WSR 98-11-095
PERMANENT RULES
DEPARTMENT OF
SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)
[Filed May 20, 1998, 10:20 a.m., effective July 1, 1998]
Date of Adoption: May 20, 1998
Purpose: To make the adult family home regulations clearer, more easily understood, and more reflective of practices and expectations that are currently in place
Citation of Existing Rules Affected by this Order: Amending WAC 388-76-540, 388-76-550, 388-76-560, 388-76-570, 388-76-595, 388-76-605, 388-76-620, 388-76-635, 388-76-655, 388-76-660, 388-76-665, 388-76-670, 388-76-675, 388-76-680, 388-76-685, 388-76-690, 388-76-695, and 388-76-705
Statutory Authority for Adoption: RCW 70.128.040
Other Authority: Chapters 70.128 and 70.129 RCW
Adopted under notice filed as WSR 98-02-077 on January 7, 1998
Changes Other than Editing from Proposed to Adopted Version:
reasons for adopting the rules
Due to laws passed in the 1995 legislative session, rules governing adult family homes were completely revised and became effective in July 1996. Since that time, internal and external stakeholders have provided input and feedback concerning their experience implementing these rules. This feedback made it evident that changes to the regulations were needed to: Eliminate faulty and/or confusing language; make the regulations clearer and more easily understood; and make the regulations more reflective of current practices and laws. In addition, some changes are necessary to ensure department expectations are clearly defined and easily understood.
VARIANCE BETWEEN PROPOSED AND FINAL RULES ADULT FAMILY HOME MINIMUM LICENSING REQUIREMENTS WAC 388-76-540 THROUGH 388-76-705
The following is a description of differences between the proposed rules and the adopted version, and the principal reasons.
WAC 388-76-540 Definitions.
Caregiver - within this definition "entity responsible individual" was changed to "entity representative." This change was made throughout the rules.
Entity representative - we changed the name from "entity responsible individual" to "entity representative" as was suggested to us; we found the latter term less awkward. Other minor editorial changes were made to make this definition clearer. Throughout the rules, "entity responsible individual" has been replaced with "entity representative."
Individual provider - clarifying changes were made to make this definition clearer.
WAC 388-76-550 License application.
Section title revised to reflect recent statutory changes (eliminating renewal applications and implementing a nonexpiring license).
(1) Deleted "renewal" to reflect recent statutory changes (eliminating renewal applications and implementing a nonexpiring license).
(3) Minor editorial changes made to make this subsection easier to read.
(4) This subsection was revised to reflect recent statutory changes (eliminating renewal applications and implementing a nonexpiring license).
(6) Deleted "or renew" from this subsection to reflect recent statutory changes (eliminating renewal applications and implementing a nonexpiring license).
(8) Added "provider" after applicant for clarity, and deleted "or renewal" from this subsection to reflect recent statutory changes (eliminating renewal applications and implementing a nonexpiring license).
(9) Made numerous editorial and clarifying changes to make this subsection easier to read and understand.
(10-11) Deleted "or renewal" from these subsections to reflect recent statutory changes (eliminating renewal applications and implementing a nonexpiring license).
(12) This subsection deleted as it is no longer relevant due to the recent statutory change (eliminating renewal applications and implementing a nonexpiring license).
WAC 388-76-560 License eligibility. Section title revised to reflect recent statutory changes (eliminating renewal applications and implementing a nonexpiring license).
(5) Added a clarifying sentence to remind adult family homes that their Department of Health (DOH) registration must be renewed annually.
(6) Added a clarifying sentence to remind adult family homes that resident manager's DOH registration must be renewed annually. Deleted "within sixty days of being designated as an adult family home resident manager" because our assistant attorney general advised the department that we do not have statutory authority to make this change.
(9) Reorganized this section and made minor editorial changes to try and make it clearer and easier to read. Deleted reference to renewal of licenses to reflect recent statutory changes. Due to comments received, clarified in (c) and (d) that the action must be taken by an agency.
(10-13) Reorganized these subsections and made minor editorial changes to try and make it clearer and easier to read. Deleted reference to renewal of licenses to reflect recent statutory changes.
(14) Deleted reference to renewal of licenses to reflect recent statutory changes.
(15) This subsection deleted as it is no longer relevant (due to the recent statutory change eliminating renewal applications and implementing a nonexpiring license).
WAC 388-76-570 Additional license requirements --Multiple-facility providers.
(5) Inserted "prior to" in new subsection (5) in order to eliminate old subsections (5-6).
WAC 388-76-595 Inspections and ombudsman visits.
(2) Added examples of willful interference and failure to cooperate in this subsection in response to comments received. (4-5) Changed "shall" to "will" for clarity.
(6-10) Reorganized this section and made minor editorial changes to try and make it clearer and easier to read. Revised some of the requirements of this section because they conflicted with public disclosure laws and confidentiality requirements.
(11) Added in "state regulations for the long-term care ombudsman program" for clarity.
WAC 388-76-605 Restraints.
(4)(b) Deleted "who has assessed the resident" for accuracy, as health care professionals with prescriptive authority follow standards of practice under their respective licenses.
(4)(c) Revised language to be clearer. Prior language was not entirely accurate.
WAC 388-76-620 Provision of services and care.
(3) Changed "service" to "care." This change has been made throughout the rules, and this "service" was accidentally missed.
(4)(b) Changed "ensures" to "promotes" in response to comments received about the use of the word ensure.
WAC 388-76-635 Nurse delegation--Penalties.
The department has changed "shall" to "may" to reflect recent statutory changes.
WAC 388-76-655 General management and administration.
(2)(d) "For example" was replaced with "including but not limited to" in order to be clear that the being on vacation was only one example, not the only example.
(3)(a) This entire subsection had been incorrectly deleted; what was needed was additional language to specify that damage or loss of the resident's property is covered if due to negligence of the insured. The correct language has been added.
(7)(a) The specific WAC citation has changed, so this subsection was revised.
(7)(b) Language was added to clarify that the maximum time a resident can be left alone must be documented in a resident's negotiated care plan.
WAC 388-76-660 Training.
(2)(a) Some minor language was revised to make this subsection clearer.
(4) Language was added to clarify that AFHs who take a special Division of Developmental Disabilities training are exempt from the fundamentals of caregiving training.
WAC 388-76-670 Disaster and emergency preparedness.
(4) Minor editorial changes were made to this subsection to make it clearer and more easily understood.
WAC 388-76-675 Reporting requirements.
(2) No changes will be made in this subsection. It was decided to leave this section as it currently is, and not make any changes.
WAC 388-76-680 Infection control and communicable disease.
(2-4) Revisions were made in these subsections to make them clearer and more reflective of current standards in regard to tuberculosis (TB).
WAC 388-76-685 Criminal history disclosure and background inquiries.
(3) "Against persons" was deleted based on our assistant attorney general's advice. The statute this subsection refers to lists more than just crimes against persons, and so the prior language was not accurate.
WAC 388-76-690 Advance directives, guardianship, and decision making.
(4-5) The language in these subsections was completely revised to be simpler, clearer, and to comply with the appropriate statutes.
WAC 388-76-705 Remedies.
(3)(a)(iii)(A-B) In order to clarify that there are two circumstances when civil fines can exceed one hundred dollars per day, new language was added in (A) and (B) to specifically identify those two circumstances. The two circumstances are defined in statute, and those statutes are referenced in (A) and (B) of this subsection.
(3)(a)(iv) "Or refusal to renew" was deleted to reflect recent statutory changes (eliminating renewal applications and implementing a nonexpiring license)
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 0, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, amended 18, repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, amended 0, repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 0, amended 18, repealed 0.
Effective Date of Rule: July 1, 1998
May 20, 1998
Marie Myerchin-Redifer, Manager
Rules and Policies Assistance Unit
SHS-2352:4
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-540 Definitions. (((1))) "Abandonment" means
action or inaction by a person or entity with a duty of care for
a frail elder or vulnerable adult that leaves the vulnerable
person without the means or ability to obtain necessary food,
clothing, shelter, or health care.
(((2))) "Abuse" means a nonaccidental act of physical or
mental mistreatment or injury, or sexual mistreatment, which
harms a person through action or inaction by another individual.
(((3))) "Adult family home" means the same as the definition
in RCW 70.128.010.
(((4))) "Applicant" means an individual, partnership,
corporation, or other entity seeking a license to operate an
adult family home.
(((5))) "Capacity" means the maximum number of persons in
need of personal or special care permitted in an adult family
home at a given time. This number shall include related children
or adults in the home who receive special care.
(((6))) "Caregiver" means any person eighteen years of age
or older responsible for providing direct personal care to a
resident and may include but is not limited to the provider,
resident manager, employee, relief caregiver, volunteer, student,
entity representative, or household member.
(((7))) "Case manager" means the department staff person or
designee assigned to negotiate, monitor, and facilitate a service
plan for residents receiving services fully or partially paid for
by the department.
(((8))) "Chemical restraint" means a psychopharmacologic
drug that is used for discipline or convenience and not required
to treat the resident's medical symptoms.
(((9))) "Department" means the Washington state department
of social and health services.
(((10))) "Entity provider" means any corporation,
partnership, association, or limited liability company that is
licensed under this chapter to operate an adult family home.
(((11)))
"Entity representative" means the individual designated by an entity provider who is responsible for the daily operation of the adult family home.
"Exploitation" means the illegal or improper use of a frail elder or vulnerable adult or that person's income or resources, including trust funds, for another person's profit or advantage.
(((12))) "Frail elder or vulnerable adult" means the same as
the definition in RCW 74.34.020 or RCW 43.43.830.
(((13))) "Individual provider" means ((a natural)) an
individual person or a legally married couple who is licensed to
operate an adult family home.
(((14))) "Inspection" means an on-site visit by department
personnel to determine the adult family home's compliance with
this chapter and chapter 70.128 RCW, Adult family homes.
(((15))) "Multiple facility provider" means an individual or
entity provider who is licensed to operate more than one adult
family home.
(((16))) "Neglect" means a pattern of conduct or inaction
resulting in deprivation of care necessary to maintain a
resident's physical or mental health.
(((17))) "Nursing assistant" means the same as the
definition in chapter 18.88A RCW.
(((18))) "Personal care services" means both physical
assistance and/or prompting and supervising the performance of
direct personal care tasks as determined by the resident's needs
as defined in WAC 388-15-202(((38))), Long-term care services--Definitions. Personal care services do not include assistance
with tasks performed by a licensed health professional.
(((19))) "Physical restraint" means a manual method,
obstacle, or physical or mechanical device, material, or
equipment attached or adjacent to the resident's body that
restricts freedom of movement or access to his or her body, is
used for discipline or convenience, and not required to treat the
resident's medical symptoms.
(((20))) "Provider" means any person or entity that is
licensed under this chapter to operate an adult family home.
(((21))) "Resident" means any adult unrelated to the
provider who lives in the adult family home and who is in need of
care. "Resident" includes former residents when examining
complaints about admissions, readmissions, transfers or
discharges. For decision-making purposes, the term "resident"
includes the resident's surrogate decision maker in accordance
with state law or at the resident's request.
(((22))) "Resident manager" means a person employed or
designated by the provider to manage the adult family home.
(((23))) "Special care" means care beyond personal care
services as defined by ((subsection (18) of)) "personal care
services" in this section.
(((24))) "Unsupervised" means the same as the definition in
RCW 43.43.830(8).
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-540, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-550 License application((--Initial and
renewal)). (1) All applications for adult family home licensure
((or renewal)) are subject to review under this chapter.
(2) ((To apply for an adult family home license, an
applicant shall complete and submit a license application on
department provided forms at least sixty days before the
requested effective date of that license)) Persons who have not
held an adult family home license within the last twelve months
must attend department orientation to receive an initial adult
family home application.
(3) ((For renewal of an adult family home license, the
provider shall complete and submit a renewal application on
department provided forms at least sixty days before the current
license's expiration date. The license must be renewed annually
to remain valid)) (a) To apply for an initial adult family home
license, an applicant shall complete and submit the department
application form.
(b) The applicant must provide all information requested, including information regarding any facilities and homes for the care or provision of services to children or vulnerable adults that the applicant is or has been affiliated with in the last ten years. This information is needed so the department can determine whether the applicant meets all applicable qualifications and requirements.
(c) An entity shall provide the information in (b) of this subsection with regard to any partner, officer, director, managerial employee, or owner of five percent or more of the entity.
(4) ((The applicant shall complete the department designated
application form providing all information necessary, including
information regarding any facilities and homes for the care or
provision of services to children or vulnerable adults that the
applicant is or has been affiliated with in the last ten years,
so the department can determine whether the applicant meets all
applicable qualifications and requirements. An entity shall
provide this information with regard to any partner, officer,
director, managerial employee, or owner of five percent or more
of the entity applicant)) (a) An adult family home license is a
nonexpiring license which means it does not need to be renewed
every year.
(b) The adult family license remains valid unless:
(i) The department takes enforcement action to suspend or revoke the license in accordance with state law;
(ii) The provider voluntarily surrenders the license or closes the home; or
(iii) The provider fails to pay the annual licensing fee.
(5) All entity providers shall include their Unified Business Identifier (UBI) and Federal Employer Identification (FEI) numbers on the application.
(6) Married couples may not apply for separate adult family home licenses for each spouse.
(7)(a) Couples considered legally married under Washington state law are the only individuals who may apply jointly for an individual provider adult family home license.
(b) After the effective date of these rules two (or more) unmarried individuals applying for an initial adult family home license to be held jointly, must become an entity provider by forming a corporation, partnership, association, or limited liability company.
(8) The license applicant/provider shall be the person or
entity ultimately responsible for the ((daily)) operation of the
adult family home. The license applicant or the applicant's
authorized representative shall sign the adult family home
license ((or renewal)) application.
(((8))) (9)(a) All entity providers shall designate an
individual on their adult family home application who is
responsible for the daily operation of the adult family home.
This person is called the entity representative and is considered
the department's primary contact person within the entity
organization.
(b) For some entity providers one person may act as both the entity representative and the resident manager.
(c) Entity providers shall immediately notify their licensor when there is a change in the entity representative.
(10) An applicant who enters into a lease or contractual
agreement with a landlord who takes an active interest in the
operation of the adult family home, shall include the landlord's
name and address on the license ((or renewal)) application.
Active interest includes but is not limited to:
(a) The charging of rent as a percentage of the business;
(b) Assistance with start up and operational expenses;
(c) Collection of resident fees;
(d) Recruitment of residents;
(e) Management oversight;
(f) Assessment and negotiated ((service)) care plan
development for residents; or
(g) The provision of personal or special care to residents.
(((9))) (11) The department shall not commence review of an
incomplete license ((or renewal)) application, and incomplete
applications shall become void sixty days following the
department's written request for additional documentation or
information to complete the application.
(((10) An adult family home license shall be valid for up to
one year.))
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-550, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-560 License eligibility((--Initial and
renewal)). (1) The department shall consider separately and
jointly as applicants each person and entity named in an
application for an adult family home license. If the department
finds any person or entity unqualified, the department shall deny
the license.
(2) In making a determination whether to grant an adult family home license, the department shall review:
(a) The information in the application; and
(b) Other documents and information the department deems relevant, including inspection and complaint investigation findings in each facility or home for the care or provision of services to children or vulnerable adults with which the applicant or any partner, officer, director, managerial employee, or owner of five percent or more of the entity applicant is or has been affiliated.
(3) The applicant and the home for which the license is sought shall comply with all requirements established by chapter 70.128 RCW and this chapter. The department may deny a license for noncompliance with any such requirements.
(4) An individual provider shall be twenty-one years of age
or older ((and all providers shall be registered with the
department of health as required by RCW 70.128.120)).
(5) All providers shall be registered with the department of health as required by RCW 70.128.120, prior to applying for an adult family home license. This registration must be renewed annually.
(6) Each resident manager shall register with the department of health as required by RCW 70.128.120. This registration must be renewed annually.
(7) A provider shall have the understanding, ability, emotional stability and physical health suited to meet the emotional and physical care needs of vulnerable adults.
(8) An adult family home shall not simultaneously be licensed as a boarding home.
(9) The department shall deny, suspend or revoke a license
if ((an applicant or any partner, officer, director, managerial
employee, or owner of five percent or more of the entity
applicant has)) any of the following people have a history of
significant noncompliance with federal or state regulations in
providing care or services to vulnerable adults or children:
* An applicant/provider,
* A resident manager,
* A partner of the entity,
* An officer of the entity,
* A director of the entity,
* A managerial employee of the entity,
* An entity representative, or
* An owner of five percent or more of the entity.
The department shall consider, at a minimum, the following as a history of significant noncompliance requiring denial of a license:
(a) Revocation or suspension of a license for the care of children or vulnerable adults;
(b) Enjoined from operating a facility for the care of
children or adults; ((or))
(c) Revocation, cancellation, suspension, or nonrenewal of a
Medicaid or Medicare provider agreement((, or)) by the
contracting agency; or
(d) Revocation, cancellation, suspension, or nonrenewal of
any ((other)) agreement with a public agency for the care or
treatment of children or vulnerable adults, when the action is
taken by the public agency.
(((6))) (10) The department may deny, suspend or revoke a
license if any of the following people meet any of the criteria
under subsection (9) of this section:
* Any person who is a caregiver;
* Any person who has unsupervised access to residents in the adult family home; or
* Any person who lives in the home but who is not a resident.
(11) The department shall deny, suspend((,)) or revoke((, or
refuse to renew)) a license if ((an applicant or any partner,
officer, director, managerial employee, an owner of fifty percent
or more of the entity applicant, or an owner who exercises
control over daily operations has been)):
* An applicant/provider,
* Any person who is a caregiver,
* Any person who has unsupervised access to residents in the adult family home,
* Any person who lives in the home but who is not a resident,
* A resident manager,
* A partner of the entity,
* An officer of the entity,
* A director of the entity,
* A managerial employee of the entity,
* An entity representative,
* An owner of fifty percent or more of the entity, or
* An owner who exercises control over daily operations, has been:
(a) Convicted of a crime against a person as defined under RCW 43.43.830 or RCW 43.43.842;
(b) Convicted of a crime relating to financial exploitation as defined under RCW 43.43.830 or RCW 43.43.842;
(c) Found by a court in a protection proceeding under chapter 74.34 RCW to have abused or financially exploited a vulnerable adult;
(d) Found in any final decision issued by a disciplinary board to have sexually or physically abused or exploited any minor or a person with a developmental disability or to have abused or financially exploited any vulnerable adult;
(e) Found in any dependency action under RCW 13.34.030
(2)(b) to have sexually ((assaulted)) abused or exploited any
minor or to have physically abused any minor; or
(f) Found by a court in a domestic relations proceeding under Title 26 RCW to have sexually abused or exploited any minor or to have physically abused any minor.
(((7) The department shall deny, suspend, revoke, or refuse
to renew a license if any person who lives in the home or who has
unsupervised access to residents meets any of the criteria
defined under subsection (6) of this section.
(8))) (12) The department may deny, suspend((,)) or revoke a
license, ((or refuse to renew a license if an applicant or any
partner, officer, director, managerial employee,)) if:
* An applicant/provider,
* Any person who is a caregiver,
* Any person who has unsupervised access to residents in the adult family home,
* Any person who lives in the home but who is not a resident,
* A resident manager,
* A partner of the entity,
* An officer of the entity,
* A director of the entity,
* A managerial employee of the entity,
* A entity representative,
* An owner of fifty percent or more of the entity
((applicant)), or
* An owner who exercises control over daily operations has:
(a) Obtained or attempted to obtain a license by fraudulent means or misrepresentation;
(b) Permitted, aided, or abetted the commission of any illegal act on the adult family home premises;
(c) Been convicted of a felony or a crime against a person if the conviction reasonably relates to the competency of the person to own or operate an adult family home;
(d) Had sanction, corrective, or remedial action taken by federal, state, county, or municipal health or safety officials related to the care or treatment of children or vulnerable adults;
(e) Engaged in or been convicted of the illegal use of drugs or the excessive use of alcohol within the past five years without evidence of rehabilitation;
(f) Been convicted of the illegal selling or distribution of drugs;
(g) Been convicted of any crime involving a firearm used in the commission of a felony or in an act of violence against a person;
(h) Operated a facility for the care of children or adults without a license;
(((g) Failed to meet financial obligations as the
obligations fell due in the normal course of business;
(h))) (i) Misappropriated property of residents;
(((i))) (j) Been denied a license or license renewal to
operate a facility that was licensed for the care of children or
vulnerable adults;
(((j))) (k) Relinquished or returned a license in connection
with the operation of any facility for the care of children or
vulnerable adults, or did not seek the renewal of such license,
following written notification of the licensing agency's
initiation of denial, suspension, cancellation or revocation of
the license;
(((k))) (l) Had resident trust funds or assets of an entity
providing care to children or vulnerable adults seized by the IRS
or a state entity for failure to pay income or payroll taxes;
(((l))) (m) Refused to permit authorized department
representatives to interview residents or have access to resident
records;
(((m))) (n) Interfered with a long term care ombudsman in
the performance of his or her official duties; ((or
(n))) (o) Exceeded licensed capacity in the operation of an
adult family home; or
(p) Been found by the court in a proceeding under Title 26 RCW to have committed an act of domestic violence toward a family or household member.
(((9))) (13) The department may deny, suspend or revoke a
license if:
* An applicant,
* A provider,
* A resident manager,
* A partner of the entity,
* An officer of the entity,
* A director of the entity,
* A managerial employee of the entity,
* An entity representative,
* An owner of fifty percent or more of the entity, or
* An owner who exercises control over daily operations,
Failed to meet financial obligations as the obligations fell due in the normal course of business, thereby impeding his/her ability to care for residents.
(14) The department shall deny ((or refuse to renew)) an
adult family home license to an applicant who is licensed to care
for children in the same home unless:
(a) It is necessary in order to allow a resident's child(ren) to live in the same home as the resident or to allow a resident who turns eighteen to remain in the home;
(b) The applicant provides satisfactory evidence to the department of the home's capability to meet the needs of children and adults residing in the home; and
(c) The total number of persons receiving care in the home does not exceed the number permitted by the licensed capacity of the adult family home.
(((10) The department's renewal of a license does not
preclude the department from taking any action under WAC 388-76-705 based on inspection.))
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-560, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-570 Additional license requirements--Multiple facility providers. (1) The department shall not issue a license to a provider to operate more than one adult family home unless:
(a) The applicant has operated an adult family home for at least one year in this state without any significant violation of the rules of this chapter; or
(b) The applicant has submitted evidence demonstrating that it has the capability to operate multiple adult family homes.
(2) An applicant that is applying to be licensed for more than one adult family home shall submit to the department for each adult family home:
(a) A twenty-four hour per day, seven days per week, staffing plan; and
(b) A plan for covering administrative responsibilities.
(3) Multiple facility providers shall have on-site at each adult family home a plan that addresses visitor parking, deliveries, and staff parking.
(4) The department may consider the applicant's credit history in determining whether to license the applicant for more than two adult family homes, when the department determines the credit history relates to an applicant's ability to provide care and services to vulnerable adults.
(((4) When)) (5) Prior to operating two or more adult family
homes, ((a)) the individual provider or entity representative
shall successfully complete forty-eight hours of residential care
administrator's training, including training in at least the
following areas:
(a) Business planning and marketing;
(b) Fiscal planning and management;
(c) Human resource planning;
(d) Resident health services;
(e) Nutrition and food service;
(f) Working with people who are elderly, chronically mentally ill, or developmentally disabled;
(g) The licensing process;
(h) Social and recreational activities;
(i) Resident rights;
(j) Legal issues;
(k) Physical maintenance and fire safety; and
(l) Housekeeping.
(((5) A provider who is operating more than one adult family
home prior to the effective date of this chapter, shall have
until June 1, 1997 to complete the residential care
administrator's training.
(6) A provider who applies for a license to operate more
than one adult family home on or after the effective date of this
chapter, shall complete the residential care administrator's
training prior to operating more than one family home.))
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-570, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-595 Inspections and ombudsman visits. (1) The department shall conduct unannounced inspections and complaint investigations to determine the provider's compliance with this chapter and chapter 70.128 RCW.
(2) The provider shall ensure that department staff have access to the home, residents, and all resident records therein and shall not willfully interfere or fail to cooperate with department staff in the performance of official duties. Examples of willful interference or failure to cooperate include but are not limited to, not allowing department staff to talk to residents in private, not allowing department staff entrance into the home, or not allowing department staff access to resident records.
(3) Department staff shall have access to relevant staff records which must be kept in the adult family home. Relevant staff records include: Criminal history background inquiries; tuberculosis test documentation; CPR-First aid cards; department of health registration; fundamentals of caregiving, modified fundamentals of caregiving, nurse delegation and continuing education certificates; and any other special certificates.
(4) Within ten calendar days of the inspection of the adult family home, the department's inspection report will be mailed or hand delivered to the provider.
(5) Within ten calendar days of the completion of complaint investigation data collection, any department inspection report related to a complaint investigation will be mailed or hand delivered to the provider.
(6) A provider shall submit to the department the planned corrective measures for violations and/or deficiencies within ten calendar days of receipt of a statement of deficiencies or an inspection report.
(7) Upon request, the department will supply to the public copies of inspection reports and complaint investigation reports, as soon as they are completed.
(8) The department will include a copy of the provider's planned corrective measures with the inspection and complaint investigation reports, if a copy is available at the time of the request.
(9) Any written decision by the department to take an enforcement action will be immediately available to the public.
(10) Subsections (7) through (9) above are subject to applicable public disclosure and confidentiality requirements.
(11) The adult family home shall not willfully interfere with a representative of the Washington protection and advocacy system as defined under RCW 71A.10.080 or the long term care ombudsman in the performance of official duties, as defined under chapter 43.190 RCW, Long-term care ombudsman program, the state regulations for the long-term care ombudsman program, and under federal law. The department shall impose a penalty of not more than one thousand dollars for any such willful interference with a representative from the long-term care ombudsman program.
(((4) The department's inspection report shall be mailed to
the provider and made available to the public within ten working
days of the inspection of the adult family home. If a provider
gives the department a plan of correction for deficiencies, the
department shall include a statement of the provider's planned
corrective measures in the department's inspection report.))
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-595, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-605 Restraints. (1) The resident has the right to be free from physical and chemical restraint and involuntary seclusion.
(2) Adult family homes are prohibited from using any and all
forms of physical restraint that are used for the purposes of
discipline or convenience and are not required to treat the
resident's medical symptoms. Treatment of such medical symptoms
must be applied and ((directly)) immediately supervised on-site
by a licensed registered nurse (RN), licensed practical nurse
(LPN) or a licensed physician. Immediate supervision means the
licensed registered nurse, the licensed practical nurse, or the
licensed physician is in the home and quickly and easily
available.
(3) The provider shall ensure that the resident is free from chemical restraints which are:
(a) Used for discipline or convenience; and
(b) Not required to treat the resident's medical symptoms.
(4) In any situation where a psychopharmacological drug is used for the resident, the provider shall ensure:
(a) That it is not used for the purpose of discipline or convenience;
(b) That it has been prescribed by a physician or health care professional with prescriptive authority;
(c) The resident's negotiated ((service)) care plan
((provides)) includes other environmental and behavioral
strategies ((and approaches to diminish or eliminate use of))
/modifications to address the symptoms for which the
psychopharmacological ((drug)) medication has been prescribed,
where possible. An actual change in medication will only occur
when the prescriber determines it is medically warranted for the
resident; and
(d) The resident or surrogate decision maker has given informed consent for its use.
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-605, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-620 Provision of services and care. (1) The provider shall ensure that the resident receives necessary services and care to promote the most appropriate level of physical, mental, and psychosocial well-being consistent with resident choice.
(2) The provider shall encourage and promote resident participation in service planning and delivery.
(3) The provider shall respect the resident's right to
decide negotiated ((service)) care plan goals and treatment
choices, including acceptance or refusal of ((service)) care plan
recommendations.
(4) The provider shall ensure that resident services are delivered in a manner and in an environment that:
(a) Promotes maintenance or enhancement of each resident's
quality of life; ((and))
(b) Promotes the safety of all residents; and
(c) Reasonably accommodates the resident's individual needs and preferences, except when the health or safety of the resident or other residents would be endangered.
(5) The provider shall ensure that appropriate professionals
provide needed services to the resident based upon the resident's
assessment and negotiated ((service)) care plan.
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-620, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-635 Nurse delegation--Penalties. The department
((shall)) may impose a civil fine on any provider ((or resident
manager)) that knowingly performs or knowingly permits an
employee to perform a nursing task except as delegated by a nurse
pursuant to chapter 18.79 RCW and chapter 246-840 WAC as follows:
(1) Two hundred fifty dollars for the first time the department finds an unlawful delegation;
(2) Five hundred dollars for the second time the department finds an unlawful delegation; and
(3) One thousand dollars for the third time or more the department finds an unlawful delegation.
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-635, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-655 General management and administration. (1) The provider shall not admit or retain any resident whose needs the provider cannot meet.
(2) The provider shall ensure all of the following:
(a) That staff are competent, and receive necessary training to perform assigned tasks;
(b) The adult family home is in compliance with the
requirements of this chapter and other applicable state laws;
((and))
(c) The home employs sufficient staff to meet the needs of the residents; and
(d) That he/she is available to respond to resident needs and caregiver inquiries within a reasonable time frame. In the event a provider is unavailable (including but not limited to being on vacation), a person must be designated to respond on behalf of the provider.
(3) The provider shall maintain liability insurance of at least one hundred thousand dollars per occurrence to cover:
(a) Damage or loss of the resident's property if due to negligence of the insured; and
(b) Injury or harm to the resident resulting from:
(i) The provision of services or failure to provide needed services; or
(ii) Incidents occurring in the adult family home or on the home's premises.
(4) ((A provider who operates only one adult family home
shall have evidence of the insurance coverage required by
subsection (3) of this section beginning January 1, 1997.
(5))) The provider shall ensure that all caregivers are at
least eighteen years of age or older.
(((6))) (5) The provider shall ensure that the provider
((or)), entity representative, resident manager and all
caregivers:
(a) Are able to communicate or make provisions for communicating with the resident in his or her primary language;
(b) Have a clear understanding of job responsibilities and
knowledge of residents' negotiated ((service)) care plans in
order to be able to provide care specific to each resident's
needs;
(c) Not engage in the illegal use of drugs or the excessive use of alcohol when providing care to residents; and
(d) Possess a valid first aid and CPR card prior to providing care for residents unless such care is directly supervised by a fully qualified caregiver who has a valid first aid and CPR card.
(((7) The provider shall ensure that there is at all times
on the premises at least one caregiver who is literate and
capable of understanding written and oral instructions
communicated in English in order to be able to respond
appropriately to emergency situations)) (6) The provider shall
ensure that:
(a) There is at least one caregiver present in the home whenever one or more residents are on the premises;
(b) The caregiver referred to in (a) of this subsection is capable of understanding and speaking English well enough to be able to respond appropriately to emergency situations; and
(c) At least one caregiver is accessible by phone or beeper for emergencies when there are no residents on the homes' premises.
(7) An adult family home shall be exempt from subsection (6)(a) of this section if:
(a) The home provides care to residents whose primary disabilities are developmental disabilities as defined by WAC 388-76-590; and
(b) It is determined and documented in a resident's current negotiated care plan that the resident is capable and willing to be left alone unsupervised in the adult family home during normal awake hours. The maximum period of time a resident can be left alone must be documented in the negotiated care plan.
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-655, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-660 Training. (1) Before operating and providing services in an adult family home, individual providers, entity representative and resident managers shall successfully complete the department's:
(a) Fundamentals of caregiving training; or
(b) Modified fundamentals of caregiving training if they meet the requirements listed in subsection (3) of this section.
(2) Providers shall ensure that:
(a) All caregivers hired in the adult family home ((on or
after the effective date of this chapter)) successfully complete
the department designated fundamentals of caregiving training
within one hundred twenty days of employment, unless he or she
meets the requirements in subsections (3) or (4) below; and
(b) ((All caregivers hired in the adult family home prior to
the effective date of this chapter successfully complete the
department designated fundamentals of caregiving training prior
to March 1, 1997, unless he or she meets the requirements in
subsection (3) below; and
(c))) All caregivers complete a minimum of ten hours of
continuing education credits per calendar year, on topics
relevant to caregiving:
(i) Topics include, but are not limited to residents' rights, personal care, dementia, mental illness, developmental disabilities, depression, medication assistance, communication skills, alternatives to restraints, and activities for residents;
(ii) Caregivers must receive a certificate of completion to meet the requirement for continuing education credit and each hour of completed instruction will count as one hour of continuing education credit; and
(iii) The continuing education requirement begins the calendar year after the year in which the caregiver completes the fundamentals or modified fundamentals of caregiving training.
(3) A caregiver who ((is)) has successfully completed
training as a registered or licensed practical nurse, a physical
or occupational therapist, a nursing assistant certified, a home
health aid from a Medicare certified home health agency, who has
successfully completed department approved adult family home
training, or department approved personal care training from an
area agency on aging or their subcontractor, or who is a resident
manager or provider prior to ((the effective date of this
chapter)) July 20, 1996, is exempt from the fundamentals of
caregiving training in subsection (2) of this section if the
caregiver successfully completes the department designated
modified fundamentals of caregiving training in accordance with
the dates specified in subsection (2) of this section.
(4) Caregivers are exempt from attending the fundamentals of caregiving or modified fundamentals of caregiving trainings if they successfully pass the department's challenge test for the class they are required to take. The caregiver has only one opportunity to successfully pass the challenge test then he/she must attend the fundamentals of caregiving or modified fundamentals of caregiving trainings as required.
(5) A provider and any of their staff who have successfully completed the division of developmental disabilities (DDD) staff training as required by chapter 275-26 WAC is exempt from the fundamentals of caregiving training in subsections (1) and (2) of this section, as long as the provider continues to work for a DDD-contracted agency. This exemption no longer applies if the provider or their staff leaves the DDD-contracted agency.
(6) Volunteers are exempt from the training requirements listed above unless they provide unsupervised direct personal care to residents.
(((5))) (7) The provider shall document that caregivers have
met the education and training requirements.
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-660, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-665 Resident records. (1) The provider or resident manager shall:
(a) Keep confidential all information contained in the resident's records, regardless of the form or storage method of the records (e.g., computer files); and
(b) Protect information in the resident's record against alteration, loss, destruction, and unauthorized use.
(2) The provider or resident manager shall release information from the resident's record when required by:
(a) The resident's transfer to a health care institution;
(b) Law;
(c) Representatives of the department when acting in accordance with state law; or
(d) The resident.
(3) The provider shall ensure that caregivers in the home have access to resident records when information in those records is needed to provide care.
(4) The provider shall retain the resident's record for three years following the resident's discharge or death.
(((4))) (5) The adult family home shall ensure that the
resident's record includes at least the following:
(a) Resident identification including the name, address, and telephone number of the person or persons the resident designates as significant;
(b) The name, address, and telephone numbers for the resident's:
(i) Surrogate decision maker, if any; and
(ii) Health care providers;
(c) A current medical history;
(d) An inventory of personal belongings which is:
(i) Updated as additional belongings accrue; and
(ii) Dated and signed by the resident and the provider or resident manager;
(e) The resident's assessment;
(f) The current negotiated ((service)) care plan;
(g) Legal documents, including but not limited to:
(i) Power of attorney (POA) if the resident has appointed a POA;
(ii) Advance health care directives if the resident has executed such directives; and
(iii) A court order, if any, appointing a legal guardian and detailing the guardian's responsibility;
(h) Financial records;
(i) Medication records;
(j) The resident's social security number; and
(k) Admission, discharge, and absences information.
(((5))) (6) The provider or resident manager shall keep the
resident's record at the adult family home in which the resident
lives.
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-665, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-670 Disaster and emergency preparedness. (1) The provider shall develop written plans and procedures to meet potential emergencies and disasters, such as fires, earthquakes, and floods.
(2) The provider shall ensure that all staff are trained in those emergency procedures when they begin to work at the home.
(3) The provider shall periodically review disaster and emergency procedures with staff, caregivers, and residents.
(4) ((The provider shall maintain a seventy-two hour food
and water supply at the home to meet resident needs in an
emergency)) In the plans (described in subsection (1) of this
section), the provider shall describe how they will supply
residents and household members with a seventy-two hour supply of
food, accommodating any specific resident needs or food
restrictions, in order to meet resident and household member
needs in an emergency. In addition to this plan, the provider
must also have on-site three gallons of drinking water per person
to meet resident and household member needs in an emergency.
(5) The provider shall ensure the adult family home has readily available first-aid supplies and a first-aid manual.
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-670, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-675 Reporting requirements. (1) The provider and all caregivers shall immediately notify the department's toll-free complaint telephone number of any incidents involving allegations of resident abuse, neglect, exploitation or abandonment in accordance with the provisions of chapter 74.34 RCW.
(2) The provider shall keep a log of injuries and accidents to residents.
(3) When there is a significant change in a resident's condition, or a serious injury, trauma, or death of a resident, the provider shall immediately notify:
(a) The resident's family, surrogate decision maker,
physician and other appropriate professionals, and other persons
identified in the negotiated ((service)) care plan; and
(b) The case manager, if the resident is receiving services paid for fully or partially by the department.
(4) The adult family home shall immediately report to the department's aging and adult services administration:
(a) Any event, actual or potential, requiring the evacuation
or relocation of all or part of the home's residents to another
address; ((and))
(b) Circumstances which threaten the home's ability to ensure continuation of services to residents; and
(c) Instances when a resident is determined to be missing.
(5) The provider shall immediately notify local law enforcement anytime the provider has reason to believe that the resident has been the victim of a crime.
(6) The provider shall notify the local public health officer and the department of any occurrence of food poisoning or communicable disease as required by the state board of health.
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-675, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-680 Infection control and communicable disease. (1) The provider or resident manager shall institute appropriate infection control measures when the resident or any household member or caregiver has, or is suspected of having, a communicable disease.
(2) The provider shall((, in addition to following)) follow
chapter 49.17 RCW, Washington Industrial Safety and Health Act
(WISHA) requirements((,)) to protect the health and safety of
residents ((from tuberculosis by requiring the provider, and each
resident manager and caregiver to have, upon employment:
(a) A tuberculin skin test by the Mantoux method, unless the
staff person:
(i) Documents a previous positive Mantoux skin test, which
is ten or more millimeters of induration read at forty-eight to
seventy-two hours;
(ii) Documents meeting the requirements of this subsection
within the six months preceding the date of employment; or
(iii) Provides a written waiver from skin testing from the
department of health or authorized local health department;
(b) A second test one to three weeks after a negative
Mantoux skin test for staff thirty-five years of age or older;
and
(c) A chest X-ray within seven days of any positive Mantoux
skin test)) and employees.
(3) The provider must ensure that tuberculosis screening is carried out as outlined below.
(a) Skin testing whether documented historically or performed currently, must be by intradermal (Mantoux) administration of PPD, and test results read in forty-eight to seventy-two hours by trained personnel. A positive reaction is ten or more millimeters of induration.
(b) The individual provider, entity representative, resident manager and caregiver must have, upon employment, tuberculosis skin testing to establish tuberculosis status.
(c) Baseline skin testing upon employment must be in two steps performed one to three weeks apart unless a person meets the requirements in (d) or (e) of this section.
(d) A person does not need to be skin tested for tuberculosis if he/she has:
(i) A documented history of a previous positive skin test; or
(ii) Documented evidence of adequate therapy for active disease; or
(iii) Documented evidence of adequate preventive therapy for infection.
(e) Exceptions to two-step testing. A person needs to have only a one-step skin test upon employment if he/she has any one of the following:
(i) A positive result from his/her initial first step skin test (a person who has a positive result from an initial first step skin test should not have any more skin testing); or
(ii) A documented history of a negative result from previous two-step baseline testing; or
(iii) A documented negative result from one step skin testing in the previous twelve months.
(f) A person with a positive reaction to skin testing must have a chest X-ray within seven days.
(g) Persons with negative test results may be required by the public health or licensing authority to have follow-up skin testing in certain circumstances such as after exposure to active tuberculosis; when tuberculosis symptoms are present; or for periodic screening.
(h) A person who has reason to decline skin testing may submit a signed statement to the employer giving the reason for declining and evidence to support the reason.
(4) The provider or resident manager shall:
(a) Report any employee's or provider's positive chest X-ray((s)) to the appropriate public health authority((,)); and
(b) Follow precautions ordered by ((a physician or)) the
public health authority, the employee's personal physician, or
other licensed health care professional.
(((4))) (5) The provider shall retain records of tuberculin
test results, reports of X-ray findings, physician or public
health official orders, and waivers in the adult family home.
(((5))) (6) The provider or resident manager shall:
(a) Use infection control standards and educational material
consistent with the current curriculum for infection control as
defined in the department's fundamentals of caregiving training
((and the adult family home provider's handbook));
(b) Dispose of used syringes, razor blades, and other sharp items in a manner that will not jeopardize the health and safety of residents, staff, and the public;
(c) Ensure disposals are placed in rigid containers, impervious to liquids and penetration by puncture. These containers shall be such that they cannot be opened either intentionally or accidentally; and
(d) Use all disposable and single-service supplies and equipment as specified by the manufacturer.
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-680, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-685 Criminal history disclosure and background inquiries. (1) Before the adult family home employs, directly or by contract, a resident manager, entity representative or caregiver, or accepts as a caregiver any volunteer or student, or allows a household member unsupervised access to residents, the home shall:
(a) Require the person to complete the residential care services background inquiry form which includes:
(i) A disclosure statement; and
(ii) A statement authorizing the adult family home, the department, and the Washington state patrol to conduct a background inquiry;
(b) Verbally inform the person:
(i) That he or she may request a copy of the background inquiry result; and
(ii) Of the inquiry result within ten days of receipt; and
(c) Notify the appropriate licensing or certification agency of any person resigning or terminated as a result of having a conviction record.
(2) The adult family home provider shall not employ any person, directly or by contract, or accept as a volunteer or student any person who may have unsupervised access to residents, or allow a household member unsupervised access to residents if the person or background inquiry discloses that the person was:
(a) Convicted of a crime against persons as defined under RCW 43.43.830;
(b) Convicted of a crime related to financial exploitation as defined under RCW 43.43.830;
(c) Found by a court in a domestic relations proceeding under Title 26 RCW to have sexually abused or exploited any minor or to have physically abused any minor;
(d) Subject to an order of protection under chapter 74.34 RCW for abuse, neglect, abandonment or financial exploitation of a vulnerable adult;
(e) Found in a final decision issued by a disciplinary board to have:
(i) Sexually or physically abused or exploited any minor or developmentally disabled person; or
(ii) Abused, neglected, abandoned or financially exploited any vulnerable adult; or
(f) Found in any dependency action under RCW 13.34.030 (2)(b) to have sexually assaulted or exploited any minor or to have physically abused any minor.
(3) The adult family home may choose to employ a person with
a conviction of a crime ((against persons)) only if the
conviction is one of the crimes listed in RCW 43.43.842 and the
required number of years has passed.
(4) An adult family home may conditionally employ a person pending the result of a background inquiry, provided the home requests the inquiry within seventy-two hours of the conditional employment.
(5) A background inquiry result is valid for two years from the date it is conducted, at which point a new background inquiry application must be submitted.
(6) The adult family home shall establish procedures ensuring:
(a) All disclosure statements and background inquiry applications and responses and all copies are maintained in a confidential and secure manner;
(b) All background inquiry results and disclosure statements are used for employment purposes only;
(c) Background inquiry results and disclosure statements are not disclosed to any person except:
(i) The person about whom the adult family home made the disclosure or background inquiry;
(ii) Authorized state and federal employees; and
(iii) The Washington state patrol auditor.
(((6))) (7) A record of inquiry results shall be retained by
the adult family home for eighteen months beyond the date of
employment termination.
(((7))) (8) The provider shall secure and submit any
additional documentation and information as requested by the
department to satisfy the requirements of this section.
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-685, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-690 Advance directives, guardianship, and decision making. (1) The provider or resident manager shall provide or ensure that the resident, at the time of admission, has received the department's current booklet on health care rights, in the language appropriate for the resident, if available from the department.
(2) The provider or resident manager shall:
(a) Immediately contact the local emergency medical services in the event of a resident medical emergency regardless of any order, directive, or other expression of resident wishes involving the provision of medical services;
(b) Have readily available for emergency medical services personnel the resident's advance directives if the resident has executed an advance directive;
(c) Inform the resident of the action required by subsection (2)(a) of this section; and
(d) Include the action required by subsection (2)(a) of this section in the home's operational policies.
(3) A licensed physician or registered nurse acting within his or her scope of practice shall be exempt from the provisions of subsection (2) of this section.
(4) ((Owners, administrators, providers, provider' family
members, and employees shall not act as legal guardian, or
attorney-in-fact, for any resident residing in or receiving care
in the home, unless he or she is the parent, spouse, adult child,
or sibling of the resident. A provider who is a guardian for a
resident of the adult family home at the time of the effective
date of this regulation shall have up to two years from the
effective date of this regulation to be legally removed as
guardian of the resident)) A provider may become a guardian for a
resident if two criteria are met:
(a) The court authorizes you under Washington state's guardianship law (chapter 11.88 RCW) to be a resident's guardian; and
(b) You inform the court in writing, through a petition, that you care for the resident in your adult family home, and you request the court to direct payment from the funds of the resident for care, maintenance, and education to you. This is required by RCW 11.92.040(6), a section in Washington state's guardianship law.
(5) A provider can not act as power of attorney for health care for a resident. Washington state's power of attorney law (chapter 11.94 RCW) says that owners, administrators, or employees of the adult family home where the resident resides or receives care can not act as power of attorney for health care for a resident, unless they are also the spouse, adult child, brother or sister of the resident.
(6) The adult family home shall provide care and services in compliance with the federal patient self determination act and with applicable state statutes related to surrogate and health care decision making, including chapters 7.70, 70.122, 11.88, 11.92, and 11.94 RCW.
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-690, filed 6/19/96, effective 7/20/96.]
Reviser's note: RCW 34.05.395 requires the use of underlining and deletion marks to indicate amendments to existing rules. The rule published above varies from its predecessor in certain respects not indicated by the use of these markings.
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-695 Protection of resident funds--Liquidation or transfer. (1) Upon the death of a resident, the adult family home shall promptly convey the resident's personal funds held by the adult family home with a final accounting of such funds to the department or to the individual or probate jurisdiction administering the resident's estate no later than forty-five calendar days after the date of the resident's death.
(2) If the deceased resident was a recipient of long-term care services paid for in whole or part by the state of Washington, then the personal funds held by the adult family home and the final accounting should be paid to the secretary, department of social and health services and mailed to the office of financial recovery, estate recovery unit, P.O. Box 9501, Olympia, WA 98507-9501 or such address as may be directed by the department in the future:
(a) The check and final accounting accompanying the payment shall contain the name and social security number of the deceased individual from whose personal funds account the monies are being paid; and
(b) The department of social and health services shall establish a release procedure for use of funds necessary for burial expenses.
(3) In situations where the resident is absent from the adult family home for an extended time without notifying the home, and the resident's whereabouts is unknown:
(a) The adult family home shall make a reasonable effort to find the missing resident; and
(b) If the resident cannot be located after ninety days, the home shall notify the department of revenue of the existence of "abandoned property," outlined in chapter 63.29 RCW. The home shall deliver to the department of revenue the balance of the resident's personal funds within twenty days following such notification.
(4) Prior to the sale or other transfer of ownership of the adult family home the provider shall:
(a) Provide each resident with a written accounting of any personal funds held by the home;
(b) Provide the new provider with a written accounting of all resident funds being transferred; and
(c) Obtain a written ((request)) receipt for those funds
from the new provider.
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-695, filed 6/19/96, effective 7/20/96.]
AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)
WAC 388-76-705 Remedies. (1) The department may take one or more of the actions listed in subsection (3)(a) of this section in any case in which the department finds that an adult family home provider has:
(a) Failed or refused to comply with the applicable requirements of chapters 70.128 and 70.129 RCW or of this chapter;
(b) Operated without a license or under a revoked license;
(c) Knowingly, or with reason to know, made a false
statement of material fact on his or her application for a
license or any data attached thereto, or in any matter under
investigation by the department; ((or))
(d) Willfully prevented ((or)), interfered with, or failed
to cooperate with any inspection or investigation by the
department; or
(e) Failed to comply with:
(i) A condition imposed on a license; or
(ii) A stop placement order.
(2)(a) For failure or refusal to comply with any applicable requirements of chapters 70.128 and 70.129 RCW or of this chapter, the department may provide consultation and shall allow the provider a reasonable opportunity to correct before imposing remedies under subsection (3)(a) unless the violations pose a serious risk to residents, are recurring or have been uncorrected.
(b) When violations of this chapter pose a serious risk to a resident, are recurring or have been uncorrected, the department shall impose a remedy or remedies listed under subsection (3)(a). In determining which remedy or remedies to impose, the department shall take into account the severity of the potential or actual impact of the violations on residents and which remedy or remedies are likely to improve resident outcomes and satisfaction in a timely manner.
(3)(a) Actions and remedies the department may impose include:
(i) Denial of an application for a license;
(ii) Imposition of reasonable conditions on a license, such as correction within a specified time, training, and limits on the type of residents the provider may admit or serve;
(iii) Imposition of civil penalties of not more than one hundred dollars per day per violation except that:
(A) Fines of up to one thousand dollars can be issued for willful interference with a representative of the long-term care ombudsman per RCW 70.128.150; and
(B) Fines of up to three thousand dollars can be issued for retaliation against a resident, employee, or any other person for making a complaint, providing information to, or cooperating with, the ombudsman, the department, the attorney's general office, or a law enforcement agency per RCW 74.39A.060(7).
(iv) Suspension((,)) or revocation((, or refusal to renew))
of a license; or
(v) Order stop placement.
(b) When the department orders stop placement, the adult family home shall not admit any person until the stop placement order is terminated. The department may approve readmission of a resident to the adult family home from a hospital or nursing home during the stop placement. The department shall terminate the stop placement when the department determines that:
(i) The violations necessitating the stop placement have been corrected; and
(ii) The provider exhibits the capacity to maintain adequate care and service.
(c) Conditions the department may impose on a license include, but are not limited to the following:
(i) Correction within a specified time;
(ii) Training related to the violations;
(iii) Limits on the type of residents the provider may admit or serve;
(iv) Discharge of any resident when the department determines discharge is needed to meet that resident's needs or for the protection of other residents;
(v) Change in the license capacity;
(vi) Removal of the adult family home's designation as a specialized home;
(vii) Prohibition of access to residents by a specified person; and
(viii) Demonstration of ability to meet financial obligations necessary to continue operation.
(d) When a provider fails to pay a fine when due under this chapter, the department may, in addition to other remedies, withhold an amount equal to the fine plus interest, if any, from any contract payment due to the provider from the department.
(e) When the department finds that a licensed provider also operates an unlicensed adult family home, the department may impose a remedy listed under subsection (3)(a) of this section on the provider and the provider's licensed adult family home or homes.
(f) When the department determines that violations existing in an adult family home are of such a nature as to present a serious risk of harm to residents of other homes operated by the same provider, the department may impose remedies on those other homes.
[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-705, filed 6/19/96, effective 7/20/96.]