) (k) Relinquished or returned a license in connection with the operation of any facility for the care of children or vulnerable adults, or did not seek the renewal of such license, following written notification of the licensing agency's initiation of denial, suspension, cancellation or revocation of the license;

(((k))) (l) Had resident trust funds or assets of an entity providing care to children or vulnerable adults seized by the IRS or a state entity for failure to pay income or payroll taxes;

(((l))) (m) Refused to permit authorized department representatives to interview residents or have access to resident records;

(((m))) (n) Interfered with a long term care ombudsman in the performance of his or her official duties; ((or))

(((n))) (o) Exceeded licensed capacity in the operation of an adult family home;

(p) Had an order of protection or a restraining order issued against him or her under Title 13 or 26 RCW;

(q) Been found by the court in a proceeding under Title 26 RCW to have committed an act of domestic violence toward a family or household member.

(((9))) (13) The department shall deny or refuse to renew an adult family home license to an applicant who is licensed to care for children in the same home unless:

(a) It is necessary in order to allow a resident's child(ren) to live in the same home as the resident or to allow a resident who turns eighteen to remain in the home;

(b) The applicant provides satisfactory evidence to the department of the home's capability to meet the needs of children and adults residing in the home; and

(c) The total number of persons receiving care in the home does not exceed the number permitted by the licensed capacity of the adult family home.

(((10))) (14) The department's renewal of a license does not preclude the department from taking any action under WAC 388-76-705 based on inspection.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-560, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-570 Additional license requirements--Multiple facility providers. (1) The department shall not issue a license to a provider to operate more than one adult family home unless:

(a) The applicant has operated an adult family home for at least one year in this state without any significant violation of the rules of this chapter; or

(b) The applicant has submitted evidence demonstrating that it has the capability to operate multiple adult family homes.

(2) An applicant that is applying to be licensed for more than one adult family home shall submit to the department for each adult family home:

(a) A twenty-four hour per day, seven days per week, staffing plan; and

(b) A plan for covering administrative responsibilities.

(3) Multiple facility providers shall have on-site at each adult family home a plan that addresses visitor parking, deliveries, and staff parking. For adult family homes located within a city, this plan shall be submitted to the city planning authority for their review and comment. Any comments from the city planning authority must be returned to the provider within thirty days in order to be considered by the provider in finalizing their plan.

(4) The department may consider the applicant's credit history in determining whether to license the applicant for more than two adult family homes, when the department determines the credit history relates to an applicant's ability to provide care and services to vulnerable adults.

(((4))) (5) When operating two or more adult family homes, ((a)) the individual provider or entity responsible individual shall successfully complete forty-eight hours of residential care administrator's training, including training in at least the following areas:

(a) Business planning and marketing;

(b) Fiscal planning and management;

(c) Human resource planning;

(d) Resident health services;

(e) Nutrition and food service;

(f) Working with people who are elderly, chronically mentally ill, or developmentally disabled;

(g) The licensing process;

(h) Social and recreational activities;

(i) Resident rights;

(j) Legal issues;

(k) Physical maintenance and fire safety; and

(l) Housekeeping.

(((5) A provider who is operating more than one adult family home prior to the effective date of this chapter, shall have until June 1, 1997 to complete the residential care administrator's training.))

(6) A provider who applies for a license to operate more than one adult family home on or after ((the effective date of this chapter)) July 20, 1996, shall complete the residential care administrator's training prior to operating more than one family home.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-570, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-590 Specialty adult family homes. (1) Beginning September 1, 1996, an applicant or provider may apply for a designation as a specialty adult family home to serve and meet the unique needs of residents with:

(a) Developmental disabilities;

(b) Mental illnesses; or

(c) Dementia.

(2) An adult family home is not required to have a specialty designation to serve residents identified in subsection (1) above.

(3) Developmental Disabilities. To be designated as a home specializing in services to residents with developmental disabilities the provider or resident manager, in addition to complying with all other rules in this chapter, shall:

(a) Complete the department approved supplemental training addressing the residential support needs for persons with developmental disabilities prior to being designated as a specialty adult family home. Training shall include, at a minimum, courses in positive behavior supports addressing behavior as a means of communication, and the division of developmental disabilities residential services guidelines;

(b) Each calendar year, complete a minimum of ten hours of continuing education credits that relates to providing care to persons with developmental disabilities. Training is to be obtained through regional division of developmental disabilities core training courses as offered for community service providers;

(i) The continuing education requirement listed above in subsection (3)(b) shall also qualify for the continuing education requirement in WAC 388-76-660 (2)(c);

(ii) The continuing education requirement begins the calendar year after the year in which the provider or resident manager completes the training listed above in subsection (3)(a); and

(c) Demonstrate an ability to accommodate for communication barriers of residents and recognize how behaviors may be a means for communication.

(4) A home specializing in services to residents with developmental disabilities shall provide the degree of supervision needed by residents and specified in the residents' negotiated service plans((, which may be less than twenty-four hour supervision)).

(5) Mental Illness. To be designated as a home specializing in services to residents with mental illnesses, the provider or resident manager shall, in addition to complying with all other rules in this chapter:

(a) Complete the department approved specialized mental health training addressing the needs of persons who have a mental illness prior to being designated as a specialty adult family home;

(b) Each calendar year, complete a minimum of ten hours of continuing education credits that relates to mental health issues;

(i) The continuing education requirement listed above in subsection (5)(b) of this section shall also qualify for the continuing education requirement in WAC 388-76-660 (2)(c);

(ii) The continuing education requirement begins the calendar year after the year in which the provider or resident manager completes the training listed above in subsection (5)(a) of this section;

(c) Have a documented crisis response plan in place, know how to access emergency mental health services, and assure all caregivers are knowledgeable and capable of implementing the plan in a crisis; and

(d) Hire qualified caregivers and assure coverage of the home during periods of absence in order to meet residents' identified service needs, and have a documented staffing plan in place at all times.

(6) Dementia. To be designated as a home specializing in services to residents with dementia, the provider or resident manager shall, in addition to complying with all other rules in this chapter:

(a) Complete the department approved training course in providing care to persons with dementia prior to being designated as a specialty adult family home;

(b) Each calendar year, complete a minimum of ten hours of continuing education credits that relate to providing care to persons with dementia;

(i) The continuing education requirement listed above in subsection (6)(b) of this section shall also qualify for the continuing education requirement in WAC 388-76-660 (2)(c);

(ii) The continuing education requirement begins the calendar year after the year in which the provider or resident manager completes the training listed above in subsection (6)(a) of this section;

(c) Hire qualified caregivers and assure coverage of the home during periods of absence in order to meet residents' identified service needs, and have a documented staffing plan in place at all times; and

(d) ((Be)) Shall ensure the home is designed to accommodate residents with dementia in a homelike environment. The design and environment of the home shall support residents in their activities of daily living; enhance their quality of life; reduce tension, agitation, and problem behaviors; and promote their safety.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-590, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-595 Inspections and ombudsman visits. (1) The department shall conduct unannounced inspections and complaint investigations to determine the provider's compliance with this chapter and chapter 70.128 RCW.

(2) The provider shall ensure that department staff have access to the home, residents, ((and)) all resident records therein, and all relevant staff records, and shall not willfully interfere or fail to cooperate with department staff in the performance of official duties.

(3) The adult family home shall not willfully interfere with a representative of the long term care ombudsman in the performance of official duties, as defined under chapter 43.190 RCW, Long-term care ombudsman program and under federal law, and the department shall impose a penalty of not more than one thousand dollars for any such willful interference.

(4) Within ten working days of the inspection of the adult family home, the department's inspection report shall be mailed or hand delivered to the provider ((and made available to the public within ten working days of the inspection of the adult family home. If a provider gives the department a plan of correction for deficiencies, the department shall include a statement of the provider's planned corrective measures in the department's inspection report)).

(5) Within ten working days of the completion of complaint investigation data collection, any department inspection report related to a complaint investigation shall be mailed or hand delivered to the provider.

(6) A provider shall submit to the department the planned corrective measures for violations and/or deficiencies within ten days of receipt of an inspection report.

(7) Department inspection reports shall be made available to the public immediately following the department's decision to summarily suspend or revoke an adult family home license.

(8) Department inspection reports shall be made available to the public following receipt of the provider's planned corrective measures or ten working days after the provider received the inspection report, whichever comes first. The department shall include the statement of the provider's planned corrective measures with the department's inspection report.

(9) Each home shall publicly post with their adult family home license a notice that the inspection reports are available in the home. The inspection reports must be available for examination in a place readily accessible to residents, family members, and others.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-595, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-605 Restraints. (1) The resident has the right to be free from physical and chemical restraint and involuntary seclusion.

(2) Adult family homes are prohibited from using any and all forms of physical restraint that are used for the purposes of discipline or convenience and are not required to treat the resident's medical symptoms. Treatment of such medical symptoms must be applied and ((directly)) immediately supervised on-site by a licensed registered nurse (RN), licensed practical nurse (LPN) or a licensed physician. Immediate supervision means the licensed registered nurse, the licensed practical nurse, or the licensed physician is in the home and quickly and easily available.

(3) The provider shall ensure that the resident is free from chemical restraints which are:

(a) Used for discipline or convenience; and

(b) Not required to treat the resident's medical symptoms.

(4) In any situation where a psychopharmacological drug is used for the resident, the provider shall ensure:

(a) That it is not used for the purpose of discipline or convenience;

(b) That it has been prescribed by a physician;

(c) The resident's negotiated service plan provides strategies and approaches to diminish or eliminate use of the psychopharmacological drug, where possible; and

(d) The resident or surrogate decision maker has given informed consent for its use.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-605, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-610 Resident assessment. (1) The provider shall not admit or retain a resident unless they can ensure:

(a) The adult family home can meet the resident's assessed needs and maintain a safe environment for all residents;

(b) The resident's admission will not:

(i) Adversely affect the provider's ability to meet the needs of other residents in the home;

(ii) Endanger the safety of other residents; and

(c) All residents and household members can be safely evacuated in an emergency.

(2) For each resident, the provider shall have a current written assessment which describes the resident's:

(a) Medical status;

(b) Strengths and needs;

(c) Activities preferences; and

(d) Preferences and choices regarding issues important to the resident (e.g., food, daily routine).

(3) The provider shall:

(a) Obtain sufficient assessment information to develop a negotiated service plan within fourteen days of the resident's admission; and

(b) Complete the assessment within thirty days of the resident's admission.

(4) The provider shall ensure that the resident's assessment is reviewed and updated for accuracy:

(a) As needed; and

(b) At the resident's request.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-610, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-620 Provision of services and care. (1) The provider shall ensure that the resident receives necessary services and care to promote the most appropriate level of physical, mental, and psychosocial well-being consistent with resident choice.

(2) The provider shall encourage and promote resident participation in service planning and delivery.

(3) The provider shall respect the resident's right to decide negotiated service plan goals and treatment choices, including acceptance or refusal of service plan recommendations.

(4) The provider shall ensure that resident services are delivered in a manner and in an environment that:

(a) Promotes maintenance or enhancement of each resident's quality of life; ((and))

(b) Ensures the safety of all residents; and

(c) Reasonably accommodates the resident's individual needs and preferences, except when the health or safety of the resident or other residents would be endangered.

(5) The provider shall ensure that appropriate professionals provide needed services to the resident based upon the resident's assessment and negotiated service plan.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-620, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-635 Nurse delegation--Penalties. The department shall impose a civil fine on any provider ((or resident manager)) that knowingly performs or knowingly permits an employee to perform a nursing task except as delegated by a nurse pursuant to chapter 18.79 RCW and chapter 246-840 WAC as follows:

(1) Two hundred fifty dollars for the first time the department finds an unlawful delegation;

(2) Five hundred dollars for the second time the department finds an unlawful delegation; and

(3) One thousand dollars for the third time or more the department finds an unlawful delegation.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-635, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-640 Resident medications. (1) Prescription medications may be administered only under the order of a physician or health care professional with prescriptive authority and with the resident's consent.

(2) The provider shall ensure that all prescription and over the counter medications are kept in:

(a) Locked storage; and

(b) The medication's original containers with the legible, original label.

(3) A self-medicating resident who wishes to retain his or her medication, shall keep the medication in a locked space in his or her own room that is not accessible to other residents.

(4) Medication organizers may be used when they are filled by:

(a) The resident;

(b) A resident's family member;

(c) The resident's surrogate decision maker acting in accordance with state law; or

(d) A health care professional licensed in Washington state who has had specialized training in medication administration.

(((4))) (5) Medication organizers shall carry a label which clearly identifies the:

(a) Name of the resident;

(b) Medications included; and

(c) Frequency ((of)) and dosage of medication.

(((5))) (6) The adult family home caregiver may administer the resident's oral medication only when the caregiver:

(a) Is a health care professional licensed in Washington state with specialized training in medication administration; or

(b) Has been authorized and trained to perform oral medication administration for the resident as a delegated nursing task in accordance with the requirements established by the nursing care quality assurance commission.

(7) Adult family home caregivers may assist the resident to self medicate with the consent of the resident or the resident's surrogate decision maker acting in accordance with state law.

(((6) Unless he or she is a licensed health professional or has been authorized and trained to perform a specifically delegated nursing task, the caregiver may only assist))

(8) Assisting the resident to self medicate ((by)) means:

(a) Reminding the resident when it is time to take a medication;

(b) Handing the resident the medication container; and

(c) Opening the resident's medication container.

(((7) The adult family home caregiver may administer the resident's oral medication only when the caregiver:

(a) Is a health care professional licensed in Washington state with specialized training in medication administration; or

(b) Has been authorized and trained to perform oral medication administration for the resident as a delegated nursing task in accordance with the requirements established by the nursing care quality assurance commission.

(8))) (9) A caregiver may assist a resident who cannot physically self-administer medication, but who can accurately direct others, by:

(a) Opening the container; and

(b) Applying or instilling oral, skin, nose, eye, and ear preparations.

(10) The provider shall ((maintain)) be responsible for ensuring that there is a record of all medications administered to and taken by the resident.

(((9))) (11) The provider shall ensure that injections are only administered to the resident by:

(a) The resident when he or she is capable;

(b) A resident's family member;

(c) The resident's surrogate decision maker acting in accordance with state law; or

(d) A health care professional licensed in Washington state who has had specialized training in medication administration.

(12) Over-the-counter medications requested by the resident shall be reviewed by the resident's physician/nurse practitioner or pharmacist for potentially harmful drug interactions.

(13) Unless the resident refuses the provider shall ensure that the resident receives prescription medication as ordered.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-640, filed 6/19/96, effective 7/20/96.]

PART IV

ADMINISTRATION

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-655 General management and administration. (1) The provider shall not admit or retain any resident whose needs the provider cannot meet.

(2) The provider shall ensure:

(a) That staff are competent, and receive necessary training to perform assigned tasks;

(b) The adult family home is in compliance with the requirements of this chapter and other applicable state laws; ((and))

(c) The home employs sufficient staff to meet the needs of the residents; and

(d) That the provider or entity responsible individual is available to respond to resident, caregiver, and department staff needs or inquiries.

(3) The provider shall maintain liability insurance of at least one hundred thousand dollars per occurrence to cover:

(a) Damage or loss of the resident's property; and

(b) Injury or harm to the resident resulting from:

(i) The provision of services or failure to provide needed services; or

(ii) Incidents occurring in the adult family home or on the home's premises.

(4) ((A provider who operates only one adult family home shall have evidence of the insurance coverage required by subsection (3) of this section beginning January 1, 1997.

(5))) The provider shall ensure that all caregivers are at least eighteen years of age or older.

(((6))) (5) The provider shall ensure that the provider ((or)), entity responsible individual, resident manager and all caregivers:

(a) Are able to communicate or make provisions for communicating with the resident in his or her primary language;

(b) Have a clear understanding of job responsibilities and knowledge of residents' negotiated service plans in order to be able to provide care specific to each resident's needs;

(c) Not engage in the illegal use of drugs or the excessive use of alcohol; and

(d) Possess a valid first aid and CPR card prior to providing care for residents; and

(e) Have not had a professional health care license or certificate, or a license for the care of children or vulnerable adults suspended, revoked or denied.

(((7))) (6) The provider shall ensure that:

(a) There is at ((all times on the premises at)) least one caregiver who ((is literate and)) has completed the department's fundamentals of caregiving or modified fundamentals of caregiving training present in the home whenever one or more residents are on the premises; and

(b) At least one caregiver is accessible by phone for emergencies when there are no residents on the homes' premises.

(7) The caregiver referred to under subsection (6) of this section shall be capable of understanding written and oral instructions communicated in English in order to be able to respond appropriately to emergency situations.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-655, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-660 Training. (1) Before operating and providing services in an adult family home, individual providers, entity responsible individuals, and resident managers shall successfully complete the department's:

(a) Fundamentals of caregiving training; or

(b) Modified fundamentals of caregiving training if they meet the requirements listed in subsection (3) of this section.

(2) Providers shall ensure that:

(a) All caregivers hired in the adult family home on or after ((the effective date of this chapter)) July 20, 1996 successfully complete the department designated fundamentals of caregiving training within one hundred twenty days of employment, unless he or she meets the requirements in subsection (3) below; and

(b) ((All caregivers hired in the adult family home prior to the effective date of this chapter successfully complete the department designated fundamentals of caregiving training prior to March 1, 1997, unless he or she meets the requirements in subsection (3) below; and

(c))) All caregivers complete a minimum of ten hours of continuing education credits per calendar year, on topics relevant to caregiving:

(i) Topics include, but are not limited to residents' rights, personal care, dementia, mental illness, developmental disabilities, depression, medication assistance, communication skills, alternatives to restraints, and activities for residents;

(ii) Caregivers must receive a certificate of completion to meet the requirement for continuing education credit and each hour of completed instruction will count as one hour of continuing education credit; and

(iii) The continuing education requirement begins the calendar year after the year in which the caregiver completes the fundamentals or modified fundamentals of caregiving training.

(3) A caregiver who ((is a)) has successfully completed training as a registered or licensed practical nurse, a physical or occupational therapist, a nursing assistant certified, a home health aid from a Medicare certified home health agency, who has successfully completed department approved adult family home training, or department approved personal care training from an area agency on aging or their subcontractor, or who is a resident manager or provider prior to ((the effective date of this chapter)) July 20, 1996, is exempt from the fundamentals of caregiving training in subsection (2) of this section if the caregiver successfully completes the department designated modified fundamentals of caregiving training in accordance with the dates specified in subsection (2) of this section.

(4) Caregivers are exempt from attending the fundamentals of caregiving or modified fundamentals of caregiving trainings if they successfully pass the department's challenge test for the class they are required to take. The caregiver has only one opportunity to successfully pass the challenge test then he/she must attend the fundamentals of caregiving or modified fundamentals of caregiving trainings as required.

(5) Volunteers are exempt from the training requirements listed above unless they provide unsupervised direct personal care to residents.

(((5))) (6) The provider shall document that caregivers have met the education and training requirements.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-660, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-665 Resident records. (1) The provider or resident manager shall:

(a) Keep confidential all information contained in the resident's records, regardless of the form or storage method of the records (e.g., computer files); and

(b) Protect information in the resident's record against alteration, loss, destruction, and unauthorized use.

(2) The provider or resident manager shall release information from the resident's record when required by:

(a) The resident's transfer to a health care institution;

(b) Law;

(c) Representatives of the department when acting in accordance with state law; or

(d) The resident.

(3) The provider shall ensure that caregivers in the home have access to resident records when information in those records is needed to provide care.

(4) The provider shall retain the resident's record for three years following the resident's discharge or death.

(((4))) (5) The adult family home shall ensure that the resident's record includes at least the following:

(a) Resident identification including the name, address, and telephone number of the person or persons the resident designates as significant;

(b) The name, address, and telephone numbers for the resident's:

(i) Surrogate decision maker, if any; and

(ii) Health care providers;

(c) A current medical history;

(d) An inventory of personal belongings which is:

(i) Updated as additional belongings accrue; and

(ii) Dated and signed by the resident and the provider or resident manager;

(e) The resident's assessment;

(f) The current negotiated service plan;

(g) Legal documents, including but not limited to:

(i) Power of attorney (POA) if the resident has appointed a POA;

(ii) Advance health care directives if the resident has executed such directives; and

(iii) A court order, if any, appointing a legal guardian and detailing the guardian's responsibility;

(h) Financial records;

(i) Medication records;

(j) The resident's social security number; and

(k) Admission, discharge, and absences information.

(((5))) (6) The provider or resident manager shall keep the resident's record at the adult family home in which the resident lives.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-665, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-670 Disaster and emergency preparedness. (1) The provider shall develop written plans and procedures to meet potential emergencies and disasters, such as fires, earthquakes, and floods.

(2) The provider shall ensure that all staff are trained in those emergency procedures when they begin to work at the home.

(3) The provider shall periodically review disaster and emergency procedures with staff, caregivers, and residents.

(4) The provider shall maintain a seventy-two hour food and water supply at the home, that is separate from the home's normal food and water supply, to meet resident needs in an emergency.

(5) The provider shall ensure the adult family home has readily available first-aid supplies and a first-aid manual.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-670, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-675 Reporting requirements. (1) The provider shall investigate, document, and immediately notify the department's toll-free complaint telephone number of any incidents involving allegations of resident abuse, neglect, exploitation or abandonment in accordance with the provisions of chapter 74.34 RCW.

(2) The provider shall keep a log of ((injuries and accidents to residents)) resident accidents, injuries sustained in accidents and injuries of unknown origin.

(3) When there is a significant change in a resident's condition, or a serious injury, trauma, or death of a resident, the provider shall immediately notify:

(a) The resident's family, surrogate decision maker, physician and other appropriate professionals, and other persons identified in the negotiated service plan; and

(b) The case manager, if the resident is receiving services paid for fully or partially by the department.

(4) The adult family home shall immediately report to the department's aging and adult services administration:

(a) Any event, actual or potential, requiring the evacuation or relocation of all or part of the home's residents to another address; ((and))

(b) Circumstances which threaten the home's ability to ensure continuation of services to residents; and

(c) Instances when a resident is determined to be missing.

(5) The provider shall immediately notify local law enforcement anytime the provider has reason to believe that the resident has been the victim of a crime.

(6) The provider shall notify the local public health officer and the department of any occurrence of food poisoning or communicable disease as required by the state board of health.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-675, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-680 Infection control and communicable disease. (1) The provider or resident manager shall institute appropriate infection control measures when the resident or any household member or caregiver has, or is suspected of having, a communicable disease.

(2) The provider shall((, in addition to following)) follow chapter 49.17 RCW, Washington Industrial Safety and Health Act (WISHA) requirements((,)) to protect the health and safety of residents ((from)) and employees. Specifically, with regard to tuberculosis ((by requiring)) the provider, ((and)) the entity responsible individual, each resident manager and caregiver ((to)) shall have, upon employment:

(a) A tuberculin skin test by the Mantoux method (PPD), unless the staff person:

(i) Documents a previous positive Mantoux skin test, which is ten or more millimeters of induration read at forty-eight to seventy-two hours;

(ii) Documents meeting the requirements of this subsection within the ((six)) twelve months preceding the date of employment; ((or))

(iii) Documents adequate therapy for active disease, or adequate preventive therapy; or

(iv) Provides a written waiver from skin testing from the department of health ((or authorized local health department;)).

(b) A second test one to three weeks after a negative Mantoux skin test ((for staff thirty-five years of age or older)); and

(c) A chest X-ray within seven days of any positive Mantoux skin test.

(3) The provider or resident manager shall:

(a) Report any employee's or provider's positive chest X-ray((s)) to the appropriate public health authority((,)); and

(b) Follow precautions ordered by ((a physician or)) the public health authority or the employee's personal physician.

(4) The provider shall retain records of tuberculin test results, reports of X-ray findings, physician or public health official orders, and waivers in the adult family home.

(5) The provider or resident manager shall:

(a) Use infection control standards and educational material consistent with the current curriculum for infection control as defined in the department's fundamentals of caregiving training ((and the adult family home provider's handbook));

(b) Dispose of used syringes, razor blades, and other sharp items in a manner that will not jeopardize the health and safety of residents, staff, and the public;

(c) Ensure disposals are placed in rigid containers, impervious to liquids and penetration by puncture. These containers shall be such that they cannot be opened either intentionally or accidentally; and

(d) Use all disposable and single-service supplies and equipment as specified by the manufacturer.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-680, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-685 Criminal history disclosure and background inquiries. (1) Before the adult family home employs, directly or by contract, a resident manager, entity responsible individual, or caregiver, or accepts as a caregiver any volunteer or student, or allows a household member unsupervised access to residents, the home shall:

(a) Require the person to complete the residential care services background inquiry form which includes:

(i) A disclosure statement; and

(ii) A statement authorizing the adult family home, the department, and the Washington state patrol to conduct a background inquiry;

(b) Verbally inform the person:

(i) That he or she may request a copy of the background inquiry result; and

(ii) Of the inquiry result within ten days of receipt; and

(c) Notify the appropriate licensing or certification agency of any person resigning or terminated as a result of having a conviction record.

(2) The adult family home provider shall not employ any person, directly or by contract, or accept as a volunteer or student any person who may have unsupervised access to residents, or allow a household member unsupervised access to residents, if the person or background inquiry discloses that the person was:

(a) Convicted of a crime against persons as defined under RCW 43.43.830;

(b) Convicted of a crime related to financial exploitation as defined under RCW 43.43.830;

(c) Found by a court in a domestic relations proceeding under Title 26 RCW to have sexually abused or exploited any minor or to have physically abused any minor;

(d) Subject to an order of protection under chapter 74.34 RCW for abuse, neglect, abandonment or financial exploitation of a vulnerable adult;

(e) Found in a final decision issued by a disciplinary board to have:

(i) Sexually or physically abused or exploited any minor or developmentally disabled person; or

(ii) Abused, neglected, abandoned or financially exploited any vulnerable adult; or

(f) Found in any dependency action under RCW 13.34.030 (2)(b) to have sexually assaulted or exploited any minor or to have physically abused any minor.

(3) The adult family home may choose to employ a person with a conviction of a crime against persons only if the conviction is one of the crimes listed in RCW 43.43.842 and the required number of years has passed.

(4) An adult family home may conditionally employ a person pending the result of a background inquiry, provided the home requests the inquiry within seventy-two hours of the conditional employment.

(5) A background inquiry result is only valid for two years from the date it is conducted, at which point a new background inquiry application must be submitted.

(6) The adult family home shall establish procedures ensuring:

(a) All disclosure statements and background inquiry applications and responses and all copies are maintained in a confidential and secure manner;

(b) All background inquiry results and disclosure statements are used for employment purposes only;

(c) Background inquiry results and disclosure statements are not disclosed to any person except:

(i) The person about whom the adult family home made the disclosure or background inquiry;

(ii) Authorized state and federal employees; and

(iii) The Washington state patrol auditor.

(((6))) (7) A record of inquiry results shall be retained by the adult family home for eighteen months beyond the date of employment termination.

(((7))) (8) The provider shall secure and submit any additional documentation and information as requested by the department to satisfy the requirements of this section.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-685, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-690 Advance directives, guardianship, and decision making. (1) The provider or resident manager shall provide or ensure that the resident, at the time of admission, has received the department's current booklet on health care rights, in the language appropriate for the resident, if available from the department.

(2) The provider or resident manager shall:

(a) Immediately contact the local emergency medical services in the event of a resident medical emergency regardless of any order, directive, or other expression of resident wishes involving the provision of medical services;

(b) Have readily available for emergency medical services personnel the resident's advance directives if the resident has executed an advance directive;

(c) Inform the resident of the action required by subsection (2)(a) of this section; and

(d) Include the action required by subsection (2)(a) of this section in the home's operational policies.

(3) A licensed physician or registered nurse acting within his or her scope of practice shall be exempt from the provisions of subsection (2) of this section.

(4) ((Owners, administrators,)) Providers, provider's family members, and employees shall not act as legal guardian((, or attorney-in-fact,)) for any resident residing in or receiving care in the home, unless ((he or she is the parent, spouse, adult child, or sibling of the resident)) they have authorization under RCW 11.92.040(6). A provider, provider's family member, or employee who is a resident's guardian ((for a resident of the adult family home at the time of the effective date of this regulation shall have up to two years from the effective date of this regulation to be legally removed as guardian of the resident)) and who does not have this authorization shall diligently seek a court order in accordance with RCW 11.92.040(6) no later than one year from the effective date of this rule.

(5) The adult family home shall provide care and services in compliance with the federal patient self determination act and with applicable state statutes related to surrogate and health care decision making, including chapters 7.70, 70.122, 11.88, 11.92, and 11.94 RCW.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-690, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-695 Protection of resident funds--Liquidation or transfer. (1) Upon the death of a resident, the adult family home shall promptly convey the resident's personal funds held by the adult family home with a final accounting of such funds to the department or to the individual or probate jurisdiction administering the resident's estate no later than forty-five calendar days after the date of the resident's death.

(2) If the deceased resident was a recipient of long-term care services paid for in whole or part by the state of Washington, then the personal funds held by the adult family home and the final accounting should be paid to the secretary, department of social and health services and mailed to the office of financial recovery, estate recovery unit, P.O. Box 9501, Olympia, WA 98507-9501 or such address as may be directed by the department in the future:

(a) The check and final accounting accompanying the payment shall contain the name and social security number of the deceased individual from whose personal funds account the monies are being paid; and

(b) The department of social and health services shall establish a release procedure for use of funds necessary for burial expenses.

(3) In situations where the resident is absent from the adult family home for an extended time without notifying the home, and the resident's whereabouts is unknown:

(a) The adult family home shall make a reasonable effort to find the missing resident; and

(b) If the resident cannot be located after ninety days, the home shall notify the department of revenue of the existence of "abandoned property," outlined in chapter 63.29 RCW. The home shall deliver to the department of revenue the balance of the resident's personal funds within twenty days following such notification.

(4) Prior to the sale or other transfer of ownership of the adult family home the provider shall:

(a) Provide each resident with a written accounting of any personal funds held by the home;

(b) Provide the new provider with a written accounting of all resident funds being transferred; and

(c) Obtain a written ((request)) receipt for those funds from the new provider.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-695, filed 6/19/96, effective 7/20/96.]

PART V

REMEDIES AND DISPUTE RESOLUTION

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-705 Remedies. (1) The department may take one or more of the actions listed in subsection (3)(a) of this section in any case in which the department finds that an adult family home provider has:

(a) Failed or refused to comply with the applicable requirements of chapters 70.128 and 70.129 RCW or of this chapter;

(b) Operated without a license or under a revoked license;

(c) Knowingly, or with reason to know, made a false statement of material fact on his or her application for a license or any data attached thereto, or in any matter under investigation by the department; ((or))

(d) Willfully prevented ((or)), interfered with, or failed to cooperate with any inspection or investigation by the department; or

(e) Failed to comply with:

(i) A condition imposed on a license; or

(ii) A stop placement order.

(2)(a) For failure or refusal to comply with any applicable requirements of chapters 70.128 and 70.129 RCW or of this chapter, the department may provide consultation and shall allow the provider a reasonable opportunity to correct before imposing remedies under subsection (3)(a) unless the violations pose a serious risk to residents, are recurring or have been uncorrected.

(b) When violations of this chapter pose a serious risk to a resident, are recurring or have been uncorrected, the department shall impose a remedy or remedies listed under subsection (3)(a). In determining which remedy or remedies to impose, the department shall take into account the severity of the potential or actual impact of the violations on residents and which remedy or remedies are likely to improve resident outcomes and satisfaction in a timely manner.

(3)(a) Actions and remedies the department may impose include:

(i) Denial of an application for a license;

(ii) Imposition of reasonable conditions on a license, such as correction within a specified time, training, and limits on the type of residents the provider may admit or serve;

(iii) Imposition of civil penalties of not more than one hundred dollars per day per violation;

(iv) Suspension, revocation, or refusal to renew a license; or

(v) Order stop placement.

(b) When the department orders stop placement, the adult family home shall not admit any person until the stop placement order is terminated. The department may approve readmission of a resident to the adult family home from a hospital or nursing home during the stop placement. The department shall terminate the stop placement when the department determines that:

(i) The violations necessitating the stop placement have been corrected; and

(ii) The provider exhibits the capacity to maintain adequate care and service.

(c) Conditions the department may impose on a license include, but are not limited to the following:

(i) Correction within a specified time;

(ii) Training related to the violations;

(iii) Limits on the type of residents the provider may admit or serve;

(iv) Discharge of any resident when the department determines discharge is needed to meet that resident's needs or for the protection of other residents;

(v) Change in the license capacity;

(vi) Removal of the adult family home's designation as a specialized home;

(vii) Prohibition of access to residents by a specified person; and

(viii) Demonstration of ability to meet financial obligations necessary to continue operation.

(d) When a provider fails to pay a fine when due under this chapter, the department may, in addition to other remedies, withhold an amount equal to the fine plus interest, if any, from any contract payment due to the provider from the department.

(e) When the department finds that a licensed provider also operates an unlicensed adult family home, the department may impose a remedy listed under subsection (3)(a) of this section on the provider and the provider's licensed adult family home or homes.

(f) When the department determines that violations existing in an adult family home are of such a nature as to present a serious risk of harm to residents of other homes operated by the same provider, the department may impose remedies on those other homes.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-705, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-765 Fire safety. (1) Every room used by residents shall have a fully opening window of sufficient size and free of obstructions for emergency escape or rescue unless the room has((:

(a) Two separate doors; or

(b) One)) a door leading directly to the outside. The provider shall comply with the 1994 Uniform Building Code, WAC 51-30-313.4.4.2 regarding escape or rescue window size.

(2) When resident bedroom windows are fitted with storm windows, the provider shall equip the storm windows with approved release mechanisms which are easily opened from the inside without the use of a key or special knowledge or effort.

(3) The provider shall assure that every occupied area used by persons under care shall have access to one exit or more and shall not pass through a room or space subject to being locked or blocked from the opposite side.

(4) The provider shall prohibit use as living space any area accessible only by ladder, folding stairs, or a trap door.

(5) The provider shall assure every bathroom door lock opens from the outside in an emergency.

(6) The provider shall assure every closet door opens from the inside.

(7) The provider shall not locate a stove or heater where the stove or heater blocks a resident's escape.

(8) The provider shall store flammable or combustible material away from exits and in areas not accessible to persons under care.

(9) A provider whose licensed home is equipped with open flame devices, cooking appliances, and other similar products shall use them in a safe manner.

(10) A provider shall not use portable oil, gas, kerosene, and electric space heaters, except in case of a power outage when the portable space heater is the home's only available heat.

(11) An adult family home shall have a posted, written plan for evacuation to safe areas in the event of fire. All staff, caregivers and residents shall be instructed in emergency evacuation procedures. The provider shall conduct fire drills at least every two months. The provider or resident manager shall maintain a log of dates and times of fire drills, and shall record the number of minutes it took to perform the fire evacuation drill. At the time of fire evacuation drills, the provider shall verify:

(a) Fire extinguishers are fully charged; ((and))

(b) Smoke detectors are in proper working order; and

(c) All residents are safely evacuated within five minutes of the commencement of the fire drill.

(12) The provider shall provide and have readily available an approved 2-A:10-B:C rated (five pound) fire extinguisher in proper operating condition on each floor of living space of the adult family home. Where local fire authorities require installation of a different type or size of fire extinguisher, the requirement of the local authority shall prevail. The provider shall maintain each required fire extinguisher in proper operating condition and shall have each required fire extinguisher inspected and serviced annually by a qualified inspector.

(13) The adult family home provider shall have an approved automatic smoke detector in each resident's bedroom and in proximity to the area where any resident or caregiver sleeps. When the licensed home is a multi-level home, a smoke detector shall be installed on each level. For violations in maintaining a smoke detector in working order, the department may require the provider to hard wire the smoke detector into the home's electrical system.

(14) An adult family home located in a rural area where there is not a public fire district shall ensure that on-site fire protection approved by the county fire authority is available to the adult family home.

(15) The provider shall assure outside exit doors open from the inside, without the use of a key or any special knowledge or effort.

(16) The provider shall comply with the 1994 Uniform Building Code, section 313, requirements for group LC occupancy (WAC 51-30-313) regarding evacuation capability and location or resident sleeping rooms.

(17) The provider shall notify the department of any fire on the premises by the first working day following the fire.

(18) Upon request, the provider shall allow the department ((may request)) to observe adult family home fire drills to assess the provider's ability to safely evacuate residents within five minutes of the commencement of the fire drill.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-765, filed 6/19/96, effective 7/20/96.]

REPEALER

The following sections of the Washington Administrative Code are repealed:

WAC 388-76-010 Authority.

WAC 388-76-020 Adult family homes.

WAC 388-76-030 Definitions.

WAC 388-76-040 Application or renewal for license.

WAC 388-76-045 Unlicensed facilities.

WAC 388-76-050 Licensing of state employee.

WAC 388-76-060 Limitations on licenses.

WAC 388-76-070 General qualifications of provider, staff persons, and other persons on the premises.

WAC 388-76-080 Multiple facility ownership.

WAC 388-76-085 General standards.

WAC 388-76-090 Licensure--Denial, suspension, or revocation.

WAC 388-76-095 License action notice--Adjudicative proceeding.

WAC 388-76-100 License fees.

WAC 388-76-110 Discrimination prohibited.

WAC 388-76-130 Persons subject to licensing.

WAC 388-76-140 Persons not subject to licensing.

WAC 388-76-155 Exceptions.

WAC 388-76-160 Capacity.

WAC 388-76-170 Providers' or resident managers' outside employment.

WAC 388-76-180 Provider or resident manager absence form home.

WAC 388-76-185 Placement of residents outside home.

WAC 388-76-190 Effect of local ordinances.

WAC 388-76-200 Fire safety.

WAC 388-76-220 Corporal punishment and physical and chemical restraints.

WAC 388-76-240 Resident's records and information.

WAC 388-76-250 Reporting of illness, death, injury, epidemic, or adult abuse.

WAC 388-76-260 Reporting change in circumstances.

WAC 388-76-280 Provider or resident manager-provided transportation for residents.

WAC 388-76-290 Clothing.

WAC 388-76-300 Personal hygiene.

WAC 388-76-310 Training.

WAC 388-76-320 Site.

WAC 388-76-325 Telephone.

WAC 388-76-330 Safety and maintenance.

WAC 388-76-340 Water safety.

WAC 388-76-350 Firearms.

WAC 388-76-360 Storage.

WAC 388-76-370 Bedrooms.

WAC 388-76-380 Kitchen facilities.

WAC 388-76-390 Laundry.

WAC 388-76-400 Toilets, lavatories, and bathing facilities.

WAC 388-76-405 Common use areas.

WAC 388-76-410 Lighting.

WAC 388-76-420 Pest control.

WAC 388-76-430 Sewage and liquid wastes.

WAC 388-76-435 Pets.

WAC 388-76-440 Water supply.

WAC 388-76-450 Temperature.

WAC 388-76-460 Ventilation.

WAC 388-76-465 Resident rights.

WAC 388-76-470 Health care plan.

WAC 388-76-475 Negotiated service plan.

WAC 388-76-480 First aid.

WAC 388-76-490 Medication services.

WAC 388-76-500 Self-administration of medications.

WAC 388-76-520 Infection control, communicable disease.