WSR 98-12-054

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Aging and Adult Services Administration)

[Filed May 29, 1998, 3:55 p.m., effective July 1, 1998]



Date of Adoption: May 29, 1998

Purpose: To comply with statutory requirements regarding special care, resident rights, and resident assessment, in adult family homes

Citation of Existing Rules Affected by this Order: Amending WAC 388-76-590, 388-76-600, 388-76-610, and 388-76-615

Statutory Authority for Adoption: RCW 70.128.040, 70.128.060, chapter 70.129 RCW, chapter 272, Laws of 1998

Adopted under notice filed as WSR 98-04-032 on January 29, 1998

Changes Other than Editing from Proposed to Adopted Version: The final rules note statutory authority for rule making regarding specialty adult family homes.

The final rules are broken into numerous rules for ease of use and clarity. New section numbers were added. All of the proposed rules were amended to make them easier to understand.

The only changes to the rules, other than editing, were to lessen or clarify requirements when possible while still maintaining legislative requirements.

WAC 388-76-561 Adult family home licensing designations, the department will not implement its proposal to designate "basic," "experienced" and "registered nurse," and their combinations, for adult family home licensing at this time, but will further study this issue.

WAC 388-76-590 Specialty adult family homes, many requirements included in the previous version were deleted from this section, with an emphasis placed on achieving outcomes for residents.

WAC 388-76-600 General resident rights, resident rights rules were amended to disclose the caregivers' primary responsibilities and availability, in addition to experience, training, and education. Several additions were made in order to update this section to reflect recent changes in statute, and to more clearly convey statutory requirements.

WAC 388-76-610 Resident assessment, several additions were made in order to update this section to reflect recent changes in statute, and to more clearly convey statutory requirements.

WAC 388-76-615 Negotiated care plan, the rules on the negotiated care plan have been amended to clearly define the differences between the negotiated care plan and the preliminary service plan

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 0, repealed 0; or Recently Enacted State Statutes: New 0, amended 4, repealed 0.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 36, amended 2, 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 36, amended 4, repealed 0.

Effective Date of Rule: July 1, 1998

May 29, 1998

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

SHS-2439.4

SPECIALTY ADULT FAMILY HOMES



AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)



WAC 388-76-590  Specialty adult family homes. (((1) Beginning September 1, 1996, an applicant or provider may apply for a designation as a specialty adult family home to serve and meet the unique needs of residents with:

(a) Developmental disabilities;

(b) Mental illnesses; or

(c) Dementia.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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



NEW SECTION



WAC 388-76-59000  What authority does the department have to adopt rules related to specialty homes? (1) The legislature under RCW 70.128.005 and 70.128.040 authorizes the department to adopt rules to cover the needs of different populations living in adult family homes. This includes, but is not limited to, the developmentally disabled and the elderly.

(2) The department is authorized to adopt rules to cover special care training necessary for adult family home providers or resident managers. The legislature established that, as a minimum qualification, each of the adult family home providers and resident managers must complete special care training before providing special care services. (See RCW 70.128.120.)



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NEW SECTION



WAC 388-76-59010  What types of specialty adult family home designations are there? Adult family homes may be designated as a specialty home in one or more of the following three categories:

(1) Developmental disability,

(2) Mental illness, and/or

(3) Dementia.



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NEW SECTION



WAC 388-76-59020  What definitions apply to specialty adult family home designations? For purposes of specialty adult family home designations, the following definitions apply:

Dementia is defined as a condition documented through the assessment process required by WAC 388-76-61020.

Developmental disability means:

(1) A person who meets the eligibility criteria defined in Washington Administrative Code by the division of developmental disabilities under chapter 275-27 WAC; or

(2) A person with a severe, chronic disability which is attributable to cerebral palsy or epilepsy, or any other condition, other than mental illness, found to be closely related to mental retardation which results in impairment of general intellectual functioning or adaptive behavior similar to that of a person with mental retardation, and requires treatment or services similar to those required for these persons (i.e., autism); and

(a) The condition was manifested before the person reached age twenty-two; and

(b) The condition is likely to continue indefinitely; and

(c) The condition results in substantial functional limitations in three or more of the following areas of major life activities:

(i) Self-care;

(ii) Understanding and use of language;

(iii) Learning;

(iv) Mobility;

(v) Self-direction; and

(vi) Capacity for independent living.

Mental illness is defined as an Axis I or II diagnosed mental illness as outlined in volume IV of the Diagnostic and Statistical Manual of Mental Disorders (a copy is available for review through the aging and adult services administration).



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NEW SECTION



WAC 388-76-59050  What is required in order to obtain the specialty designation? The department will grant an adult family home a specialty designation for one or more of the three areas of specialty when:

(1) The individual provider or entity representative, and the resident manager, if there is a resident manager, have successfully completed one or more of the specialty care trainings; and

(2) The provider supplies the department with certification of successful completion of the required specialty care training or the challenge test; and

(3) The provider ensures that the specialty needs of the resident are identified and met, and that all caregivers in the home receive training regarding the specialty needs of the individual residents in the home. This training must cover the routine and changing care needs of the resident. The provider or a person knowledgeable about the specialty area may give this training.



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NEW SECTION



WAC 388-76-59060  Are adult family home providers required to obtain more than one specialty designation if an individual resident has more than one specialty need? If an individual resident has needs that meet more than one of the definitions for developmental disability, mental illness, and dementia, described in WAC 388-76-59020, the provider must determine which one of the specialty trainings will most appropriately address the overall needs of the resident. The provider must then obtain the specialty training and designation that corresponds with this determination. The provider must ensure additional training of caregivers is obtained if needed to meet all of the resident's needs. This additional training may be the specialty designation training or another training chosen by the provider.



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NEW SECTION



WAC 388-76-59070  Are adult family home providers required to obtain more than one specialty designation if they serve two or more residents with different specialty needs? When adult family home providers serve two or more residents with different specialty needs they must obtain a separate specialty designation for each of the specialty needs. For example, if one resident has needs meeting the definition for dementia, and a second resident has needs meeting the definition for mental illness, the provider must obtain a specialty designation for both dementia and mental illness. In a home where one resident has needs meeting the definition for a developmental disability, a second resident has needs meeting the definition for mental illness, and a third resident has needs meeting the definition for dementia, the provider must obtain a specialty designation for developmental disabilities, mental illness, and dementia.



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NEW SECTION



WAC 388-76-59080  When will providers be required to become specialty adult family homes in order to serve persons with mental illness or dementia? Beginning October 1, 1999:

(1) An adult family home is required to become a specialty adult family home in order to admit and serve residents who have been determined to meet the definitions in this section for a mental illness or dementia; and

(2) Individual providers, entity representatives, and resident managers will have one hundred twenty days to complete specialty care training after a resident already living in the home develops mental illness or dementia as defined in this section.



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NEW SECTION



WAC 388-76-59090  When will providers be required to become specialty adult family homes in order to serve persons with developmental disabilities? (1) For providers serving persons with developmental disabilities prior to July 1, 1998, the deadline for successfully completing specialty training is July 1, 1999.

(2) All other adult family home providers must obtain a specialty designation before admitting and serving a person with a developmental disability.



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NEW SECTION



WAC 388-76-59100  Does completion of this training substitute for any other required trainings? Successful completion of specialty training in any of the three areas of specialty will substitute for the fulfillment of two years of continuing education requirements. The substitutions count toward different years, depending on the following:

(1) When the specialty training is completed in the same year as the required fundamentals in caregiving training or the modified fundamentals of caregiving training, the specialty training will substitute for the following two calendar years training.

(2) When the specialty training is successfully completed in separate years from the required fundamentals in caregiving training or the modified fundamentals of caregiving training, the specialty training will substitute for the year in which the specialty training is successfully completed and the following calendar year.



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NEW SECTION



WAC 388-76-59110  For the dementia and mental health specialties can providers take a test instead of attending the training? For the dementia and mental health specialties, individuals have one opportunity to take a "challenge" test. If they successfully pass the department's test, this substitutes for the specialty training. There is only one opportunity to successfully pass the challenge test. After failing a challenge test, the individual must attend the specialty training if he or she chooses to apply for an adult family home specialty.



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NEW SECTION



WAC 388-76-59120  Are there any different training requirements for adult family homes providing services to persons with developmental disabilities? (1) Providers and resident managers serving persons with developmental disabilities may not take a challenge test for the specialty of developmental disabilities.

(2) Providers are exempt from the developmental disabilities specialty training if they are both licensed as an adult family home and hold a current contract and certification by the division of developmental disabilities as a group home.



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GENERAL RESIDENT RIGHTS



AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)



WAC 388-76-600  General resident rights. (((1) The provider shall comply with all requirements of chapter 70.129 RCW, Long-term care resident rights. The provider shall promote and protect the resident's exercise of all rights granted under that law.

(2) The provider shall have written policies for the services provided, house policies, financial arrangements expected, and the home's policy on refunds and deposits. Prior to admitting any resident, the provider shall provide this information to the prospective resident and his or her surrogate decision maker, if applicable.

(3) The provider shall inform the resident both orally and in writing in a manner and in a language the resident understands when there are changes in:

(a) House policies governing resident conduct and responsibilities during the resident's stay in the adult family home;

(b) Services available in the adult family home;

(c) Charges for available services including charges for services not covered by the home's per diem rate or applicable public benefit programs; and

(d) Refund and deposit policies.

(4) House policies implemented by the provider shall be reasonable and may not conflict with rights granted to the resident under chapter 70.129 RCW, Long-term care resident rights or this chapter.

(5) The resident has the right to be fully informed in language that he or she can understand of his or her total health status, including, but not limited to, his or her medical condition as defined under RCW 7.70.060.

(6) The resident has the right to be fully informed in advance about recommended care and treatment and of any recommended changes in that care or treatment.

(7) The provider shall not require or ask the resident to sign any contract or agreement that waives any rights of the resident.

(8) The resident shall be free from abuse, neglect, abandonment, or financial exploitation.

(9) The provider shall comply with all applicable federal and state statutory requirements regarding nondiscrimination.

(10) The provider shall post in a place and manner clearly visible to residents and visitors the department's toll-free complaint telephone number, and the names, addresses, and telephone numbers of the state licensure office, the state ombudsman program, and the protection and advocacy systems.))



[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), § 388-76-600, filed 6/19/96, effective 7/20/96.]



NEW SECTION



WAC 388-76-60000  What are resident rights? (1) Under RCW 70.129.005 long-term care facility residents should have the opportunity to exercise reasonable control over life decisions.

(2) Long-term care residents should have privacy and choices to engage in religious, political, civic, recreational, and other social activities to foster a sense of self-worth and enhance the quality of life. (See chapter 70.129 RCW.)

(3) Long-term care residents should receive appropriate services, be treated with courtesy, and continue to enjoy their basic civil and legal rights. (See chapter 70.129 RCW.)



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NEW SECTION



WAC 388-76-60010  Why do providers need to know resident rights? The legislature determined that residents of long term care facilities are entitled to certain rights. The provider is required to comply with all requirements of chapter 70.129 RCW, Long-term care resident rights. The provider must promote and protect the resident's exercise of all rights granted under that law.



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NEW SECTION



WAC 388-76-60020  Is the provider required to supply information to potential residents and current residents, or the resident's representative? RCW 70.128.007(3) states that it is the goal of the legislature to "Encourage consumers, families, providers, and the public to become active in assuring their full participation in development of adult family homes that provide high quality and cost-effective care." The information that the provider supplies to potential residents and their families assists them to make informed choices about whether the individual adult family home will be able to provide appropriate high quality services, and what the costs will be for services.



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NEW SECTION



WAC 388-76-60030  When must this information be supplied? Before admitting any resident, the provider must supply information about the adult family home to the potential resident. This information must also be supplied to current residents at least every twenty four months. The information must be presented orally and in writing in a language understandable to the potential resident or resident, or the resident's representative, and acknowledged in writing.



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NEW SECTION



WAC 388-76-60040  Must the information be updated and supplied again in advance of changes? The provider must inform each resident or the resident's representative in writing thirty days in advance of changes in the availability or the charges for services, items, or activities, or of changes in the adult family home's rules. Except in emergencies, thirty days' advance notice must be given prior to the change. When there are substantial and continuing changes in the resident's condition necessitating substantially greater or lesser services, items or activities, then the related charges may be changed with fourteen days' advance written notice.



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NEW SECTION



WAC 388-76-60050  What information is the provider required to supply to potential residents and current residents? At a minimum, information supplied to the resident prior to admission must include:

(1) House rules and policies, including:

(a) A description of services, items, and activities regularly available in the home or arranged for by the home;

(b) House rules and policies governing resident conduct and responsibilities;

(c) A statement describing charges for all services, items and activities provided in the home. This must include a description of added charges for items, services or activities that are not covered by the home's per diem rate or applicable public benefit programs;

(d) The schedule for payment of fees expected of residents by the provider;

(e) The home's policy on refunds and deposits, which must be consistent with RCW 70.129.150;

(f) House policies governing resident conduct and responsibilities during the resident's stay in the adult family home;

(g) A statement indicating whether the provider will accept Medicaid or other public funds as a source of payment for services.

(2) Information about caregivers, including:

(a) The following information describing the licensed provider and the resident manager if there is a resident manager:

(i) Availability in the home, including a general statement about how often he or she is in the home;

(ii) Education and training relevant to resident caregiving;

(iii) Caregiving experience;

(iv) His or her primary responsibilities, including whether he or she makes daily general care management decisions;

(v) How to contact the provider or resident manager when he or she is not in the home.

(b) The following information describing a licensed practical nurse or registered nurse, if there is one who is in any way involved in the care of residents:

(i) Whom the LPN or RN is employed by, including the adult family home or another agency;

(ii) The specific routine hours that the LPN or RN is on site, if they are on-site routinely;

(iii) His or her primary responsibilities, including whether he or she makes daily general care management decisions;

(iv) The nonroutine times when the LPN or RN will be available, such as on-call; and

(vi) A description of what the provider will do to make available the services of an RN or LPN in the event of an emergency or a change in the resident's condition.

(3) A statement indicating whether the provider or staff are qualified or willing to become qualified to perform nurse delegation as allowed under state law;

(4) Types of care that can and cannot be offered:

(a) A description of what the adult family home will try to do to make adjustments to accommodate a resident's foreseeable or likely increasing care needs for the kinds of residents served by the home;

(b) A list of the types of predictable resident needs and conditions for which the adult family home cannot or will not provide care.



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NEW SECTION



WAC 388-76-60060  Do residents have rights that are not listed here? Residents have many rights that are listed in detail in RCW 70.129. The provider must promote and protect all of these rights, in addition to those listed in this section.



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NEW SECTION



WAC 388-76-60070  What are some of the other resident rights that must be considered? (1) House policies implemented by the provider are required to be reasonable and must not conflict with rights granted to the resident under chapter 70.129 RCW, Long-term care resident rights or this chapter.

(2) The resident has the right to be fully informed in a language that he or she can understand of his or her total health status, including, but not limited to, his or her medical condition. This right is described in detail in chapter 7.70 RCW. The provider must not interfere with the resident's access to information from health care providers.

(3) The resident has the right to be fully informed in advance about recommended care and treatment and of any recommended changes in that care or treatment.

(4) The provider must not require or ask the resident or the resident's representative to sign any contract or agreement that waives any rights of the resident or waives potential liability for losses of personal property or injury.

(5) The resident shall be free from abuse, neglect, abandonment, or financial exploitation.

(6) The provider must comply with all applicable federal and state statutory requirements regarding nondiscrimination.

(7) The provider must post in a place and manner clearly visible and readable to residents and visitors the department's toll-free complaint telephone number, and the names, addresses, and telephone numbers of the state licensure office, the state ombudsman program, and the protection and advocacy systems. This posting shall include at a minimum all of the information listed on the notice supplied by the department containing the toll free complaint hot line and the toll free ombudsman number, and a brief description of ombudsman services.

(8) The provider must post in a place and manner clearly visible and readable to residents and visitors a statement that copies of the results of the most recent licensing inspection, and, if there has been a complaint investigation, the results of the investigation, are available to be read in the adult family home.

(9) The provider is required to maintain a safe, clean, comfortable, and home-like environment, that supports residents in their activities of daily living and promotes their quality of life.



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RESIDENT ASSESSMENT



AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)



WAC 388-76-610  Resident assessment. (((1) The provider shall not admit a resident unless:

(a) The adult family home can meet the resident's assessed needs;

(b) The resident's admission will not adversely affect the provider's ability to meet the needs of other residents in the home; and

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

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

(a) Medical status;

(b) Strengths and needs;

(c) Activities preferences; and

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

(3) The provider shall:

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

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

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

(a) As needed; and

(b) At the resident's request.))



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



NEW SECTION



WAC 388-76-61000  Is an assessment needed before a person can be admitted to an adult family home? Before a person can be admitted, the provider must obtain a written assessment that contains current information. The contents of this assessment must at a minimum include the list in WAC 388-76-61020.



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NEW SECTION



WAC 388-76-61010  Under what circumstances can a provider admit or continue services for a person? A provider must be knowledgeable about the needs of a resident, based on the needs documented in the resident assessment. The provider may only admit or continue services for a person when:

(1) The adult family home can meet the person's assessed needs with current staff or through reasonable accommodations.

(2) The person's admission will not adversely affect the provider's ability to meet the needs of other residents in the home or endanger the safety of other residents; and

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



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NEW SECTION



WAC 388-76-61020  What must be included in the resident assessment? The current written assessment must contain specific information regarding the resident applicant. If, despite the best efforts of the person conducting the assessment, an element of the required assessment information is not available, the effort to obtain the information must be documented with the assessment. At a minimum, the assessment must include:

(1) Recent medical history;

(2) Current prescribed medications, and contraindicated medications (including, but not limited to, medications that are known to cause adverse reactions or allergies);

(3) Medical diagnosis by a licensed medical professional;

(4) Significant known behaviors or symptoms that may cause concern or require special care;

(5) Evaluation of cognitive status in order to determine the individual's current level of functioning. This must include an evaluation of disorientation, memory impairment, and impaired judgment;

(6) History of depression and anxiety;

(7) History of mental illness, if applicable;

(8) Social, physical, and emotional strengths and needs;

(9) Functional abilities in relationship to activities of daily living including: Eating, toileting, ambulating, transferring, positioning, specialized body care, personal hygiene, dressing, bathing, and management of own medication;

(10) Preferences and choices regarding daily life that are important to the person (including, but not limited to, such preferences as the type of food that the person enjoys, what time he or she likes to eat, and when he or she likes to sleep);

(11) Preferences for activities; and

(12) A preliminary service plan.



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NEW SECTION



WAC 388-76-61030  How does the preliminary service plan fit within the resident assessment? The preliminary service plan is part of the resident assessment, and is completed by the person conducting the assessment. The assessment and preliminary service plan create the foundation for the negotiated care plan, which is described in WAC 388-76-61500. The preliminary service plan describes needs for services and an initial plan for how to meet the needs that are identified at the time of the assessment. This plan should be developed by the provider and made more specific when the negotiated care plan is developed and reviewed. At a minimum, the preliminary service plan must contain:

(1) A complete description of the client's specific problems and needs;

(2) A description of needs for which the client chooses not to accept services;

(3) Identification of client goals and preferences; and

(4) A description of how the client's needs can be met.



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NEW SECTION



WAC 388-76-61040  Is the use of an approved form required for the assessment? Beginning July 1, 1999 the assessment must be completed on a form that is approved by the department.



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NEW SECTION



WAC 388-76-61050  Who can do the assessment? (1) Effective July 1, 1999, a qualified assessor is a person who:

(a) Has a master's degree in social services, human services, behavioral sciences or an allied field and two years social service experience working with adults who have functional or cognitive disabilities; or

(b) A bachelor's degree in social services, human services, behavioral sciences, or an allied field and three years social service experience working with adults who have functional or cognitive disabilities; or

(c) Has a valid Washington state license to practice as a registered nurse and three years of clinical nursing experience; or

(d) Is a physician with a valid Washington state license to practice medicine. This includes licensed osteopathic physicians.

(2) For individuals who will receive services paid for fully or partially by the department, the assessment must be completed by the authorized department case manager.



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NEW SECTION



WAC 388-76-61060  In emergency situations, can a provider admit a resident without an assessment? In circumstances of genuine emergency, the provider may admit an individual without the required assessment and service plan. It is expected these situations will occur very infrequently. These circumstances are:

(1) For individuals who use private funds to pay for care, the provider must determine that the individual's life, health or safety are at serious risk due to circumstances in the individual's current place of residence, or, if due to such circumstances, harm to an individual has occurred. Under these circumstances the required assessment must be completed within five working days of the resident's admission.

(2) For individuals whose care is paid for fully or partially by the department, the provider must obtain the approval of the authorized department case manager prior to admission. If this approval is obtained verbally, the provider must document the time, the date, and the name of the case manager.



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NEW SECTION



WAC 388-76-61070  Does the assessment have to be updated? The provider must ensure that the assessment is reviewed and updated to document the resident's ongoing needs and preferences according to the following criteria:

(1) At least every twelve months;

(2) When there is a significant change in the resident's physical or mental condition; and

(3) At the resident's request or at the request of the resident's legal representative.



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NEW SECTION



WAC 388-76-61080  Who is qualified to update the assessment? Effective July 1, 1999, persons meeting the qualifications of an assessor are also qualified to update the assessment for an individual who will use private funds to pay for the adult family home.



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NEGOTIATED CARE PLAN



AMENDATORY SECTION (Amending WSR 96-14-003, filed 6/19/96, effective 7/20/96)



WAC 388-76-615  Negotiated ((service)) care plan. (((1) Within fourteen days of the resident's admission the provider shall develop a negotiated service plan with the resident which identifies:

(a) The services to be provided;

(b) Who will provide the services; and

(c) When and how the services will be provided.

(2) The provider shall ensure that the negotiated service plan is:

(a) Designed to meet resident needs and preferences currently identified in the assessment; and

(b) Agreed to and signed by the resident or the resident's surrogate decision maker, if applicable.

(3) The negotiated service plan shall be completed with input from:

(a) The resident to the greatest extent practicable;

(b) The resident's family, if approved by the resident;

(c) The resident's surrogate decision maker, if applicable;

(d) Appropriate professionals;

(e) Other individuals the resident wants included; and

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

(4) The provider shall ensure that the resident's negotiated service plan is reviewed and revised:

(a) As needed;

(b) At the resident's request; and

(c) If changes or additions to assessment information result in significant changes to the resident's identified needs or preferences and choices.))



[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), § 388-76-615, filed 6/19/96, effective 7/20/96.]



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WAC 388-76-61500  What is a negotiated care plan? A negotiated care plan is a written plan developed between the provider and the resident, or the resident's representative, if the resident has a representative. The provider is responsible to make sure that it is written and signed. This plan identifies:

(1) The care and services to be provided;

(2) Who will provide the care and services;

(3) When and how the care and services will be provided;

(4) The resident's activities preferences and how those preferences will be accommodated; and

(5) Other preferences and choices regarding issues important to the resident (including, but not limited to, food, daily routine, grooming), and what efforts will be made to accommodate those preferences and choices;

(6) If needed, a plan to follow in case of a foreseeable crisis due to a resident's assessed need, such as, but not limited to, how to access emergency mental health services;

(7) If needed, a plan to reduce tension, agitation and problem behaviors;

(8) If needed, a plan to respond to residents' special needs, including, but not limited to, the availability of staff when resident needs change;

(9) If needed, the identification of any communication barriers of the resident, including, but not limited to, how behaviors and nonverbal gestures may be used as a means for communication.



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WAC 388-76-61510  When must the negotiated care plan be developed? The plan must be developed within fourteen days of the resident's admission.



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WAC 388-76-61520  How does the negotiated care plan fit in with the assessment and preliminary service plan? The assessment and preliminary service plan, which are done by the person conducting the assessment, create the foundation for the negotiated care plan. The preliminary service plan describes needs for services and an initial plan for how to meet the needs. This plan is limited to needs that are identified at the time of the assessment. It is expected that, over time, the provider will learn more about the resident's needs and how to make sure they are met. The provider is responsible to work with the preliminary service plan and update it and make it more specific. As it is updated and made more specific, and as the resident or the resident's representative becomes involved in its development, it becomes the negotiated care plan. The negotiated care plan provides specific details about how the resident's needs and preferences will be addressed within the individual adult family home.

The provider must implement the negotiated care plan after it has been agreed to and signed by the resident or the resident's representative, if the resident has a representative.



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WAC 388-76-61530  Who must be involved in the development of the negotiated care plan? The provider must involve the following people in developing the plan:

(1) The resident, to the greatest extent he or she is able to participate,

(2) The resident's family, if approved by the resident;

(3) The resident's representative, if the resident has a representative;

(4) Professionals involved in the care of the resident;

(5) Other individuals the resident wants included; and

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



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WAC 388-76-61540  Who must sign the negotiated care plan? The provider must ensure that the negotiated care plan is agreed to and signed by the resident, or the resident's representative, if the resident has a representative.



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WAC 388-76-61550  How often must the negotiated care plan be reviewed and revised? The provider must ensure that the plan is reviewed and revised according to the following schedule:

(1) At least every twelve months;

(2) When there is a significant change in the resident's physical or mental condition;

(3) At the resident's request; and

(4) If changes or additions to assessment information result in significant changes to the resident's identified needs or preferences and choices.



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WAC 388-76-61560  When does the department's case manager get a copy of the negotiated care plan? The copy of the plan must be given to the authorized department case manager each time it is completed or updated, and after it has been signed by the resident, if the resident's services are being paid fully or partially by the department.



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WAC 388-76-61570  How are payment rate changes authorized for residents receiving services paid for fully or partially by the department? If there is improvement or decline causing significant changes in a resident's identified needs, and the resident is receiving services paid for fully or partially by the department, the provider must notify the authorized department case manager. No payment rate change will be approved without an assessment and authorization by the department.



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