PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 05-07-132.
Title of Rule and Other Identifying Information: The department is creating and repealing sections in chapter 388-101 WAC, Certified community residential services and support.
Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6094), on November 6, 2007, at 10:00 a.m.
Date of Intended Adoption: Not earlier than November 7, 2007.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail DSHSRULESCOORDINATOR@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on November 6, 2007.
Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS Rules Consultant, by October 30, 2007, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at johnsjl4@dshs.wa.gov.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of this proposed rule making is to:
(1) Comply with the governor's executive order 05-03 plain talk;
(2) Simplify language, eliminate the question and answer format, reorganize and renumber the chapter so that the requirements are clearer for certified community residential service providers to understand;
(3) Clarify issues that have been brought to the attention of the department;
(4) Update rules to comply with statute changes; and
(5) Repeal all sections in current chapter 388-101 WAC and create sections as described in (2) above without making substantive changes to current requirements.
Reasons Supporting Proposal: To make the rule:
(1) Easier to read and understand and enforce;
(2) Easier to find information by changing the format;
(3) Easier to comply with by clarifying issues that have been brought to the attention of the department; and
(4) Up-to-date with statute changes.
Statutory Authority for Adoption: Chapters 71A.12 and 74.34 RCW.
Statute Being Implemented: Chapters 71A.12 and 74.34 RCW.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Department of social and health services, governmental.
Name of Agency Personnel Responsible for Drafting: John Gaskell, P.O. Box 45600, Mailstop 45600, Olympia, WA 98504-5600, (360) 725-3210; Implementation and Enforcement: Joyce Stockwell, Director, P.O. Box 45600, Mailstop 45600, Olympia, WA 98504-5600, (360) 725-2401.
No small business economic impact statement has been prepared under chapter 19.85 RCW. Residential care services analyzed the proposed rule amendments and concludes that costs to small businesses will be minor, if there are any costs at all. The primary purposes of the proposed amendments are to clarify preexisting requirements and to update existing rules to conform to changes in procedures, Washington state statutes, or rules of other Washington state agencies.
As a result, the preparation of a small business economic impact statement is not required.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting John Gaskell, P.O. Box 45600, Mailstop 45600, Olympia, WA 98504-5600, phone (360) 725-3210, fax (360) 438-7903, e-mail gaskejw@dshs.wa.gov.
August 28, 2007
Stephanie E. Schiller
Rules Coordinator
3914.3DEFINITIONS"Abuse" means:
(1) The willful action or inaction that inflicts injury, unreasonable confinement, intimidation, or punishment of a vulnerable adult;
(2) In instances of abuse of a vulnerable adult who is unable to express or demonstrate physical harm, pain, or mental anguish, the abuse is presumed to cause physical harm, pain, or mental anguish; and
(3) Abuse includes sexual abuse, mental abuse, physical abuse, and exploitation of a vulnerable adult, which have the following meanings:
(a) "Sexual abuse" means any form of nonconsensual sexual contact, including but not limited to unwanted or inappropriate touching, rape, sodomy, sexual coercion, sexually explicit photographing, and sexual harassment. Sexual abuse includes any sexual contact between a staff person, who is not also a resident or client, of a facility or a staff person of a program authorized under chapter 71A.12 RCW, and a vulnerable adult living in that facility or receiving service from a program authorized under chapter 71A.12 RCW, whether or not it is consensual.
(b) "Physical abuse" means the willful action of inflicting bodily injury or physical mistreatment. Physical abuse includes, but is not limited to, striking with or without an object, slapping, pinching, choking, kicking, shoving, prodding, or the use of chemical restraints or physical restraints unless the restraints are consistent with licensing and certification requirements, and includes restraints that are otherwise being used inappropriately.
(c) "Mental abuse" means any willful action or inaction of mental or verbal abuse. Mental abuse includes, but is not limited to, coercion, harassment, inappropriately isolating a vulnerable adult from family, friends, regular activity, and verbal assault that includes ridiculing, intimidating, yelling, or swearing.
(d) "Exploitation" means an act of forcing, compelling, or exerting undue influence over a vulnerable adult causing the vulnerable adult to act in a way that is inconsistent with relevant past behavior, or causing the vulnerable adult to perform services for the benefit of another.
"Case manager" means the division of developmental disabilities case resource manager or social worker assigned to a client.
"Certification" means a process used by the department to determine if an applicant or service provider complies with the requirements of this chapter and is eligible to provide certified community residential services and support to clients.
"Chaperone agreement" means a plan or agreement that describes who will supervise a community protection program client when service provider staff is not present. This plan or agreement is negotiated with other agencies and individuals who support the client, including the client's legal representative and family.
"Chemical restraint" means the use of psychoactive medications for discipline or convenience and not prescribed to treat the client's medical symptoms.
"Client" means a person who has a developmental disability as defined in RCW 71A.10.020(3) and who also has been determined eligible to receive services by the division of developmental disabilities under chapter 71A.16 RCW. For purposes of informed consent and decision making requirements, the term "client" includes the client's legal representative to the extent of the representative's legal authority.
"Client services" means instruction and support services that service providers are responsible to provide as identified in the client's individual support plan.
"Crisis diversion" means temporary crisis residential services and supports provided to clients at risk of psychiatric hospitalization and authorized by the division of developmental disabilities.
"Crisis diversion bed services" means crisis diversion that is provided in a residence maintained by the service provider.
"Crisis diversion support services" means crisis diversion that is provided in the client's own home.
"Department" means the Washington state department of social and health services.
"Financial exploitation" means the illegal or improper use of the property, income, resources, or trust funds of the vulnerable adult by any person for any person's profit or advantage other than the vulnerable adult's profit or advantage.
"Functional assessment" means a comprehensive evaluation of a client's challenging behavior(s). This evaluation is the basis for developing a positive behavior support plan.
"Group home" means a residence that is licensed as either a boarding home or an adult family home by the department under chapters 388-78A or 388-76 WAC. Group homes provide residential services to two or more clients who are unrelated to the provider.
"Group training home" means a certified nonprofit residential facility that provides full-time care, treatment, training, and maintenance for clients, as defined under RCW 71A.22.020(2).
"Immediate" or "Immediately" means within twenty-four hours for purposes of reporting abandonment, abuse, neglect, or financial exploitation of a vulnerable adult.
"Individual financial plan" means a plan describing how a client's funds will be managed when the service provider is responsible for managing any or all of the client's funds.
"Individual instruction and support plan" means a plan developed by the service provider and the client. The individual instruction and support plan:
(1) Uses the information and assessed needs documented in the individual support plan to identify areas the client would like to develop;
(2) Includes client goals for instruction and support that will be formally documented during the year; and
(3) Must contain or refer to other applicable support or service information that describes how the client's health and welfare needs are to be met (e.g. individual financial plan, positive behavior support plan, cross system crisis plan, individual support plan, individual written plan, client-specific instructions).
"Individual support plan" means a document that authorizes and identifies the division of developmental disabilities paid services to meet a client's assessed needs.
"Instruction" means goal oriented teaching that is designed for acquiring and enhancing skills.
"Legal representative" means a person's legal guardian, a person's limited guardian when the subject matter is within the scope of the limited guardianship, a person's attorney at law, a person's attorney in fact, or any other person who is authorized by law to act for another person.
"Managing client funds" means that the service provider:
(1) Has signing authority for the client;
(2) Disperses the client's funds; or
(3) Limits the client's access to funds by not allowing funds to be spent.
"Mechanical restraint" means a device or object, which the client cannot remove, applied to the client's body that restricts his/her free movement.
"Medication administration" means the direct application of a prescribed medication whether by injection, inhalation, ingestion, or other means, to the body of the client by an individual legally authorized to do so.
"Medication assistance" means assistance with self-administration of medication rendered by a non-practitioner to a client receiving certified community residential services and supports in accordance with chapter 69.41 RCW and chapter 246-888 WAC.
"Medication service" means any service provided by a certified community residential services and support provider related to medication administration or medication assistance provided through nurse delegation and medication assistance.
"Neglect" means:
(1) A pattern of conduct or inaction by a person or entity with a duty of care that fails to provide the goods and services that maintain physical or mental health of a vulnerable adult, or that fails to avoid or prevent physical or mental harm or pain to a vulnerable adult; or
(2) An act or omission that demonstrates a serious disregard of consequences of such a magnitude as to constitute a clear and present danger to the vulnerable adult's health, welfare, or safety, including but not limited to conduct prohibited under RCW 9A.42.100.
"Physical intervention" means the use of a manual technique intended to interrupt or stop a behavior from occurring. This includes using physical restraint to release or escape from a dangerous or potentially dangerous situation.
"Physical restraint" means physically holding or restraining all or part of a client's body in a way that restricts the client's free movement. This does not include briefly holding, without undue force, a client in order to calm him/her, or holding a client's hand to escort the client safely from one area to another.
"Psychoactive" means possessing the ability to alter mood, anxiety level, behavior, cognitive processes, or mental tension, usually applied to pharmacological agents.
"Psychoactive medications" means medications prescribed to improve or stabilize mood, mental status or behavior. Psychoactive medications include anti-psychotics/neuroleptics, atypical anti-psychotics, antidepressants, stimulants, sedatives/hypnotics, and anti-mania and anti-anxiety drugs.
"Qualified professional" means a person with at least three years' experience working with individuals with developmental disabilities.
"Residential service" means services provided to clients by a service provider.
"Restrictive procedure" means any procedure that restricts a client's freedom of movement, restricts access to client property, requires a client to do something which he/she does not want to do, or removes something the client owns or has earned.
"Risk assessment" means an assessment done by a qualified professional to determine the likelihood that a community protection program client will offend or re-offend.
"Service provider" means a person or entity certified by the department who delivers services and supports to meet a client's identified needs.
"Support" means assistance a service provider gives a client based on needs identified in the individual support plan.
"Supported living" means residential services provided by service providers to clients living in homes that are owned, rented, or leased by the client or their legal representative.
"Treatment team" means the program participant and the group of people responsible for the development, implementation, and monitoring of the person's individualized supports and services. This group may include, but is not limited to, the case manager, therapist, the service provider, employment/day program provider, and the person's legal representative and/or family, provided the person consents to the family member's involvement.
"Vulnerable adult" includes a person:
(1) Sixty years of age or older who has the functional, mental, or physical inability to care for himself or herself; or
(2) Found incapacitated under chapter 11.88 RCW; or
(3) Who has a developmental disability as defined under RCW 71A.10.020; or
(4) Admitted to any facility; or
(5) Receiving services from home health, hospice, or home care agencies licensed or required to be licensed under chapter 70.127 RCW; or
(6) Receiving services from an individual provider.
"Willful" means the deliberate, or non-accidental, action or inaction by an alleged perpetrator that he/she knew or reasonably should have known could cause a negative outcome, harm, injury, pain, and anguish.
"Written individual plan" means a plan developed for clients in the community protection program that includes:
(1) An assessment of the client's emotional and behavioral issues as related to community protection risks;
(2) Specific intervention strategies and techniques related to community protection risks;
(3) Specific restrictions and measures, including security precautions, both in-home and out-of-home; and
(4) Signatures of the client's case manager and the client.
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CERTIFICATION AND MONITORING(1) Be certified by the department; and
(2) Be granted a contract by the department.
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(1) All the requirements of this chapter. Except that, the licensing requirements for adult family homes and boarding homes supersede this chapter if the requirements under respective chapters 388-76 and 388-78A WAC conflict with this chapter;
(2) The laws governing this chapter, including chapter 71A.12 and 71A.22 RCW;
(3) The requirements of chapter 74.34 RCW;
(4) The department's residential services contract. Except that, the requirements of this chapter supersede any conflicting requirements with the contract, or appendices to the contract; and
(5) Other relevant federal, state and local laws, requirements, and ordinances.
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(2) The service provider must complete an application before the department will consider a request for change of ownership as detailed in WAC 388-101-3060.
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(2) The service provider must have a separate contract for each region where they receive referrals to serve clients.
(3) The service provider's residential services contract will be terminated by the department upon termination of certification.
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(a) A letter of intent that includes:
(i) Contact information;
(ii) Geographical area of service; and
(iii) Type of service provided, including group home, supported living, community protection, or group training home.
(b) A completed and signed application on forms designated by the department;
(c) All attachments specified in the application and any other information the department may request including but not limited to:
(i) Administrator resumes;
(ii) Statements of financial stability;
(iii) Professional references;
(iv) Relevant experiences and qualifications of the individual or agency; and
(v) Assurances the applicant will not discriminate against any client or employee.
(d) A copy of the license if applying for certification as a group home;
(e) The name of the administrator of the program; and
(f) Department criminal history background check on forms designated by the department for the individual or individuals designated to serve as administrator of the proposed program.
(2) The applicant must submit a revised application, if any information on the application changes before the initial certification is issued.
(3) The department will only process a completed application.
(4) Each person named in the application for initial certification is considered separately and jointly by the department.
(5) Based on the documentation received, the department will notify the applicant in writing regarding the department's certification decision.
(6) The applicant must comply with additional requirements identified in this chapter if intending to support community protection clients.
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(a) The business entity ownership; or
(b) The form of legal organization.
(2) The service provider applying for a change of ownership may be required to provide any or all items listed in WAC 388-101-3050.
(3) If the applicant is not a current service provider, the applicant must apply for initial certification.
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(1) The department in writing sixty days before a change of ownership; and
(2) Clients or their legal representatives in writing thirty days before a change of ownership.
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(1) Has shown a lack of understanding, ability or emotional stability to meet the identified needs of vulnerable adults;
(2) Had a department contract or certification withdrawn or denied by the department, or has been subjected to enforcement actions;
(3) Had a contract, certification, or license from another state withdrawn or denied;
(4) Obtained or attempted to obtain a license or certification by fraudulent means or misrepresentation;
(5) Has relinquished or been denied a license or license renewal to operate a home or facility that was licensed for the care of children or vulnerable adults;
(6) Refused to permit authorized department representatives to interview clients or to have access to client records;
(7) Has been convicted of a drug related conviction within the past five years without evidence of rehabilitation; or
(8) Has been convicted of an alcohol related conviction within the past five years without evidence of rehabilitation.
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(1) Convicted of a crime against children or other persons or crimes relating to financial exploitation as defined under RCW 43.43.830 or 43.43.842;
(2) Found by a court in a protection proceeding or in a civil damages lawsuit under chapter 74.34 RCW to have abused, neglected, abandoned or financially exploited a vulnerable adult;
(3) Found in any dependency action under chapter 13.34 RCW to have sexually assaulted, neglected, exploited, or physically abused any minor;
(4) Found by a court in a domestic relations proceeding under Title 26 RCW to have sexually abused, exploited, or physically abused any minor;
(5) Found in any final decision issued by a disciplinary board to have sexually or physically abused or exploited any minor or have abused, neglected, abandoned, or financially exploited any vulnerable adult as defined under chapter 74.34 RCW; or
(6) The subject of a stipulated finding of fact, conclusion of law, an agreed order, finding of fact, final order issued by a disciplining authority or final decision by any federal or state agency or department, a court of law, or entered into a state registry or department or agency list with a finding of abuse, neglect, financial exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW.
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(a) Grant initial certification for up to one hundred and eighty days of the effective date of the residential services contract; and
(b) Extend initial certification for an additional period up to one hundred and eighty days.
(2) If an applicant does not receive a residential services contract, initial certification will be valid for up to one year.
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(a) Grant certification to a service provider for up to two years; and
(b) Extend regular certification for an additional period up to one hundred and eighty days.
(2) If a service provider does not comply with the certification requirements, the department may provisionally certify or decertify a service provider.
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(2) During certification evaluations the service provider's administrator or designee must:
(a) Cooperate with department representatives during the on-site visit;
(b) Provide all records and information requested by the department representatives;
(c) Ensure the service provider's administrator or designee is available during any visit to respond to questions or issues identified by department representatives; and
(d) Ensure the service provider's administrator or designee is present at the exit conference.
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(1) Allow any state or federal department or agency to conduct audits, evaluations, or complaint investigations related to this program or to clients served in this program;
(2) Allow department representatives to review a client's records and activities at any time to see if the service provider continues to address the clients' needs for instruction and support activities;
(3) Allow the department representatives' access to clients, the client's legal representative and family members; and
(4) Cooperate with department representatives in the performance of official duties.
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(1) Submit a signed plan of correction to the department according to established department processes and timelines; and
(2) Include in the plan of correction:
(a) What the service provider did or will do to correct each deficiency;
(b) How the service provider will prevent future problems of this type;
(c) Who will be responsible for monitoring the corrections to ensure the problems do not recur; and
(d) When lasting correction will be achieved.
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(1) Complete an application on forms and attachments designated by the department; and
(2) Currently be:
(a) Certified as a community residential services and support provider;
(b) Licensed as an adult family home under chapter 70.128 RCW; and
(c) A nonprofit business in accordance with state and federal law.
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(1) The needs of the program;
(2) Available funding;
(3) The information received from the applicant;
(4) The certification history of the applicant;
(5) The licensing history of the applicant; and
(6) The capacity of the home.
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ADMINISTRATIVE REQUIREMENTS(a) This chapter;
(b) Each contract and statement of work entered into with the department;
(c) Each client's individual support plan when the individual support plan identifies the service provider as responsible; and
(d) Each client's individual instruction and support plan.
(2) The service provider must:
(a) Have a designated administrator and notify the department when there is a change in administrator;
(b) Ensure that clients have immediate access to staff, or the means to contact staff, at all times;
(c) Provide adequate staff within contracted hours to administer the program and meet the needs of clients;
(d) Not routinely involve clients in the unpaid instruction and support of other clients;
(e) Not involve clients receiving crisis diversion services in the instruction and support of other clients; and
(f) Retain all records and other material related to the residential services contract for six years after expiration of the contract.
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(1) Have a high school diploma or GED equivalent, unless the employees were hired before September 1, 1991;
(2) Be eighteen years of age or older when employed as a direct care staff, or twenty-one years of age or older when employed as an administrator;
(3) Have a clear understanding of job responsibilities and knowledge of individual support plans and client needs; and
(4) Passed the department criminal background check and have no criminal convictions listed in RCW 43.43.830 or 43.43.842 and no state or federal findings of abandonment, abuse, neglect or financial exploitation.
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(1) A mission statement;
(2) A program description;
(3) An organizational chart and description showing all supervisory relationships;
(4) Description of staff roles and responsibilities, including the person designated to act in the absence of the administrator; and
(5) Staffing schedules.
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(1) Overseeing all aspects of staffing, such as recruitment, staff training, and performance reviews;
(2) Developing and maintaining policies and procedures that give staff direction to provide appropriate services and support as required by this chapter and the department contract; and
(3) Maintaining and securely storing client, personnel, and financial records.
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(1) Provide care and services in accordance with this chapter and with licensing requirements under chapters 388-76 and 388-78A WAC respectively;
(2) Comply with the home's licensing requirements if there is a conflict with requirements in this chapter; and
(3) Comply with this chapter if the requirement is over and above the home's licensing requirements.
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(a) Related to client rights, including a client's right to file a complaint or suggestion without interference;
(b) Related to soliciting client input and feedback on instruction and support received;
(c) Related to reporting suspected abuse, neglect, financial exploitation, or abandonment;
(d) To protect clients when there have been allegations of abuse, neglect, financial exploitation, or abandonment;
(e) In emergent situations that may pose a danger or risk to the client or others, such as in the event of death or serious injury to a client;
(f) In responding to missing persons and client emergencies;
(g) Related to emergency response plans for natural or other disasters;
(h) When accessing medical, mental health, and law enforcement resources for clients;
(i) Related to notifying a client's legal representative, and/or relatives in case of emergency;
(j) When receiving and responding to client grievances; and
(k) To respond appropriately to aggressive and assaultive clients.
(2) The service provider must develop, implement, and train staff on policies and procedures in all aspects of the medication support they provide, including but not limited to:
(a) Supervision;
(b) Client refusal;
(c) Services related to medications and treatments provided under the delegation of a registered nurse consistent with chapter 246-840 WAC;
(d) The monitoring of a client who self-administers their own medications;
(e) Medication assistance for clients needing this support; and
(f) What the service provider will do in the event they become aware that a client is no longer safe to take their own medications.
(3) The service provider must maintain current written policies and procedures and make them available to all staff; and to clients and legal representatives upon request.
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(2) The service provider must not allow the following persons to have unsupervised access to clients until the service provider receives successful results from the criminal history background check from the department:
(a) Administrators;
(b) Employees;
(c) Volunteers or students; and
(d) Subcontractors.
(3) Service providers or applicants who have lived in Washington state less than three years or who are otherwise required to complete a fingerprint-based background check may be hired for a one hundred twenty-day provisional period as allowed under law when:
(a) The applicant or service provider is not disqualified based on the initial result of the background check from the department; and
(b) A fingerprint-based background check is pending.
(4) The service provider must notify the person that he or she may request a copy of the background check result within ten days of receiving the result.
(5) The service provider must renew at least every thirty-six months and keep current department background checks for each administrator, employee, volunteer or subcontractor of a service provider.
(6) Licensed boarding homes or adult family homes must adhere to the current regulations in this chapter and in the applicable licensing laws.
(7) Service providers must follow the requirements of RCW 43.43.830 through 43.43.842 and RCW 74.15.030.
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(1) Provide and document required training to staff;
(2) Within the first six months, ensure that staff receives a minimum of thirty-two total hours of training that meets the training requirements of this chapter;
(3) Provide staff training sooner if required by the client's identified needs; and
(4) Meet state and federal laws regarding training; such as, bloodborne pathogens training referenced in WAC 296-823-120.
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(1) Current individual instruction and support plans of each client with whom the employee works;
(2) Emergency procedures for clients;
(3) The reporting requirements for abuse and neglect under chapter 74.34 RCW; and
(4) Client confidentiality.
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(1) The service provider's mission statement;
(2) Policies and procedures; and
(3) On-the-job training.
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(1) First aid and CPR;
(2) Bloodborne pathogens with HIV/AIDS information;
(3) Client services;
(4) Residential guidelines; and
(5) Positive behavior support.
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(a) Prior to certification review;
(b) When household configuration changes affect staff coverage; or
(c) When additional staffing is requested or needed by the client.
(2) The service provider must retain copies of the staff coverage schedules for a minimum of three months.
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CLIENT RIGHTS AND TREATMENT(2) Service providers must promote and protect all of the following client rights, including but not limited to:
(a) The right to be free from discrimination;
(b) The right to be reasonably accommodated in accordance with the Americans with Disabilities Act;
(c) The right to privacy, including the right to receive and send private mail and telephone calls;
(d) The right to participate in an appropriate program of publicly supported education;
(e) The right to be free from harm, including unnecessary physical restraint, isolation, excessive medication, abuse, neglect, abandonment, and financial exploitation; and
(f) The right to refuse health services, medications, restraints, and restrictions.
(3) For group homes that have a boarding home or adult family home license, refer to chapter 388-78A or 388-76 WAC respectively for additional rights.
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CLIENT SERVICES
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(1) Health and safety;
(2) Personal power and choice;
(3) Competence and self-reliance;
(4) Positive recognition by self and others;
(5) Positive relationships; and
(6) Integration in the physical and social life of the community.
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(1) Home living activities;
(2) Community living activities;
(3) Life-long learning activities;
(4) Health and safety activities;
(5) Social activities;
(6) Employment;
(7) Protection and advocacy activities;
(8) Exceptional medical support needs; and
(9) Exceptional behavioral support needs.
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(1) Provide instruction and/or support as identified in the individual support plan to assist the client in:
(a) Accessing health, mental health, and dental services; and
(b) Medication management, administration, and assistance.
(2) Maintain health records;
(3) Assist the client in arranging appointments with health professionals;
(4) Monitor medical treatment prescribed by health professionals;
(5) Communicate directly with health professionals when needed; and
(6) Ensure that the client receives an annual physical and dental examination unless the appropriate medical professional gives a written exception.
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(2) The service provider must not allow an employee to perform any nursing task that violates applicable statutes and rules, including:
(a) Chapter 18.79 RCW, Nursing care;
(b) Chapter 18.88A RCW, Nursing assistants;
(c) Chapter 246-840 WAC, Practical and registered nursing;
(d) Chapter 246-841 WAC, Nursing assistants; and
(e) Chapter 246-888 WAC, Medication assistance.
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(a) Not charging the client for transportation costs except as specified in the client's individual support plan;
(b) Using the client's Medicaid coupons for covered transportation, if available; and
(c) Ensuring that other transportation is provided as specified in the client's individual support plan.
(2) The service provider must provide transportation or ensure that clients have a way to get to and from:
(a) Emergency medical care;
(b) Medical appointments; and
(c) Therapies.
(3) As specified in the client's individual support plan, the service provider must provide necessary assistance with transportation to and from:
(a) School or other publicly funded services;
(b) Work;
(c) Leisure or recreation activities; and
(d) Client-requested activities.
(4) A vehicle that the service provider uses to transport clients must be insured as required by chapters 46.29 and 46.30 RCW.
(5) The service provider must maintain a business automobile insurance policy on service provider owned vehicles used to transport clients.
(6) The service provider must maintain non-owned vehicle insurance coverage for vehicles not owned by the service provider but used to transport clients.
(7) Service providers, employees, subcontractors, and volunteers who transport clients must have a valid driver's license as required by chapter 46.20 RCW.
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(2) The service provider must ensure that the following home safety requirements are met for each client unless otherwise specified in the client's individual support plan:
(a) A safe and healthy environment;
(b) Accessible telephone equipment and a list of emergency contact numbers;
(c) An evacuation plan developed and practiced with the client;
(d) Unblocked door and window for emergency exit;
(e) A safe storage area for flammable and combustible materials;
(f) An operating smoke detector, with a light-alarm for clients with hearing impairments;
(g) An accessible flashlight or other safe accessible light source in working condition; and
(h) Basic first-aid supplies.
(3) The service provider must assist clients in regulating household water temperature unless otherwise specified in the client's individual support plan as follows:
(a) Maintain water temperature in the household no higher than one hundred and twenty degrees Fahrenheit;
(b) Check water temperature when the client first moves into the household and at least once every three months from then on; and
(c) Regulate water temperature for clients who receive twenty-four hour support, and for other clients as specified in the individual support plan.
(4) The service provider must document and keep records that indicate that physical safety requirements are met for each client.
(5) A client may independently document these requirements are met when the client's individual support plan specifies this level of client involvement.
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(1) Provide the department with a written description of the household composition;
(2) Obtain written approval from the division of developmental disabilities; and
(3) Obtain written consent from each client in the household or the client's legal representative if the client is unable to consent.
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(1) Provide the department with a written description of the household composition;
(2) Participate with the treatment team during the household composition review;
(3) Obtain written approval from the division of developmental disabilities; and
(4) Obtain written consent from each client in the household or the client's legal representative if the client is unable to consent.
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(2) Service providers must document each client's refusal to participate in:
(a) Physical and safety requirements, as outlined in WAC 388-101-3390; and
(b) Client health services support under WAC 388-101-3370.
(3) Service providers must document the following:
(a) A description of events relating to the client's refusal to participate in these services;
(b) That the client was informed of the benefits of these services and the possible risks of refusal;
(c) A description of the service provider's efforts to give or acquire the services for the client; and
(d) Any health or safety concerns that the refusal may pose.
(4) The service provider must:
(a) Review this documentation with the client or the client's legal representative at least every six months; and
(b) Request that the client or client's legal representative sign and date the document after reviewing it.
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(1) When a client's service needs change and the individual support plan no longer addresses the client's needs; and
(2) May request in writing, assistance from the department's case manager in setting up an assessment meeting.
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(2) If further assistance is needed, the service provider must confirm in writing to the client's case manager on the first working day after initiating a verbal request for such assistance:
(a) The nature of the emergency; and
(b) The need for immediate assistance and the specific type of assistance needed.
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(1) Notify the department in writing ten working days before termination of services and include:
(a) Why the provider cannot meet the client's needs; and
(b) How the refusal to serve the client would be in the best interest of the client or other clients.
(2) Notify the client and the client's legal representative in writing ten working days before terminating services; and
(3) Notify the department immediately if the situation is urgent and the client or other clients are at risk.
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INDIVIDUAL INSTRUCTION AND SUPPORT PLAN
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(2) In developing the individual instruction and support plan, the service provider must:
(a) Work with the client and select goals based on the individual support plan that will be worked on during the implementation of the individual instruction and support plan for the upcoming year;
(b) Identify how the instruction and/or support activities will be provided to meet the assessed needs of the client as described in the individual support plan;
(c) Ensure that the individual instruction and support plan contains or refers to other applicable support and/or service information; and
(d) Include the participation and agreement of the client and other individuals the client wants included.
(3) The service provider must send a copy of the individual instruction and support plan goals together with a list of applicable support and service information and where the information is located to the case manager for review.
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(1) Develop and keep a written record of the individual instruction and support plan that includes the elements required in WAC 388-101-3470;
(2) Include a section or page in the individual instruction and support plan that provides or references all applicable support or service information pertaining to the client;
(3) Review and update the plan to reflect changes in the assessed needs as described in the individual support plan;
(4) Sign and date the plan's documents; and
(5) Document the client's agreement with the plan as well as the client's legal representative if applicable.
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(1) Oversee the progress made on each client's individual instruction and support plan;
(2) Coordinate with other staff, and other providers serving the client, and other interested persons as needed, in implementing the individual instruction and/or support plan; and
(3) Revise and update the plan as the client's assessed needs change.
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(1) Staff to provide direction on what they are to do to instruct and/or support the client;
(2) The client receiving service;
(3) The client's legal representative; and
(4) Representatives of the department.
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(1) Review and revise the individual instruction and support plan as goals are achieved or as client assessed needs change in order to reflect the client's current needs, goals, and preferences:
(a) At least semi-annually; and
(b) At any time requested by the client or the client's legal representative.
(2) Send an updated copy of the instruction and support goals of the individual instruction and support plan and the list of applicable support and service information and where the information is located to the case manager for review.
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CLIENT FINANCES(1) Given to the client or the client's legal representative;
(2) Deposited to the client's account; or
(3) Used only for the client.
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(a) Identifies that the client needs support to manage funds; and
(b) Designates the service provider as responsible for that support; or
(c) Indicates the service provider manages any portion of the client's funds.
(2) The service provider must obtain signatures from the client and the client's legal representative on the individual financial plan.
(3) The service provider must include the following in the client's individual financial plan:
(a) Client funds and income managed by the service provider;
(b) Client funds and income managed by the client and the client's legal representative;
(c) The type of accounts containing client funds;
(d) A description of how the client's funds will be spent during a typical month;
(e) Money management instruction or support provided to the client; and
(f) If applicable, asset management including such things as personal property, burial plan, retirement funds, stock, and vehicles.
(4) The service provider must review the individual financial plan with the client at least every twelve months.
(5) The service provider must send a copy of each client's individual financial plan to:
(a) The client's legal representative; and
(b) The client's case manager upon request.
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(a) Obtain written consent from the client or the client's legal representative; or
(b) Become the representative payee.
(2) For any client funds managed by the service provider, the service provider must:
(a) Separately track each client's money, even when several clients reside together;
(b) Maintain a current running balance of each client account;
(c) Make deposits to the client's bank account within one week of receiving the client's money;
(d) Prevent the client's bank account from being overdrawn;
(e) Ensure that client cash funds do not exceed seventy-five dollars per client unless specified differently in the individual financial plan; and
(f) Retain receipts for each purchase over twenty-five dollars.
(3) Social Security Administration requirements for managing the client's social security income take precedence over these rules if:
(a) The service provider is the client's representative payee; and
(b) The Social Security Administration requirement conflicts with these rules.
(4) When the service provider manages the client's funds and receives a check made out to the client, the service provider must:
(a) Get the client's signature and designation "for deposit only,"; or
(b) Get the client's "x" mark in the presence of a witness and cosign the check with the designation "for deposit only,"; and
(c) Deposit the check in the client's bank account as required under subsection (2)(c) of this section.
(5) If a check for the client is made out to a payee other than the client, the service provider must ask the payee to sign the check.
(6) The service provider must not ask the client to sign a blank check.
(7) The service provider may only assist the client to make purchases by check when the client signs the check at the time of the purchase unless:
(a) Otherwise specified in the client's individual financial plan; or
(b) The service provider is the client's representative payee.
(8) The service provider must document in the client's record the name of each staff that may assist the client with financial transactions.
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(1) Must notify the case manager of the denial in writing; and
(2) May use client funds for the client's health services if no other funding is available.
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(a) Reconcile the client's bank accounts to the client's bank statements each month;
(b) Reconcile the client's cash account each month; and
(c) Verify the accuracy of the reconciliation.
(2) The service provider must not allow the same staff person to do both the verification and reconciliation of the client's account.
(3) The service provider must ensure that the verification or reconciliation is done by a staff person who did not:
(a) Make financial transactions on the client's behalf; or
(b) Assist the client with financial transactions.
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(2) When the service provider holds the client's bankcards or bankbooks as requested by the client:
(a) It is not assumed that the service provider is managing the client's funds; and
(b) The client must continue to have access to his or her own funds.
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(2) The service provider must also keep the following documentation for client financial transactions:
(a) Monthly bank statements and reconciliations;
(b) Checkbook registers and bankbooks;
(c) Deposit receipts;
(d) Receipts for purchases over twenty-five dollars;
(e) A ledger showing deposits, withdrawals, and interest payments to each client; and
(f) A control journal for trust accounts.
(3) The service provider must keep the following documentation for cash and debit transactions:
(a) A detailed ledger signed by the staff who withdrew any of the client's money;
(b) A detailed accounting of the funds received on behalf of the client including:
(i) Cash received from writing checks over the purchase amount; and
(ii) A list of where the money was spent.
(c) Receipts for purchases over twenty-five dollars when service provider staff withdrew the money.
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(2) When transferring funds, the previous provider must:
(a) Have an agreement with the client regarding the amount of money to be withheld to pay bills;
(b) Inform the client's case manager about any agreement in subsection (2)(a) of this section;
(c) Give the client and the client's legal representative a written accounting of all known client funds;
(d) When applicable, give the new service provider a written accounting of all transferred client funds;
(e) Obtain a written receipt from the client and legal representative for all transferred funds; and
(f) When applicable, obtain the new service provider's written receipt for the transferred funds.
(3) When the client moves to another living arrangement without supported living services or the client's whereabouts are unknown, the service provider must transfer the client's funds within one hundred eighty days to:
(a) The client's legal representative;
(b) The department; or
(c) The requesting governmental entity.
(4) When the client dies, the service provider must transfer the client's funds within ninety days to:
(a) The client's legal representative;
(b) The requesting governmental entity; or
(c) The department if the client does not have a legal heir.
(5) Social Security Administration requirements for managing the client's social security income take precedence over these rules for transferring client funds if:
(a) The service provider is the client's representative payee; and
(b) The Social Security Administration requirement conflicts with these rules.
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(2) The client's service provider must not:
(a) Charge the client interest for any money loaned; or
(b) Borrow funds from the client.
(3) The provider must keep the following loan documentation for each loan:
(a) A loan agreement signed by the client or the client's legal representative;
(b) Amount of the loan;
(c) Payments on the loan balance; and
(d) The current balance owed.
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(1) The service provider or staff has stolen, misplaced, or mismanaged client funds; or
(2) Service charges are incurred on a trust account that the service provider manages for the client.
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(1) At least the current minimum wage; and
(2) According to state and federal requirements.
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CLIENT MEDICATIONS(a) Have systems in place to ensure that medications are given as ordered and in a manner that safeguards the client's health and safety;
(b) Ensure that each client receives their medication as prescribed, except as provided for in the medication refusal section or in the medication assistance section regarding altering medication; and
(c) Have a legible prescription label completed by a licensed pharmacy before providing medication assistance or medication administration to a client for prescribed medications.
(2) Group homes licensed as a boarding home or adult family home must meet the medication management requirements of chapter 388-78A or 388-76 WAC. For any difference in requirements the boarding home or adult family home medication rules take precedence over the medication rules of this chapter.
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(1) Self-administration of medication;
(2) Medication assistance;
(3) Nurse delegated medication administration; and
(4) Medication administration by a practitioner.
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(1) Communicating the prescriber's order to the client in such a manner that the client self-administers his/her medication properly;
(2) Reminding or coaching the client when it is time to take a medication;
(3) Opening the client's medication container;
(4) Handing the client the medication container;
(5) Placing the medication in the client's hand;
(6) Transferring medication from one container to another for the purpose of an individual dose (e.g., pouring a liquid medication from the container to a calibrated spoon or medication cup or using adaptive devices);
(7) Altering a medication by crushing or mixing:
(a) Only if the client is aware that the medication is being altered or added to food or beverage; and
(b) A pharmacist or other qualified practitioner has determined it is safe to alter medication; and
(c) It is documented on the prescription container or in the client's record.
(8) Guiding or assisting the client to apply or instill skin, nose, eye and ear preparations. Hand-over-hand administration is not allowed; and
(9) For group homes that have a boarding home or adult family home license, refer to chapter 388-78A or 388-76 WAC for additional tasks that may be allowed.
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(2) Service providers may only administer medication under the order of a physician or a health care professional with prescriptive authority.
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(a) Respect the client's right to choose not to take the medication(s); and
(b) Document the time, date and medication the client did not take.
(2) The service provider must take the appropriate action, including notifying the prescriber or primary care practitioner, when the client chooses to not take his or her medications and the client refusal could cause harm to the client or others.
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(2) The service provider must store medications:
(a) Under proper conditions for sanitation, temperature, moisture and ventilation, and separate from food or toxic chemicals; and
(b) In the original medication containers with pharmacist-prepared or manufacturer's label, or in medication organizers which are clearly labeled with the:
(i) Name of the client for whom the medication is prescribed;
(ii) Name of the medications; and
(iii) Dosage and frequency.
(3) Group homes must:
(a) Keep all medications in locked storage; and
(b) Use medication organizers only when filled by a pharmacist.
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(a) The client;
(b) A licensed pharmacist;
(c) An RN; or
(d) The client's legal representative or a family member.
(2) Service providers must assure that the medication organizers are labeled.
(3) The client, a pharmacist, an RN, or the client's legal representative or family member may label the medication organizer.
(4) When there is a change in medications by the prescriber, the individual filling the medication organizers must replace labels with required updated information immediately.
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(2) When disposing client medications the service provider must list the:
(a) Medication;
(b) Amount; and
(c) Date that it was disposed.
(3) Two people, one of whom may be the client, must verify the disposal by signature.
(4) For group homes that have a boarding home or adult family home license, refer to chapters 388-78A or 388-76 WAC for medication disposal requirements.
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PSYCHOACTIVE MEDICATIONS(1) Refer the client for a professional assessment;
(2) Prior to the referral, prepare a psychiatric referral summary, including the frequency and severity of the symptoms or behaviors, and take or send this document to the treatment professional conducting the assessment;
(3) Respect the client's preference to visit the treatment professional independently; and
(4) If drugs are prescribed, have the prescribing professional assess the client at least annually to review the continued need for the medication(s) and possible dosage reduction.
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(a) A description of the behaviors, symptoms or conditions for which the medication is prescribed and a mental health diagnosis, if available;
(b) The name, dosage, and frequency of the medication and subsequent changes in dosage must be documented in the person's medical record;
(c) The length of time considered sufficient to determine if the medication is effective;
(d) The behavioral criteria to determine whether the medication is effective and what changes in behavior, mood, thought, or functioning are considered evidence that the medication is effective; and
(e) The anticipated schedule of visits with the prescribing professional.
(2) The service provider must make sure the treatment plan is updated when there is a change in psychoactive medication type, including intraclass changes.
(3) The service provider must:
(a) Review the name, purpose, potential side effects and any known potential drug interactions of the psychoactive medication(s) with the client and his/her legal representative and document the review in the client record; and
(b) Have available to staff and clients an information sheet for each psychoactive medication that is being used by each client served by the provider.
(4) The service provider must assist the client in obtaining and taking the medication when:
(a) The client's legal representative if any, is unavailable; and
(b) In the prescribing professional's opinion, medication is needed and no significant risks are associated with the use of the medication.
(5) If a client takes psychoactive medications to reduce challenging behaviors or to treat symptoms of a mental illness that are interfering with the client's ability to have positive life experiences and form and maintain relationships, the service provider must develop and implement a positive behavior support plan.
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(1) Monitor the client to help determine if the medication is effective based on criteria identified in the psychoactive medication treatment plan; and
(2) Report to the prescribing professional when:
(a) The medication does not appear to have the desired effects; and
(b) Any changes in client behavior or health that might be adverse side effects of the medication(s).
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CLIENT AND PROGRAM RECORDS(a) Keep all client record information confidential;
(b) Ensure the department's right to have access to and copies of any records as requested or needed; and
(c) Provide access to and copies of client records to the client, or the client's legal representative upon their request.
(2) The service provider must have an authorized release of information form for any transfer or inspection of records, other than those specified in subsection (1) of this section. The authorization form must:
(a) Be specific to the type of information about the transfer or inspection; and
(b) Be signed by the client or client's legal representative.
(3) A signed release of information is valid for up to one year from the date of signature.
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(1) Must not charge the department or the client for any searching or duplication of records requested or needed; and
(2) May charge the client's legal representative acting on behalf of the client for searching and duplication of records at a cost not to exceed twenty-five cents a page.
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(2) After a client's participation with a service provider ends, the service provider must keep the client's records for at least six years.
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(2) Service providers must keep, in each client's record, information including but not limited to the following:
(a) Client's name, address, and Social Security number;
(b) Name, address, and telephone number of the client's involved family members, guardian or legal representative;
(c) Copies of legal guardianship papers, if provided;
(d) Client health records, including:
(i) Name, address, and telephone number of the client's physician, dentist, mental health service provider, and any other current health care service provider;
(ii) Current health care service providers' instructions about health care needed, including appointment dates and date of next appointment if appropriate;
(iii) Written documentation that the health care service providers' instructions have been followed; and
(iv) Record of major health events and surgeries when known.
(e) Copy of the client's most recent individual support plan;
(f) Client's individual instruction and support plan including:
(i) Instruction and support activities for each client as a basis for review and evaluation of client's progress;
(ii) Semiannual review of the individual instruction and support plan;
(iii) Consultation with other service providers and other interested persons;
(iv) Individual instruction and support plan revisions and changes; and
(v) Other activities relevant to the client that the client wants included.
(g) Progress notes and incident reports;
(h) The client's financial records for funds managed by the service provider, including:
(i) Receipts, ledgers and records of the client's financial transactions; and
(ii) Client's related bankbooks, checkbooks, bank registers, tax records and bank statements.
(i) Burial plans and wills.
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(2) The service provider must assist clients in maintaining current, written property records unless otherwise specified in the individual support plan. The record must consist of:
(a) A list of personal possessions with a value of at least twenty-five dollars that the client owns when moving into the program;
(b) A list of personal possessions with a value of seventy-five dollars or more per item after the client moves into the program;
(c) Description and identifying numbers, if any, of the property;
(d) The date the client purchased the items after moving into the program;
(e) The date and reason for addition or removal from the record; and
(f) The signature of the staff or client making the entry.
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(1) Documented in ink;
(2) Written legibly at the time of or immediately following the occurrence of the event recorded; and
(3) Signed and dated by the person making the entry.
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POSITIVE BEHAVIOR SUPPORTS
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(2) The service provider must start the functional assessment when the client begins to engage in behaviors that are considered challenging or are of concern.
(3) The service provider must ensure that a client's written functional assessment addresses:
(a) A description of the client and pertinent history;
(b) The client's overall quality of life;
(c) The behaviors that are considered challenging and/or are of concern;
(d) The factors or events which increase the likelihood of challenging behaviors;
(e) When and where the challenging behavior(s) occurs most frequently;
(f) The factors or events which increase the likelihood of appropriate behavior;
(g) An analysis and assessment of the possible functions or purpose the challenging behavior(s) serve for the client including what he or she obtains or avoids by engaging in the behavior(s); and
(h) A concluding summary of the functions or purpose that each challenging behavior serves for the client.
(4) The service provider must include the following sections in the format of each client's written functional assessment:
(a) Description and pertinent history;
(b) Definition of challenging behaviors;
(c) Data analysis/assessment procedures; and
(d) Summary statement(s).
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(a) The client takes psychoactive medications to reduce challenging behavior or treat a mental illness currently interfering with the client's ability to have positive life experiences and form and maintain personal relationships; or
(b) Restrictive procedures, including physical restraints, identified in the residential services contract are planned or used.
(2) The service provider must:
(a) Base each client's positive behavior support plan on the functional assessment required in WAC 388-101-3850; and
(b) Complete and implement the client's positive behavior support plan within ninety days of identifying the client's symptoms and challenging behavior.
(3) The service provider must develop and implement a positive behavior support plan that is consistent with the client's cross system crisis plan, if any.
(4) The service provider must include the following sections in the format of each client's written positive behavior support plan:
(a) Prevention strategies;
(b) Teaching and training supports;
(c) Strategies for responding to challenging behaviors; and
(d) Data collection and monitoring methods.
(5) If data indicates that progress is not occurring after a reasonable time, but not longer than six months, the service provider must:
(a) Evaluate the positive behavior support plan and the data collected;
(b) Conduct a new functional assessment when necessary; and
(c) Develop and implement revisions as needed.
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(1) Protect the client and others; and
(2) Document in the client's record how the protection is being done.
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RESTRICTIVE INTERVENTIONS(2) When considering restrictive procedures, group home providers licensed as adult family homes must comply with all requirements in chapter 388-76 WAC regarding restraints.
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(a) A description of the behavior(s) that the restrictive procedures address;
(b) A functional assessment of the challenging behavior(s);
(c) The positive behavior support strategies that will be used;
(d) A description of the restrictive procedure that will be used including:
(i) When and how it will be used; and
(ii) Criteria for termination of the procedure; and
(e) A plan to document the use of the procedure and its effect.
(2) The service provider must terminate implementation of the restrictive procedures as soon as the need for protection is over.
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(a) Lists the risks of the challenging behavior(s);
(b) Lists the risks of the proposed restrictive procedure(s);
(c) Explains why less restrictive procedures are not recommended;
(d) Indicates non-restrictive alternatives to the recommendation that have been tried but were unsuccessful; and
(e) Includes space for the client and/or the client's legal representative to write comments and opinions regarding the plan and the date of those comments.
(2) The service provider must consult with the division of developmental disabilities if:
(a) The client and/or the client's legal representative disagree with parts of the proposed restrictive procedure; and
(b) An agreement cannot be reached.
(3) Before the service provider implements restrictive procedures they must be approved in writing by:
(a) The service provider's administrator; or
(b) Someone designated by the service provider to have approval authority; and
(c) Someone designated by the division of developmental disabilities, when required by the residential services contract.
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(1) Discussion of the need for positive behavior support;
(2) Communication styles that help the client to calm down and resolve problems;
(3) Techniques to prevent escalation of behavior before it reaches the stage of physical assault;
(4) Techniques for staff to use in response to clients and their own fear, anger, aggression, or other negative feelings;
(5) Cautions that physical intervention technique(s) may not be changed except as needed for individual disabilities, medical, health, and safety issues. A healthcare professional and a program trainer must approve all modifications;
(6) Evaluation of the safety of the physical environment;
(7) Issues of respect and dignity of the client;
(8) Use of the least restrictive physical interventions depending upon the situation;
(9) Identification of division of developmental disabilities approved and prohibited physical intervention techniques;
(10) The need to release clients from physical restraint as soon as possible;
(11) Instruction on how to support physical interventions as an observer, recognizing signs of:
(a) Distress by the client; and
(b) Fatigue by the staff; and
(12) Discussion of the importance of complete and accurate documentation.
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(2) The service provider may only use physical interventions with a client when positive or less restrictive techniques have been tried and determined to be insufficient to:
(a) Protect the client;
(b) Protect others; or
(c) Prevent property damage.
(3) The service provider must:
(a) Terminate the intervention for the client as soon as the need for protection is over; and
(b) Only use restrictive physical interventions for the client as part of a positive behavior support plan except:
(i) In an emergency; or
(ii) When an unknown, unpredicted response from a client jeopardizes the client's or others safety.
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(1) Provide documentation to the division of developmental disabilities regarding the proposed intervention;
(2) Involve the client and the client's legal representative in discussion regarding the need for physical intervention;
(3) Determine the kind of notification the client's legal representative wants to receive when physical interventions are used; and
(4) Comply with the requirements defined under WAC 388-101-3890.
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(a) The use of physical interventions;
(b) Crisis prevention techniques; and
(c) Positive behavior support.
(2) Each staff designated to supervise or observe restraint use must be trained in:
(a) The observation and supervision of physical restraints; and
(b) The recognition of potential risks or negative outcomes related to the use of physical restraints.
(3) The service provider must ensure that staff receiving physical intervention techniques training:
(a) Complete the course of instruction;
(b) Demonstrate competency before being authorized to use the techniques with clients; and
(c) Review de-escalation and physical intervention techniques annually.
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(2) The service provider must use the least restrictive alternatives needed to protect the client, others, or property.
(3) If needed, mechanical restraints may only be used for needed medical or dental treatment and only under the direction of a licensed physician or dentist.
(4) Restraints used as allowed by subsection (3) of this section must be justified and documented in the client's record.
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(2) The service provider must keep documentation that includes:
(a) A description of events immediately preceding the client's behavior which led to the use of the restraint;
(b) The type of restraint used;
(c) Length of time the client was restrained;
(d) The client's reaction to the restraint;
(e) Staff that were involved; and
(f) Injuries sustained by anyone during the intervention.
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COMMUNITY PROTECTION(1) Be approved by the division of developmental disabilities to serve community protection clients;
(2) Have security precautions reasonably available to enhance protection of neighbors, children, vulnerable adults, animals, and others;
(3) Have for each client an integrated treatment plan with goals, objectives, and therapeutic interventions to assist the client to avoid offending or re-offending; and
(4) Collaborate and coordinate between division of developmental disabilities staff, the treatment team, and community agencies and members.
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(1) Client security and supervision;
(2) Use of a chaperone agreement that describes who will supervise the client when the client is not under the direct supervision of the community protection service provider;
(3) Compliance with state laws requiring sex offender registration with law enforcement;
(4) Reporting to the division of developmental disabilities the client's refusal to comply with the treatment plan; and
(5) Reporting to the division of developmental disabilities and law enforcement client actions that violate the law or a court order.
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(1) Community protection within ninety calendar days of working with a community protection client; and
(2) The needs, supports, and services for clients to whom they are assigned.
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(a) A qualified professional's risk assessment of emotional and behavioral issues related to community protection risks; or
(b) A written risk assessment and treatment recommendations by:
(i) A sexual offender treatment provider or sexual offender treatment provider affiliate if the client has a sexual offense history; or
(ii) A licensed psychologist or psychiatrist with specialized training in the treatment of or three or more years' experience treating violent or aggressive behavior when the person being assessed has demonstrated violent, dangerous, or aggressive behavior.
(2) In addition to the requirements in WAC 388-101-3460 through 388-101-3510, the community protection service provider must include the following in the client's written individual plan:
(a) Intervention strategies and techniques related to community protection risks;
(b) Restrictions and measures, including security precautions; and
(c) A therapist's approval of the written individual plan.
(3) For community protection clients with a history of sexual offending, the assessment by a certified sexual offender treatment provider or sexual offender treatment provider affiliate may serve as the functional assessment and treatment recommendations related to the sexual behaviors.
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(1) Psychosexual and/or psychological evaluations and risk assessments;
(2) Plans and assessments including:
(a) The written individual plan;
(b) The functional assessment;
(c) The positive behavior support plan; and
(d) A therapist approved treatment plan.
(3) The client's sex offender registration with law enforcement authorities when required by law;
(4) Notice to the division of developmental disabilities of the client's sex offender registration; and
(5) Agreements, requirements, and plans, including the chaperone agreement, with individuals who support the client.
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(1) Conduct and document site checks of the proposed residence at different days and times of the week;
(2) Consider the client's specific offense patterns;
(3) Determine appropriate and necessary restrictive procedures, including security precautions; and
(4) Obtain written approval for the residential site from the division of developmental disabilities.
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(2) Document the client's departure in the client's record.
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CRISIS DIVERSION BED AND SUPPORT SERVICES(1) Be approved by the department to provide crisis diversion services; and
(2) Make crisis diversion services available to clients twenty-four hours per day.
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(1) Provide those services in a residence that is maintained by the crisis diversion bed services provider;
(2) Provide a private, furnished bedroom for each crisis diversion client; and
(3) Support only one client in each residence.
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(1) Support staff, twenty-four hour per day, seven days a week, to meet the client's needs as identified in the client's assessment;
(2) Access to the instruction and support services identified in the client's individual support plan;
(3) Three meals per day plus snacks;
(4) The following items at no cost to the client:
(a) Toiletries and personal care items;
(b) Bedding and towels;
(c) Access to laundry facilities; and
(d) Access to local telephone calls.
(5) Therapeutic interventions aimed at improving the client's functioning;
(6) Medication monitoring as needed;
(7) Transportation to and from the crisis diversion bed location and other necessary appointments or services;
(8) Referral to health care services as needed;
(9) Supports for performing personal hygiene routines and activities of daily living if needed by the client; and
(10) An accessible site for clients with physical disabilities.
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(2) The treatment plan must include:
(a) The supports and services that must be provided; and
(b) Client discharge goals.
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(a) Client's name, address, and Social Security number;
(b) Name, address, and telephone number of the client's relative or legal representative; and
(c) Progress notes and incident reports on clients.
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(2) The client record must include the following information when available:
(a) Basic demographic information;
(b) Referral process and intake information;
(c) Medication records;
(d) Psychiatric records;
(e) Crisis diversion bed services provider notes;
(f) The crisis services treatment plan;
(g) Cross systems crisis plan;
(h) Disposition at the client's discharge;
(i) Dates of admission and discharge;
(j) Incident reports;
(k) Copies of legal representative and guardianship papers;
(l) Health records including the name, address, and telephone number of the client's:
(i) Physician;
(ii) Dentist;
(iii) Mental health service provider; and
(iv) Any other health care service providers.
(m) Health care service providers' instructions, if any, about health care tasks and date of next appointment;
(n) Written documentation that the health care service providers' instructions have been followed; and
(o) A record of known major health events, including surgeries.
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(1) Therapeutic interventions to help stabilize the client's behavioral symptoms;
(2) Assistance with referral to mental health services if needed; and
(3) Technical assistance to the client's caregivers on support strategies.
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INCIDENT REPORTING(1) Are mandated reporters and must meet the requirements of chapter 74.34 RCW;
(2) Must make mandated reports to the department's centralized toll free complaint telephone number or FAX number immediately when:
(a) There is reasonable cause to believe that a vulnerable adult, as defined in chapter 74.34 RCW, has been abandoned, abused, neglected, or financially exploited; or
(b) There is a reason to suspect physical or sexual assault.
(3) Must also make written and oral reports to the department as specified in the provider's residential services contract;
(4) Must protect the alleged victim and others from further abuse, neglect, abandonment, and financial exploitation; and
(5) May have their certification and/or contract terminated if they fail to report such incidents.
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(1) Sexual Assault: Any alleged or suspected sexual assault;
(2) Physical Assault (nonclient to client): Any suspected physical assault as well as any act that causes fear of imminent harm; and
(3) Physical Assault (client to client): Any suspected physical assault that causes bodily injury requiring more than first aid, or in the event of:
(a) Injuries that appear on the back, face, head, neck, chest, breasts, groin, inner thigh, buttock, genital, or anal area;
(b) Fractures;
(c) Choking attempts;
(d) Patterns of physical assault between the same vulnerable adults or involving the same vulnerable adults;
(e) A reasonable cause to believe that an act has caused fear of imminent harm; and
(f) Any incident, regardless of injury, if requested by the client, his/her legal representative, or family member.
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(a) Immediately reporting mandated reporting incidents to:
(i) The department and law enforcement;
(ii) Appropriate persons within the service provider's agency as designated by the service provider; and
(iii) The alleged victim's legal representative.
(b) Protecting clients;
(c) Preserving evidence when necessary; and
(d) Initiating an outside review or investigation.
(2) The service provider must not have or implement any policies or procedures that interfere with a mandated reporter's obligation to report.
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(2) The department investigation will include an investigation of allegations about one or more of the following:
(a) A service provider;
(b) Anyone associated with a service provider; or
(c) A client receiving services under this chapter.
(3) If, after completing an investigation under this chapter, the department concludes that it is more likely than not that the alleged perpetrator abandoned, abused, neglected, or financially exploited a client, the department will make a preliminary finding against the perpetrator, as defined in WAC 388-101-4270 through 388-101-4340.
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REMEDIES(2) At the end of provisional certification the department may:
(a) Approve the service provider for regular certification if the service provider has complied with certification requirements; or
(b) Revoke the service provider's certification and terminate the residential services contract if the service provider has not complied with all certification requirements.
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(2) The department is authorized to impose the enforcement remedies described in chapter 71A.12 RCW when the service provider has:
(a) Failed or refused to comply with the requirements of chapter 71A.12 RCW and the rules adopted under the chapter;
(b) Failed or refused to comply with the certification process;
(c) Prevented or interfered with the department's certification evaluation or complaint investigation by the department;
(d) Failed to comply with any applicable requirements regarding vulnerable adults under chapter 74.34 RCW; or
(e) Knowingly, or with reason to know, made a false statement of material fact related to certification or contracting with the department, or in any matter under investigation by the department.
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(2) Whenever circumstances in WAC 388-101-4210 are present the department may impose any enforcement remedies authorized by chapter 71A.12 RCW and any rules adopted under it. The department may:
(a) Decertify or refuse to renew the certification of a service provider;
(b) Impose conditions on a service provider's certification status;
(c) Suspend department referrals to the service provider;
(d) Require a service provider to implement a plan of correction developed by the department and to cooperate with subsequent monitoring of the service provider's progress;
(e) Impose civil penalties of not more than one hundred fifty dollars per day per violation in the event a service provider fails to implement the plan of correction developed by the department or fails to cooperate with any subsequent monitoring; and
(f) Impose a separate violation each day during which the same or similar action or inaction occurs.
(2) The provisions of chapter 34.05 RCW apply to enforcement actions under this section. Except for the imposition of civil penalties, the effective date of enforcement actions will not be delayed or suspended pending any hearing or informal review.
(3) The enforcement actions and penalties authorized in this section are not exclusive or exhaustive and nothing in this section prohibits the department from taking any action authorized in statue or rule or under the terms of a contract with the service provider.
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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.
NEW SECTION
WAC 388-101-4230
Community protection
program--Considerations for imposing remedies.
(1) This
section applies only to service providers providing services
to community protection clients.
(2) When determining the appropriate enforcement action under WAC 388-101-4220, the department will select actions in proportion to the seriousness of the harm or threat of harm to clients being served by the service provider.
(3) The department may take enforcement actions that are more severe for violations that are uncorrected, repeated, or pervasive or which present a serious threat of harm to the health, safety or welfare of clients served by the service provider.
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INFORMAL DISPUTE RESOLUTION AND APPEALS(2) The service provider must make a written request to the department for an informal dispute resolution meeting within ten working days of receipt of the written notice of the department's final report of findings and/or certification action.
(3) The service provider must submit a written statement identifying the challenged action, and include specifically the issues and regulations involved.
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(2) The service provider must make the request in writing and must:
(a) Sign the request;
(b) Identify the challenged decision and the date it was made;
(c) State specifically the issues and regulations involved and the grounds for the disagreement; and
(d) Include with the request copies of any supporting documentation for the service provider's position.
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(a) May contest a decision made by the department pursuant to chapter 71A.12 RCW and according to the provisions of chapter 34.05 RCW and chapter 388-02 WAC;
(b) Must file any request for a hearing with the office of administrative hearings at the mailing address specified in the notice of imposition of an enforcement remedy; and
(c) Must make the request within twenty-eight days of receipt of the written notice of the department's certification action.
(2) Certification actions are effective immediately upon notice and will continue pending any hearing.
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ABUSE-NEGLECT FINDING - INDIVIDUAL(1) Notify the alleged perpetrator in writing within ten working days of making a preliminary finding of abandonment, abuse, neglect or financial exploitation of a client. The written notice will not include the identities of the alleged victim, reporter and witnesses;
(2) Make a reasonable, good faith effort to determine the last known address of the alleged perpetrator; and
(3) Serve notice of the preliminary finding as provided in chapter 388-02 WAC.
(4) The department may extend the time frame for written notification beyond ten working days to include the time needed to translate the notification letter or make provisions for the safety of the alleged victim.
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(a) Other divisions within the department;
(b) The agency or program identified under RCW 74.34.068 with which the alleged perpetrator is associated as an employee, volunteer or contractor;
(c) Law enforcement; and
(d) Other investigative authorities consistent with chapter 74.34 RCW.
(2) The notification will identify the finding as a preliminary finding.
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(2) The request must be made in writing to the office of administrative hearings.
(3) The office of administrative hearings must receive the alleged perpetrator's written request for a hearing within thirty calendar days of the date the individual was served with notice of the preliminary finding.
(4) The written request for a hearing must include:
(a) The full legal name, current address and phone number of the alleged perpetrator;
(b) A brief explanation of why the alleged perpetrator disagrees with the preliminary finding;
(c) A description of any assistance needed in the administrative appeal process by the alleged perpetrator, including a foreign language or sign language interpreter or any reasonable accommodation for a disability; and
(d) The alleged perpetrator's signature.
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(2) Confidential information such as the name and other personal identifying information of the reporter, witnesses, or the client will be redacted from documents unless otherwise ordered by the administrative law judge consistent with chapter 74.34 RCW and other applicable state and federal laws.
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(2) The administrative law judge shall determine whether a preponderance of the evidence supports the preliminary finding that the alleged perpetrator abandoned, abused, neglected, or financially exploited a vulnerable adult, and shall issue a preliminary order.
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(2) If the department appeals the administrative law judge's decision, the department will not modify the finding in the department's records until a final hearing decision is issued.
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(a) The department gives the alleged perpetrator notice of the preliminary finding pursuant to WAC 388-101-4270 and the alleged perpetrator does not request an administrative hearing;
(b) The administrative law judge:
(i) Dismisses the hearing following withdrawal of the appeal or default; or
(ii) Issues a preliminary order upholding the finding and the alleged perpetrator fails to appeal the preliminary order to the department's board of appeals; or
(c) The board of appeals issues a final order upholding the finding.
(2) The final finding is permanent and will only be removed from the department's records if:
(a) It is rescinded following judicial review; or
(b) The department may decide to remove the single finding of neglect from its records based upon a written petition by the alleged perpetrator provided that no further findings have occurred, and at least one calendar year has passed since the finding was finalized and recorded.
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(a) The perpetrator;
(b) The service provider that was associated with the perpetrator during the time of the incident;
(c) The service provider that is currently associated with the perpetrator, if known;
(d) The appropriate licensing, contracting, or certification authority; and
(e) The department's list of findings of abandonment, abuse, neglect, and financial exploitation.
(2) The findings may be disclosed to the public upon request.
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The following sections of the Washington Administrative Code are repealed:
| WAC 388-101-1010 | What is the purpose of this chapter? |
| WAC 388-101-1020 | What definitions apply to this chapter? |
| WAC 388-101-1101 | Abuse and neglect reporting requirements. |
| WAC 388-101-1106 | Investigation of mandated reports. |
| WAC 388-101-1111 | Notice of an initial finding. |
| WAC 388-101-1116 | Reporting initial findings. |
| WAC 388-101-1121 | Disputing an initial finding. |
| WAC 388-101-1126 | Disclosure of investigative and finding information. |
| WAC 388-101-1131 | Hearing procedures to dispute an initial finding. |
| WAC 388-101-1136 | Appeal of the administrative law judge's initial order on a finding. |
| WAC 388-101-1141 | Finalizing an initial finding. |
| WAC 388-101-1146 | Reporting final findings. |
| WAC 388-101-1180 | What are residential services? |
| WAC 388-101-1190 | Who certifies residential services? |
| WAC 388-101-1200 | Where are residential services provided? |
| WAC 388-101-1205 | Where are crisis diversion services provided? |
| WAC 388-101-1210 | Who may receive residential services? |
| WAC 388-101-1220 | What physical and safety requirements exist for residential services? |
| WAC 388-101-1230 | How must service providers assist clients in regulating water temperature? |
| WAC 388-101-1240 | What are supported living services? |
| WAC 388-101-1250 | What are crisis diversion services? |
| WAC 388-101-1260 | What are group homes? |
| WAC 388-101-1400 | When must a service provider document a client's refusal to participate in services? |
| WAC 388-101-1410 | May a service provider offer services to nonclients in the same household as clients? |
| WAC 388-101-1420 | Who pays for a client's residential services? |
| WAC 388-101-1430 | When may a service provider receive initial set-up funds from DSHS? |
| WAC 388-101-1440 | What are the different types of certification? |
| WAC 388-101-1460 | When may RCS grant initial certification to an agency? |
| WAC 388-101-1470 | How does an agency apply for initial certification? |
| WAC 388-101-1480 | What happens after an agency receives initial certification? |
| WAC 388-101-1490 | May initial certification be extended for a service provider? |
| WAC 388-101-1500 | How does a service provider receive regular certification? |
| WAC 388-101-1510 | How often are reviews and evaluations done for service providers? |
| WAC 388-101-1520 | What occurs during review and evaluation? |
| WAC 388-101-1530 | May service providers disagree with evaluation findings? |
| WAC 388-101-1540 | May a service provider receive provisional certification? |
| WAC 388-101-1550 | When may RCS decertify a service provider? |
| WAC 388-101-1600 | What are administrators of service providers required to do? |
| WAC 388-101-1610 | What type of administrative documents are service providers required to have? |
| WAC 388-101-1620 | What are the requirements for personnel policies? |
| WAC 388-101-1630 | What nondiscrimination requirements must agencies and service providers meet? |
| WAC 388-101-1640 | What staffing requirements must service providers meet? |
| WAC 388-101-1650 | May clients instruct and support other clients? |
| WAC 388-101-1660 | Who needs background checks? |
| WAC 388-101-1670 | What are the minimum requirements for staff employed by service providers? |
| WAC 388-101-1680 | What staff training is required? |
| WAC 388-101-1690 | How often must performance reviews be conducted for staff of service providers? |
| WAC 388-101-1700 | When must service providers have staff-coverage schedules approved by DDD? |
| WAC 388-101-1710 | What happens when a service provider's ownership changes? |
| WAC 388-101-1720 | When may a client's service provider change? |
| WAC 388-101-1730 | Are clients' records considered confidential? |
| WAC 388-101-1740 | How long does a service provider need to keep client records? |
| WAC 388-101-1750 | What information do service providers need to keep in client records? |
| WAC 388-101-1760 | What information do crisis diversion service providers need to keep in client records? |
| WAC 388-101-1770 | Do service providers need to keep client's property records? |
| WAC 388-101-1780 | Are there requirements for record entries? |
| WAC 388-101-1790 | Who must service providers notify in emergencies? |
| WAC 388-101-1800 | What are client services? |
| WAC 388-101-1810 | What health and safety support may a service provider offer to a client? |
| WAC 388-101-1820 | What support may a service provider offer to a client to increase personal power and choices? |
| WAC 388-101-1830 | What support may a service provider offer to increase a client's competence and self-reliance? |
| WAC 388-101-1840 | How may service providers assist clients in gaining positive recognition? |
| WAC 388-101-1850 | What support may a service provider offer to increase the positive relationships in the client's life? |
| WAC 388-101-1860 | How may a service provider assist clients with becoming integrated into their community? |
| WAC 388-101-1870 | What is an individual service plan/plan of care (ISP/POC) for clients? |
| WAC 388-101-1880 | Who is responsible for completing and overseeing a client's ISP/POC? |
| WAC 388-101-1890 | Who may participate in creating a client's ISP/POC? |
| WAC 388-101-1900 | How often must the ISP/POC be reviewed? |
| WAC 388-101-2000 | What plans must crisis diversion service providers develop? |
| WAC 388-101-2010 | What is an individual instruction and support plan (IISP) for clients? |
| WAC 388-101-2020 | Who may participate in developing the IISP for each client? |
| WAC 388-101-2030 | Who oversees the IISP for each client? |
| WAC 388-101-2040 | May a service provider manage a client's funds? |
| WAC 388-101-2050 | May a service provider hold bankbooks and bankcards for a client? |
| WAC 388-101-2060 | May a service provider combine agency and client funds? |
| WAC 388-101-2070 | Does the service provider need to develop an individual financial plan (IFP) for clients? |
| WAC 388-101-2080 | What information must the IFP include? |
| WAC 388-101-2090 | How does a service provider manage client funds? |
| WAC 388-101-2100 | What documentation must service providers keep to protect a client's financial interests? |
| WAC 388-101-2110 | How are a client's funds transferred when they are managed by a service provider? |
| WAC 388-101-2120 | How does a service provider handle loans to a client? |
| WAC 388-101-2130 | When must a service provider pay a client? |
| WAC 388-101-2140 | What must service providers do to support a client's health? |
| WAC 388-101-2150 | May a client refuse health care services? |
| WAC 388-101-2160 | When may client funds be used for health services? |
| WAC 388-101-2300 | Client transportation. |
| WAC 388-101-2330 | May an agency or service provider contest a RCS decision? |
| WAC 388-101-2340 | When does an administrative review conference occur? |
| WAC 388-101-2350 | May an administrative review conference be conducted by telephone? |
| WAC 388-101-2360 | What happens during the administrative review conference? |
| WAC 388-101-2370 | May an agency or service provider contest the decision from the administrative review conference? |
| WAC 388-101-2380 | Does RCS make exceptions to the requirements in this chapter? |
| WAC 388-101-2400 | Who may delegate nursing care tasks? |
| WAC 388-101-2410 | What training is required before staff are qualified to perform delegated tasks? |
| WAC 388-101-2420 | Do nursing assistants need to comply with department of health requirements? |
| WAC 388-101-2430 | Who is authorized to provide consent for a client's receiving health care? |
| WAC 388-101-2440 | What rights do nursing assistants have concerning the delegation of nursing care tasks? |
| WAC 388-101-2450 | Are nursing assistants liable for errors while doing nursing care tasks? |
| WAC 388-101-2460 | What happens if unqualified staff do a nursing task? |
| WAC 388-101-2470 | What technical assistance may service providers get from DSHS for nurse delegation requirements? |
| WAC 388-101-2480 | What happens when DSHS finds a service provider in violation of nurse delegation requirements? |
| WAC 388-101-2490 | May a service provider have a chance to correct violations before being fined? |
| WAC 388-101-2500 | May civil fines be imposed during technical assistance visits? |
| WAC 388-101-2510 | How does DSHS impose a civil fine? |
| WAC 388-101-2520 | When is payment due for a civil fine? |
| WAC 388-101-2530 | May a service provider disagree with DSHS findings of a violation? |
| WAC 388-101-2540 | May a service provider contest a civil fine? |