Date of Adoption: September 25, 2002.

     Purpose: The purpose of the proposed emergency rules for group receiving centers (GRC), new chapter 388-140 WAC, is to establish licensing standards immediately for facilities providing out-of-home receiving or emergency care to children for up to thirty days. Licensing standards do not currently exist for GRCs. The emergency rules would provide protection for children placed in facilities in emergency situations. Currently, the one group receiving center in operation is licensed under standards that do not accurately or adequately address the program. Children's Administration is working with stakeholders for the permanent adoption of rules appropriate to this type of facility. The client age range and other sections may be modified during the permanent rule making process.

     Statutory Authority for Adoption: RCW 74.15.030(2), 74.08.090.

     Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.

     Reasons for this Finding: Children's Administration has licensed a facility as a group care program with several waivers as there are no current licensing standards for a group receiving center. After consulting with the program's assistant attorney general and representatives of the federal IV-E program, we have learned that the approval of waivers jeopardizes federal funds received by Children's Administration to support services to children.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 125, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 125, Amended 0, Repealed 0.
     Effective Date of Rule: Immediately.

September 25, 2002

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

     The department is committed to ensuring that children who receive receiving care in a group setting experience health, safety, and well-being. We want these children's experiences to be beneficial to them not only in the short term, but also in the long term. Our licensing requirements reflect our commitment to children.

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     "Abuse or neglect" means injury, sexual abuse, sexual exploitation, negligent treatment or mistreatment of a child where the child's health, welfare and safety are harmed.

     "Assessment" means the appraisal or evaluation of a child in terms of his or her physical, mental, and emotional condition.

     "Capacity" means the maximum number of children that a home or facility is licensed to care for at a given time.

     "Children" or "youth," means individuals who are under eighteen years old, including expectant mothers under eighteen years old.

     "Compliance agreement" means a written licensing improvement plan to address specific skills, abilities, or other issues of a fully licensed home or facility to maintain and/or increase the safety and well-being of children in their care.

     "DCFS" means the division of children and family services.

     "DDD" means the division of developmental disabilities.

     "DSHS" or "department" means the department of social and health services (DSHS).

     "DLR" means the division of licensed resources.

     "DOH" means the department of health.

     "Group receiving center" or "GRC" is a facility providing the basic needs of food, shelter, and supervision for more than six children placed by the department, generally for thirty or less days.

     "Firearms" means guns or weapons, including but not limited to the following: BB guns, pellet guns, air rifles, stun guns, antique guns, bows and arrows, handguns, rifles, and shotguns.

     "Full licensure" means an entity meets the requirements established by the state for licensing or approved as meeting state licensing requirements.

     "Hearing" means the department's administrative review process.

     "I" refers to anyone who operates or owns group receiving center.

     "Individual with developmental disabilities" means an individual who meets the eligibility requirements in RCW 71A.10.020 and WAC 388-825-030 for services. A developmental disability is any of the following: Mental retardation, cerebral palsy, epilepsy, autism, or another neurological condition described in WAC 388-825-030. These conditions must originate before the age of eighteen years; be expected to continue indefinitely; and result in a substantial handicap.

     "Infants" means children under one year of age.

     "License" means a permit issued by the department affirming that a home or facility meets the licensing requirements.

     "Licensee" means the name of the individual or legal entity granted the license for a group receiving center.

     "Licensor" means a division of licensed resources (DLR) employee at DSHS that:

     (1) Approves licenses for group receiving centers; and

     (2) Monitors centers to ensure that they continue to meet health and safety requirements.

     "Medically fragile" means the condition of a child who has a chronic illness or severe medical disabilities requiring regular nursing visits, extraordinary medical monitoring, or under a physician's care.

     "Nonambulatory" means not able to walk.

     "Nonmobile" refers to children who are not yet walking, are unable to walk, or unable to use a wheelchair or other device to move about freely.

     "Out-of-home placement" means a child's placement in a home or facility other than the child's parent, guardian, or legal custodian.

     "Premises" means a facility's buildings and adjoining grounds that are managed by a person or agency in charge.

     "Probationary license" means a license issued as a disciplinary measure to an individual or agency that has previously been issued a full license but is out of compliance with licensing standards.

     "Psychotropic medication" means a type of medicine that is prescribed to affect or alter thought processes, mood, sleep, or behavior. These include anti-psychotic, antidepressants and anti-anxiety medications.

     "Severe developmental disabilities" means significant disabling, physical and/or mental conditions(s) that cause a child to need external support for self-direction, self-support and social participation.

     "Service plan" means a description of the services to be provided or performed and who will provide or perform the activities.

     "Universal precautions" is a term relating to procedures designed to prevent transmission of blood borne pathogens in health care and other settings. Under universal precautions (sometimes call standard precautions), blood or other potentially infectious materials of all people should always be considered potentially infectious for HIV and other pathogens. Individuals should take appropriate precautions using personal protective equipment like gloves to prevent contact with blood.

     "We" or "our" refers to the department of social and health services, including DLR licensors and DCFS social workers.

     "You" refers to anyone who operates a group receiving center.

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     (1) Need temporary placement after being taken into protective custody by law enforcement or the court;

     (2) Need temporary placement awaiting a more permanent placement; or

     (3) Need emergency placement during a temporary disruption of a current placement.

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     (a) A clean, homelike environment;

     (b) Basic necessities such as adequate food and appropriate clothing;

     (c) Safety; and

     (d) An age-appropriate environment with necessary structure, routine, and rules.

     (2) Your center must be staffed with employees who are competent to provide for the safety and needs of the children in your care.

     (3) You must provide a written statement that includes your mission, goals, and a description of the services you provide.

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     (2) A group receiving center may provide transportation and/or family support services, such as the supervision of family visits.

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     (1) Arrange for transportation for each child in care to travel to school;

     (2) Support each child participating in their education plan; and

     (3) Provide suitable study areas for children under your care.

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     (a) A description of the program and services;

     (b) The physical facility;

     (c) The department-approved policy that states that youth may not have guns and other weapons, alcohol, tobacco, and drugs within the facility; and

     (d) The department approved policy on client visitation that includes access to the youth's attorney.

     (2) Written documentation of this orientation must be in each child's file.

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     (1) Demonstrate an understanding, ability, physical health, emotional stability and personality suited to meet the physical, mental, emotional, and social needs of the children under your care.

     (2) You must not have been found to have committed abuse or neglect of a child or vulnerable adult, unless the department determines that you do not pose a risk to a child's safety, well-being, and long-term stability.

     (3) Be able to furnish the child with a nurturing, respectful, supportive, and responsive environment.

     (4) Not have been disqualified by our background check (chapter 388-06 WAC) before having unsupervised access to children.

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     (a) Substance and alcohol abuse evaluations and/or documentation of treatment;

     (b) Psychiatric evaluations;

     (c) Psycho-sexual evaluations; and

     (d) Medical evaluations and/or medical records.

     (2) The applicant/licensees pays for any evaluation requested by the department.

     (3) The applicant/licensee must give permission for the licensor to speak with the evaluator/provider before and after the evaluation.

     (4) If an applicant or licensee refuses to comply with subsections (1), (2), or (3) above, then DLR may deny the application or revoke the license.

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     (2) With the application form, you must send written verification for each applicant of the following information:

     (a) A tuberculosis test or chest X-ray unless you can demonstrate medical or religious reasons prohibiting the test;

     Note: Written documentation from your physician that indicates that you are free of the signs and symptoms of tuberculosis may be accepted.

     (b) First-aid and cardio-pulmonary resuscitation (CPR) training appropriate to the age of the children in care; and

     (c) HIV/AIDS and blood borne pathogens training including infection control standards.

     (3) You must send a completed background check form to your licensor on anyone on the premises having unsupervised access to children who:

     (a) Is not a foster child; and

     (b) Is at least sixteen years old.

     (4) You must send a completed FBI fingerprint form for any individual at your facility who has lived outside Washington state within the last three years and meets subsection (3) above.

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     (a) Basic standard first aid; and

     (b) Approved age-appropriate cardiopulmonary resuscitation (CPR) training provided by an instructor certified in accordance with a nationally recognized standard.

     (2) A person with first aid and CPR training must be on the premises of a group receiving center at all times, when children are present.

     (3) The CPR training may be waived for persons with a statement from their physician that the training is not advised for medical reasons. However, another person with CPR training must be on the premises when children are present.

     (4) You must keep records in your center showing who has completed current first aid and CPR training. This includes copies of the certificate of completion for the training for each staff person.

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     (2) You must comply with infection control requirements and educational material consistent with the approved current curriculum "Know - HIV/AIDS Prevention Education for Health Care Facility Employees," published by the department of health, office on HIV/AIDS.

     (3) Child care workers and anyone else providing direct care to children at a group receiving center must use Universal Precautions (see definitions) when coming in contact with the bodily fluids or secretions of a child.

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     (2) If you fail to meet this deadline and have not contacted your licensor, your licensor may consider your application withdrawn.

     (3) If you are applying for a license renewal, you must send the application form to your licensor at least ninety days prior to the expiration of your current license.

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     (2) You must send to DLR a detailed written program description outlining assessment, educational, recreational, therapeutic, and other services you will provide to children and their families.

     (3) A sample of the schedule of daily activities for children under care must be included with the program description.

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     (a) Physical accommodations in the center;

     (b) The number of staff and volunteers available for providing care;

     (c) Your skills and the skills of your staff;

     (d) The ages and characteristics of the children you are serving;

     (e) The evaluation of fire safety by the office of the state fire marshal; and

     (f) The evaluation of health and safety by the department of health.

     (2) Based on the evaluation, the department may license you for the care of fewer children or different age groups than your facility could house.

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     (a) Must only be nonsafety requirements; and

     (b) Must not compromise the safety and well being of the children receiving care.

     (2) You must make a written request for an exception to the licensing requirements.

     (3) After granting an exception to a licensing requirement, the department may:

     (a) Limit or restrict your license; and/or

     (b) Require you to enter into a compliance agreement to ensure the safety and well being of the children in your care.

     (4) You must keep a copy of the approved exception and any compliance agreement to the licensing requirements for your files.

     (5) You do not have appeal rights if the department denies your request for an exception to our licensing requirements.

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     (2) The department must base its decision about whether to issue a probationary license on the following:

     (a) Intentional or negligent noncompliance with the licensing rules;

     (b) A history of noncompliance with the rules;

     (c) Current noncompliance with the rules;

     (d) Evidence of a good faith effort to comply; and

     (e) Any other factors relevant to the specific situation.

     (3) A probationary license may be issued for up to six months. At its discretion, the department may extend the probationary license for an additional six months.

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     (2) The department must disqualify you for any of the reasons that follow:

     (a) Your facility fails to meet the health and safety requirements to receive a certificate of compliance as required by the department of health and/or office of the state fire marshal.

     (b) You have been disqualified by your background check (see chapter 388-06 WAC).

     (c) You or your staff have been found to have committed abuse, neglect, or you treat, permit or assist in treating children in your care with cruelty, indifference, or exploitation, unless the department determines that you do not pose a risk to a child's safety, well-being, and long term stability.

     (d) You or anyone on the premises had a license denied or revoked from an agency that provided care to children or vulnerable adults.

     (e) You try to get a license deceitfully, such as making false statements or leaving out important information on the application.

     (f) You commit, permit or assist in an illegal act on the premises of a group receiving center providing care to children.

     (g) You are using illegal drugs, or excessively using alcohol and/or prescription drugs.

     (h) You knowingly allowed employees or volunteers with false statements on their applications to work at your agency.

     (i) You repeatedly lack qualified or an adequate number of staff to care for the number and types of children under your care.

     (j) You have refused to allow our authorized staff and inspectors to have requested information or access to your facility, child and program files, and/or your staff and clients.

     (k) You are unable to manage the property, fiscal responsibilities, or staff in your agency.

     (l) You have failed to comply with the federal and state laws for any Native American children that you have under care.

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     (a) Having more children than your license allows; or

     (b) Having children with ages different than your license allows.

     (2) The department also may suspend or revoke your license if you:

     (a) Fail to provide a safe, healthy and nurturing environment for children under your care; or

     (b) Fail to comply with any of our other licensing requirements.

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     (2) In this situation, the suspension of a center license, for noncompliance of a support order, would be effective on the date the licensee receives a notice from the licensor.

     (3) The license remains suspended until the licensee provides proof that he or she is in compliance with the child support order.

     (4) The licensee does not have a right to an administrative hearing based on a suspension of the center license due to noncompliance of a child support order.

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     (2) In the letter, the department also will tell you what you may do if you disagree with the decision of the department to deny, suspend or revoke your group receiving center license.

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     (2) Your right to appeal and the procedures for that process are outlined in RCW 43.20A.205 and 74.14.130; chapter 34.05 RCW, and chapter 388-02 WAC.

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     (a) Your location or designated space, including address;

     (b) Your phone number;

     (c) The maximum number, age ranges, and sex of children you wish to serve; or

     (d) The changes in the structure of your facility or on the premises from events causing damage, such as a fire, or from remodeling.

     (2) A license is valid only for the person or organization named on the license at a specific address. If you operate a group receiving center, you must also report any of the following changes to your licensor:

     (a) A change of your agency's executive director;

     (b) The death, retirement, or incapacity of the person who holds the license;

     (c) A change in the name of a licensed corporation, or the name by which your center is commonly known; or

     (d) Changes in an agency's articles of incorporation and bylaws that apply to the operation or the license of the facility.

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     (2) The office of the state fire marshal will issue a notice of approval for licensing to the licensing agency when you have met their requirements for fire safety.

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     (2) The department may require you to provide proof that you have met local ordinances.

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     (1) Every sleeping room used by children under care must have at least one operable window or door approved for emergency escape or rescue that must open directly into a public street, public alley, yard, or exit court.

     (2) Centers with floors located more than four feet above or below ground (one-half story) must not be used for care of nonmobile children.

     (3) Emergency windows must:

     (a) Be operable from the inside to provide a full, clear opening without the use of separate tools;

     (b) Have a minimum net clear open area of 5.7 square feet (0.53 mm);

     (c) Have a minimum net clear open height dimension of 24 inches (610 mm);

     (d) Minimum net clear open width dimension of 20 inches (508 mm);

     (e) Have a finished sill height of not more than 44 inches (1118 mm) above the floor.

     (4) No child may occupy a space that is accessible only by a ladder, folding stairs, or a trap door.

     (5) Every bathroom door lock must be designed to permit the opening of the locked door from the outside.

     (6) Every closet door latch must be designed to open from the inside.

     (7) Open-flame devices and fireplaces, heating and cooking appliances, and products capable of igniting clothing must not be left unattended or used incorrectly.

     (8) Fireplaces, wood stoves and other heating systems that have a surface hot enough to cause a burn must have a barrier to prevent access by children under age six years.

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     (2) Operation of any fire alarm activating device must automatically, without delay, activate off-site monitoring and signal a general alarm indication and sound an audible alarm throughout the building or affected part of the building.

     (3) Group receiving centers licensed for fewer than sixteen persons must have smoke detectors installed in all sleeping room, corridors, and in areas separating use areas from sleeping areas.

     (4) Smoke detectors must be installed following the approved manufacturer's instructions.

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     (2) The evacuation plan must include:

     (a) An evacuation floor plan, identifying exit doors and windows;

     (b) Action that the person discovering a fire must take;

     (c) Methods for sounding an alarm on the premises;

     (d) Ways to evacuate the building that ensures responsibility for children; and

     (e) Action that staff must take while waiting for the fire department.

     (3) The plan must be posted at each exit door.

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     (1) You must assure that furnace rooms are:

     (a) Maintained free of lint, grease, and rubbish; and

     (b) Suitably isolated, enclosed, or protected.

     (2) Flammable or combustible materials must be stored away from exits and in areas that are not accessible to children. Combustible rubbish must not be allowed to collect and must be removed from the building or stored in closed, metal containers away from building exits.

     (3) All trash must be removed daily from the building and thrown away in a safe manner outside the building. All containers used for the disposal of waste material must consist of noncombustible materials and have tops.

     (4) All electrical motors must be kept free of dust.

     (5) Open-flame devices capable of igniting clothing must not be left on, unattended or used in a manner that could result in an accidental ignition of children's clothing.

     (6) Candles must not be used.

     (7) All electrical circuits, devices and appliances must be properly maintained. Circuits must not be overloaded. Extension cords and multi-plug adapters must not be used in place of permanent wiring and proper outlets.

     (8) Fireplaces, woodstoves, and similar devices must be installed and approved according to the rules that were in effect at the time of installation (see the local building permit). These devices must be properly maintained and must be cleaned and certified at least once a year or maintained according to the manufacturer's recommendations.

     (9) Separate hazardous areas by at least a "one-hour" fire-resistant wall. Hazardous areas include rooms or spaces containing:

     (a) A commercial-type cooking kitchen;

     (b) A boiler;

     (c) A maintenance shop;

     (d) A janitor closet;

     (e) A woodworking shop;

     (f) A vehicle garage;

     (g) Flammable or combustible materials; or

     (h) Painting operations.

     (10) The department does not require a fire-resistant wall when:

     (a) A kitchen contains only a domestic cooking range; and

     (b) Food preparation does not produce smoke or grease-laden vapors.

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     (2) The monthly fire drill must be conducted on each shift, so that each person providing care to children participates in the drill.

     (3) You must consult with and follow the state fire marshal protocol for "mock" fire drills, if you care for nonambulatory children.

     (4) You must maintain a written record on the premises that indicates the date and time that drill practices were completed at your group receiving center.

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     (1) Safety procedures related to fire prevention; and

     (2) All aspects of a fire drill.

     (3) Your and your staff must be able to:

     (a) Operate all fire extinguishers installed on the premises;

     (b) Test smoke detectors (single station types);

     (c) Conduct frequent inspections of the facility to identify fire hazards; and

     (d) Correct any hazards noted during the inspection.

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     (2) A Washington state licensed fire sprinkler contractor must annually test and certify sprinkler systems installed in a group receiving center for fire prevention.

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     (2) The department of health (DOH) conducts the health and safety survey. A registered nurse (RN) and/or a public health sanitarian may complete the survey.

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     (a) Maintain your buildings, premises, and equipment in a clean and sanitary condition, free of hazards, and in good repair.

     (b) Provide handrails for steps, stairways, and ramps, if required by the department.

     (c) Have emergency lighting devices available and in operational condition.

     (d) Furnish your center appropriately, based on the age and activities of the children under care.

     (e) Have washable, water-resistant floors in your center bathrooms, kitchens, and any other rooms exposed to moisture. The department may approve washable, short-pile carpeting that is kept clean and sanitary for your facility's kitchens.

     (f) Provide tamper proof or tamper resistant electrical outlets or blank covers installed in areas accessible to children under the age of six or other persons with limited mental capacity or who might be endangered by access to them.

     (g) Have easy access to rooms occupied by children in case an emergency arises. Some examples are bedrooms, toilet rooms, shower rooms, and bathrooms.

     (h) Have a written disaster plan for emergencies such as fire and earthquakes.

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     (2) The safety of the children in care is paramount. You must discuss with the licensor any potential hazardous conditions, considering the children's ages, behaviors, and abilities.

     (3) If DLR decides that hazardous conditions are present at the group receiving center, a supervision plan must be written for the children in care.

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     (2) Your address must be clearly visible on the facility or mailbox so that firefighters or medics can easily find your center location.

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     (2) On a daily basis, you must empty and clean any portable wading pool that children use.

     (3) When they are swimming, wading, or near a body of water, children under twelve must be in continuous visual range at all times by an adult with current first aid and age appropriate CPR.

     (4) You must ensure age and developmentally appropriate supervision of any child that uses hot tubs, swimming pools, spas, and other man-made and natural bodies of water.

     (5) All safety devices and rescue equipment, such as life jackets, must meet state water safety regulations.

     (5) You must lock or secure hot tubs and spas when they are not in use.

     (6) You must place a fence designed to discourage climbing and have a locking gate around a pool or have another DLR approved safety device. The pool must be inaccessible to children when not in use.

     (7) A certified lifeguard must be on duty when children are using a swimming pool.

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     Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-140-0235   What measures must I take for pest control?   You must make reasonable attempts, using the least toxic methods, to keep the premises of the group receiving center free from pests. This includes rodents, flies, cockroaches, fleas, and other insects.

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     (2) Common household pets, exotic pets, animals, birds, insects, reptiles, and fish must:

     (a) Be cared for in compliance with state regulations and local ordinances; and

     (b) Be free from disease and cared for in a safe and sanitary manner.

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     (2) You may permit adults to smoke outdoors away from children.

     (3) Nothing in this section is meant to interfere with traditional or spiritual Native American ceremonies involving the use of tobacco.

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     (1) You must keep all medications, including pet medications, vitamins and herbal remedies, in locked storage.

     (2) You must store external medications separately from internal medications.

     (3) You must store medications according to the manufacturer or pharmacy instructions.

     (4) Pet and human medications must be stored in separate places.

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     (a) Cleaning supplies;

     (b) Toxic or poisonous substances;

     (c) Aerosols; and

     (d) Items with warning labels.

     (2) When containers are filled with toxic substances from a stock supply, you must label the containers filled from a stock supply.

     (3) Toxic substances must be stored separately from food items.

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     (2) The following first-aid supplies must be kept on hand:

     (a) Barrier gloves and one-way resuscitation mask;

     (b) Bandages;

     (c) Scissors and tweezers;

     (d) Ace bandage;

     (e) Gauze;

     (f) Thermometer; and

     (g) A first-aid manual.

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     (a) Isolation;

     (b) Aseptic procedures;

     (c) Reporting communicable diseases;

     (d) Hygiene, including hand washing, using the toilet, diapering, and laundering.

     (2) Group receiving centers must maintain current written medical policies and procedures to be followed on:

     (a) Prevention of the transmission of communicable diseases including:

     (i) Hand washing for staff and children; and

     (ii) Management and reporting of communicable diseases.

     (b) Medication management, including steps to be taken if medication is incorrectly administered;

     (c) First aid;

     (d) Care of minor illnesses;

     (e) Actions to be taken for medical emergencies;

     (f) Infant care procedures when infants are under care; and

     (g) General health practices.

     (3) You must arrange to have one of the following help you develop and periodically review your medical policies and procedures:

     (a) An advisory physician,

     (b) A physician's assistant, or

     (c) A registered nurse.

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     (2) If a child's placement at a center extends beyond thirty days, you must obtain the child's immunization records and if the child is not current update immunizations as soon as medically possible.

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     (2) In a group receiving center, staff with a reportable communicable disease or notifiable disease conditions, as defined by the department of health, in chapter 246-101 WAC, in an infectious stage must not be on duty until they have a physician's approval for returning to work.

     (3) Applicants for a license or adults authorized to have unsupervised access to children in a center must have a tuberculin (TB) skin test by the Mantoux method of testing. They must have this skin test upon being employed or licensed unless:

     (a) The person has evidence of testing within the previous twelve months;

     (b) The person has evidence that they have a negative chest x-ray since a previously positive skin test;

     (c) The person has evidence of having completed adequate preventive therapy or adequate therapy for active tuberculosis.

     (4) The department does not require a tuberculin skin test if:

     (a) A person has a tuberculosis skin test that has been documented as negative within the past twelve months; or

     (b) A physician indicates that the test is medically unadvisable.

     (5) Persons whose tuberculosis skin test is positive must have a chest x-ray within thirty days following the skin test.

     (6) The department does not require re-testing unless a person believes they have been exposed to someone with tuberculosis or if testing is recommended by their health care provider.

     (7) The center must keep the results of the applicant and employees TB test results in the personnel file available for review by DLR.

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     (2) If you care for children in the custody of a tribal court you must follow the direction of that court regarding giving or applying prescription and nonprescription medications or ointments.

     (3) Only you or another authorized care provider (staff) may:

     (a) Have access to medications for the child under your care; and

     (b) Give medications, prescription and nonprescription, only on the written approval of a parent, person or agency having authority by court order to approve medical care.

     Exception: There are several over-the-counter medications that may be given without a physician's order. Those medications are listed in WAC 388-140-0295(13).

     (4) You or another authorized care provider must give medications, prescription and nonprescription:

     (a) Only as specified on the prescription label; or

     (b) As otherwise approved by a physician or another person legally authorized to prescribe medication.

     (5) You must keep a record of all medications you give a child.

     (6) You and other authorized care provider must consult with a pharmacist on the proper disposal of medications that are no longer being taken or have expired.

     (7) The disposal of any prescription medication must be documented and contain the following information:

     (a) What medication was disposed;

     (b) The name of the child the medication was prescribed for;

     (c) The amount disposed;

     (d) The name of the individual disposing of the medication; and

     (e) The name of the individual witnessing the disposal.

     (8) Children taking oral medications must have the prescribing physician's written authorization before any medications, herbal supplements or remedies, or vitamins and minerals are given.

Nonprescription medications

     (9) Nonprescription medications may be given with a physician's standing order, if the order is child specific.

     (10) The prescribing physician must be aware of all prescription and nonprescription medication the child is taking.

     (11) You or another authorized care provider (staff) may give the following medications without a physician's order:

     (a) Nonaspirin antipyretics/analgesics, fever reducers/pain relievers;

     (b) Nonnarcotic cough suppressants;

     (c) Decongestants;

     (d) Antacids and anti-diarrhea medication;

     (e) Anti-itching ointments or lotions intended specifically to relieve itching;

     (f) Shampoo for the removal of lice;

     (g) Diaper ointments and powders intended specifically for use in the diaper area of children;

     (h) Sun screen for children over six months; and

     (i) Antibacterial ointment for first aid use.

Psychotropic medications

     (12) Care providers must not approve giving or stopping psychotropic medications to a child in care. Approval can only be given by one of these:

     (a) The child's parent;

     (b) Dependency guardians;

     (c) A court order; or

     (d) The child's social worker, if:

     (i) The child is legally free and in the permanent custody of the department; or

     (ii) It is impossible to obtain informed parental consent after normal work hours, on weekends, or on holidays.

     (13) Children who are at least thirteen years old may decline to take prescription psychotropic medication. If this happens contact the child's social worker immediately and document the child's refusal.

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     (1) The child's first and last names;

     (2) The date the prescription was filled;

     (3) The medication's expiration date; and

     (4) Legible instructions for the administration of the drug (manufacturer's instructions or prescription label).

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     (a) They are physically and mentally capable of properly taking the medicine; and

     (b) The child's parent or legal guardian approves in writing.

     (2) You must keep the written approval by the child's parent or legal guardian in your records.

     (3) When children take their own medication, the medication and medical supplies must be kept locked or inaccessible to other children and unauthorized persons.

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     (a) Been under regular medical supervision; or

     (b) Had a physical exam by a physician, a physician's assistant, or an advanced registered nurse practitioner (ARNP).

     (2) A physical exam (EPSDT) must be completed within thirty days of placement and annually thereafter.

     Note: You may contact the child's social worker for information on this.

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     (2) You must notify the child's social worker and physician about any adverse reactions the child has to medications.

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     (1) Your program must be in compliance with the department of health standards in chapter 246-215 WAC on food service sanitation.

     (2) You must prepare and date daily menus, including snacks, at least one week in advance.

     (3) You must provide for the proper storage, preparation, and service of food to meet the needs of the program.

     (4) A menu must specify a variety of foods for adequate nutrition and meal enjoyment.

     (5) You must keep the menus on file for a minimum of six months so that we can review your menus.

     (6) You must post each person's dietary restrictions, if any, for staff to follow.

     (7) You must post a schedule of mealtimes.

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     (2) The time interval between the evening meal or snack and breakfast must not be more than fourteen hours.

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     (1) Nutrient concentrates, supplements, or amnio-acids;

     (2) Vitamins; or

     (3) Modified diets.

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     (2) With thirteen or more children, you must provide at least one separate indoor recreation area. Its size and location must be sufficient for the age and number of the children using it to engage in recreational and informal education activities.

     (3) You must provide a room or area that is used as an administrative office. In addition, suitable offices must be provided for social service staff. In facilities caring for fewer than thirteen children, these offices may be combined with the administrative office.

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     (2) A special care room must:

     (a) Be located in a place that easily allows the person to be supervised;

     (b) Have toilet and lavatory facilities that are easily accessible to any person staying in the special care room.

     (3) After each use have the area and equipment sanitized if used by any person who is suspected of having a communicable disease.

     (4) The special care room may be used for other purposes when it is not needed for the separation and care of an ill or injured person.

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     (2) You must consider the age and needs of the children under your care in determining appropriate temperature.

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     (2) All food service facilities and food handling practices must comply with rules and regulations of the state board of health governing food service sanitation (chapter 246-215 WAC). This includes food handler's permit for all staff.

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     (1) The room is of sufficient size; and

     (2) The room's usage for one purpose does not interfere with usage of the room for another purpose.

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     (1) An adult must be on the same floor or within easy hearing distance and accessibility to where children less than six years of age are sleeping.

     (2) For children six years and older, you must furnish separate sleeping quarters for each gender.

     (3) Any room used for sleeping must provide adequate floor space for the safety and comfort of the child. Normally, this would be at least fifty square feet of floor space, not including closets, per child.

     (4) Bedrooms must have both:

     (a) Adequate ceiling height for the safety and comfort of the children (normally, at least seven and a half feet); and

     (b) At least one window of not less than one-tenth of the required floor space that opens to the outside. This allows natural light into the bedroom and permits emergency access or exit.

     (5) You must use only bedrooms that have unrestricted direct access to hallways, corridors, living rooms, day rooms, or other such common use areas.

     (6) You must not use hallways, kitchens, living rooms, dining rooms, and unfinished basements as bedrooms.

     (7) The number of beds allowed at a group receiving center is established in by the licensor in consultation with the DOH surveyor for each center.

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     (2) For each child in care, you must provide a pillow and pillowcase, blankets, and sheets.

     (3) Pillows must be covered with waterproof material or be washable.

     (4) Bedding must be clean.

     (5) You must provide waterproof mattress covers or moisture resistant mattresses, if needed.

     (6) You may use toddler beds with a standard crib mattress that is sufficient in length and width for the comfort of a toddler.

     (7) You must not allow children to use the loft style beds or upper bunks of double-deck beds if using them due to age, development or condition could hurt them. Examples: Preschool age children and children with disabilities.

     (8) If a cot is used as the bed, the licensee must ensure the child's cot is of sufficient length and width, and constructed to provide adequate comfort for the child to sleep. You must ensure that the cot surface is of a material that can be cleaned with a detergent solution, disinfected, and allowed to air dry.

     (9) You must not use canvas cots.

     (10) A mat may be used for napping but not as a substitute for a bed.

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     (1) You must separate diaper-changing areas from food preparation areas.

     (2) You must sanitize diaper-changing areas between each use or you must use a nonabsorbent, disposable covering that is discarded after each use.

     (3) For cleaning children, you must use either disposable towels or clean cloth towels that have been laundered between each use.

     (4) You and any caregiver must wash hands before and after diapering each child.

     (5) You must use disposable diapers, a commercial diaper service, or reusable diapers supplied by the child's family.

     (6) Diaper-changing procedures must be posted at the changing areas.

     (7) Diaper-changing areas must be adjacent to a hand-washing sink.

     (8) The staff must be within arms-length of the child being diapered at all times while changing diapers. The use of safety belts is prohibited.

     (9) Diaper-changing tables or surfaces must have a barrier or edge that is a minimum of four inches above the pad or six inches above the top of the table.

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     (1) Bathing facilities must be inaccessible to preschool age and younger children when not in use.

     (2) Preschool age and younger children must be supervised while using bathing facilities.

     (3) Bathing facilities must be equipped with a conveniently located grab bar or other safety device such as a nonskid pad.

     (4) The ratio of bathing facilities to children in care must be at least one bathing facility for eight children.

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     (2) You must post emergency phone numbers next to the phone.

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     (2) Group receiving centers must have nonhazardous light fixture covers or shatter resistant (or otherwise made safe) light bulbs or tubes.

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     (2) A mechanical exhaust fan to the outside must ventilate toilets and bathrooms, and utility rooms with mop sinks that do not have windows opening to the outside.

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     (a) A public water supply or a private water supply approved by the local health authority at the time of licensing or re-licensing; and

     (b) Disposable paper cups, individual drinking cups or glasses, or angled jet type drinking fountains.

     (2) You must not use bubbler type fountains or common drinking cups.

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     (1) You must have separate and adequate facilities for storing soiled and clean linen.

     (2) You must provide adequate laundry and drying equipment, or make other arrangements for getting laundry done on a regular basis.

     (3) You must locate laundry equipment in an area separate from the kitchen and child care areas.

     (4) Laundry equipment must be vented to the outdoors.

     (5) You must make laundry equipment inaccessible to young children.

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     (2) The children's hand washing facilities must be located in or adjacent to rooms used for toileting.

     (3) The center must provide the child with soap and individual towels or other appropriate devices for washing and drying the child's hands and face.

     (4) Hand washing sinks must be of appropriate height and size for children in care or your center must furnish safe, easily cleanable platforms impervious to moisture.

     (5) A group receiving center must provide:

     (a) A minimum of two hand washing sinks; and

     (b) A ratio of one sink for every eight children at the center.

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     (2) Children eighteen months of age or younger and other children using toilet training equipment need not be included when determining the number of required flush-type toilets.

     (3) If urinals are provided, the number of urinals must not replace more than one-third of the total required toilets.

     (4) Privacy for toileting must be provided for children of the opposite sex who are six years of age and older and for other children demonstrating a need for privacy.

     (5) A mounted toilet paper dispenser for each toilet must be provided.

     (6) Toilets and urinals must be of appropriate height and size for children in care or your center must furnish safe, easily cleanable platforms impervious to moisture.

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     (2) The equipment must be sanitized after each child's use.

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     (2) You must provide a minimum of thirty-five square feet of usable floor space per child, not counting bathrooms, hallways, and closets.

     (3) You may use and consider the napping area as child care space, if there are not beds or cots on the floor space.

     (4) Any room used for napping or sleeping must have a window to allow natural light into the room.

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     (2) The fenced or approved enclosed outdoor recreation area must prevent child access to roadways and other dangers.

     (3) The fence or enclosure must protect the play area from unauthorized exit or entry. Any fence or enclosure must be designed to discourage climbing.

     (4) The outdoor recreation area must adjoin directly the indoor premises or be reachable by a safe route and method.

     (5) The outdoor recreation area must promote the child's active play, physical development, and coordination.

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     (2) If not all of the children are using the outdoor recreation area at the same time, you may reduce the outdoor recreation area size by the number of children normally using the area at one time.

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     (2) You must arrange, design, construct, and maintain equipment and ground cover to prevent child injury.

     (3) The quantity of outdoor play equipment must offer the child a range of outdoor recreation options.

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     (1) The vehicle must be kept in a safe operating condition.

     (2) The driver must have a valid driver's license.

     (3) There must be at least one adult other than the driver in a vehicle when:

     (a) There are more than five preschool-aged children in the vehicle;

     (b) Staff-to-child ratio guidelines or your contract require a second staff person; or

     (c) The child's specific needs require a second adult person.

     (4) The driver or owner of the vehicle must be covered under an automobile liability and insurance policy.

     (5) Your vehicles must be equipped with seat belts, car seats and booster seats, and/or other appropriate safety devices for all passengers as required by law.

     (6) The number of passengers must not exceed the vehicle's seat belts.

     (7) All persons in the vehicle must use seat belts or approved child passenger restraint systems, as appropriate for age, whenever the vehicle is in motion.

     (8) Buses approved by the state patrol are not required to have seat belts.

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     (a) The child's name and birthdate;

     (b) Inventory of personal belongings at the time of placement; and

     (c) Names, address and telephone numbers of department social worker to be contacted in case of emergency;

     (d) Information on specific cultural needs of the child;

     (e) Medical history including any medical problems, name of doctor, type of medical coverage and provider, when available;

     (f) Mental health history and any current mental health and behavioral issues, including medical and psychological reports when available; and

     (g) Any other pertinent information related to the child, such as his or her visitation plan.

     (2) Daily center logs are required with the signature of the person making the entry in the log. The logs must document the following:

     (a) Date, time, and which residents and staff are participating in an activity;

     (b) Narrative to note behavior and issues of residents;

     (c) Any health or safety issues;

     (d) Staff to resident ratio on each shift;

     (e) On-call and relief staff on duty during emergencies;

     (f) The after-hours telephone number of the supervisor;

     (g) Dates and illnesses or accidents while at the center;

     (h) Medications and treatments given at the center with the child's name;

     (i) A copy of any suspected child abuse and/or neglect referrals made to children's administration; and

     (j) Other information determined relevant by the department.

     (3) Identifying and personal information about the child and their family must be kept confidential, unless permission has been given for release by the parent.

     (4) You must keep information about the child and their families in a secure place.

     (5) You must keep client files containing information not returned to the department, you must keep them for six years following the termination or expiration of any contract you have with the department.

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     (1) Permission authorizing the placement of the child;

     (2) Permission to seek emergency medical care or surgery on behalf of the child;

     (3) The name and telephone number of the children's administration's social worker and emergency contacts; and

     (4) Basic medical information, including current medication, known allergies, and at-risk behaviors of the child.

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     (2) Children may do work assignments other than "household" tasks that are appropriate to their age and physical conditions and receive monetary compensation if this is part of their service plan.

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     (2) You must assist these children in using these items, based on the child's developmental needs.

     (3) Clothing must be clean and age-appropriate.

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     (2) Discipline must be based on an understanding of the child's needs and stage of development.

     (3) Discipline must be designed to help the child under your care to develop inner control, acceptable behavior and respect for the rights of others.

     (4) Discipline must be fair, reasonable, consistent, and related to the child's behavior.

     (5) Your discipline must comply with children's administration's behavior management guidelines for residential programs.

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     (a) Spanking children with a hand or object;

     (b) Biting, jerking, kicking, hitting, or shaking the child;

     (c) Pulling the child's hair;

     (d) Throwing the child;

     (e) Purposely inflicting pain as a punishment;

     (f) Name-calling or using derogatory comments;

     (g) Threatening the child with physical harm;

     (h) Threatening or intimidating the child; or

     (i) Placing or requiring a child to stand under a cold water shower.

     (2) You must not use discipline methods that interfere with a child's basic needs. These include, but are not limited to:

     (a) Depriving the child of sleep;

     (b) Depriving the child of adequate food, clothing or shelter;

     (c) Restricting a child's breathing;

     (d) Interfering with a child's ability to take care of their own hygiene and toilet needs; or

     (e) Providing inadequate medical or emergency dental care.

     (3) You must not use medication in an amount or frequency other than that prescribed by a physician or psychiatrist.

     (4) You must not give one child's medications to another child.

     (5) You must not use medication for behavior management unless a physician prescribes the medication to control that child's behavior.

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     (2) If your discipline methods change, you must immediately provide a new statement to your licensor describing your current practice.

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     (2) You must comply with children's administration's behavior management guidelines for residential programs for child de-escalation and physical restraint

     (3) If a child's behavior poses an immediate risk to physical safety, you may use a physical restraint on a child. The restraint must be reasonable and necessary to:

     (a) Prevent a child on the premises from harming himself/herself or others; or

     (b) Protect property from serious damage.

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     (1) Physical restraint as a form of punishment or discipline;

     (2) Mechanical restraints, such as handcuffs and belt restraints;

     (3) Locked time-out rooms; or

     (4) Physical restraint techniques that restrict breathing, or inflict pain as a strategy for behavior control, or that might injure a child. These include, but are not limited to:

     (a) Restriction of body movement by placing pressure on joints, chest, heart, or vital organs;

     (b) Sleeper holds, which are holds used by law enforcement officers to subdue a person;

     (c) Arm twisting;

     (d) Hair holds;

     (e) Choking or putting arms around the throat; or

     (f) Chemical restraints, including but not limited to pepper spray.

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     (a) Any reasonable cause to believe that a child has suffered child abuse or neglect;

     (b) Any violations of the licensing or certification requirements;

     (c) Death of a child;

     (d) Any child's suicide attempt that results in injury requiring medical treatment or hospitalization;

     (e) Any use of physical restraint that is alleged to be improper, excessive, or results in injury;

     (f) Sexual contact between two or more children that is not considered typical play between pre-school age children;

     (g) Any disclosures of sexual or physical abuse by a child in care;

     (h) Physical assaults between two or more children that result in injury requiring off-site medical treatment or hospitalization;

     (i) Any medication that is given incorrectly and requires off-site medical treatment;

     (j) Serious property damage that is a safety hazard and is not immediately corrected; or

     (k) Anytime a child refuses to take any medication that may result in a situation that is life threatening.

     (2) You or your staff must report immediately, any of the following incidents, to the child's social worker:

     (a) Suicidal/homicidal ideation, gestures, or attempts that do not require professional medical treatment;

     (b) Unexpected health problems that require professional medical attention or raise questions for the staff;

     (c) Any significant incident of medication administered incorrectly;

     (d) Physical assaults between two or more children that resulted in injury but did not require professional medical treatment;

     (e) Runaways;

     (f) Any emergency medical or psychiatric care that requires offsite attention; and

     (g) Use of physical restraints for routine behavior management.

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     (1) At least two staff, including at least one child care staff person, must be on site whenever children are on the premises.

     (2) The ratio for a group receiving center is at least one child care staff person on site for every four children who are under six during waking and sleeping hours.

     (3) The ratio for a group receiving center is at least one child care staff person on site for every six children age six years and older, during waking and sleeping hours.

     (4) The center may only provide care for two or more of the following age groups: Age two through five, six through twelve, and thirteen through seventeen, if a DLR approved safety plan addressing this circumstance is fully in effect.

     (5) If the center provides care for children under age six and children six and older, you may allow common activities for the children of different age groups provided you maintain the staffing ratio designated for the youngest child in the group and have an approved safety plan in place.

     (6) To keep the proper ratio of staff to children, the executive director, on-site program manager, support staff, and maintenance staff may serve temporarily as child care staff if they have adequate training and are performing child care staff duties.

     (7) You must have relief staff so that all staff can have the equivalent of two days off a week.

     (8) If you have more than one program in one building, such as a group receiving center and a crisis residential center, you must follow the most stringent staffing ratio requirements.

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     (2) A group receiving center must provide or arrange for care and supervision that is appropriate and assures the safety of each child depending on:

     (a) The child's age, developmental level, and condition;

     (b) The activities, including recreation, the child is involved in; and

     (c) The age and gender of other children involved in any group activity.

     (3) At a group receiving center, children under age six must be within visual range at all times during waking hours.

     (4) You must ensure that the staff providing direct care and supervision of the children is free of other duties at the time of care.

     (5) When a child has exhibited behavior that posed a safety risk to other children in a previous placement or the placing agency believes the child poses a risk to other children the placing agency must inform the provider and jointly develop a plan to address the risk.

     (6) When a child exhibits behavior that poses a safety risk to other children in care, sleeping arrangements, bedroom assignments, and shared activity plans must be made, in consultation with the child's social worker, to ensure the safety of other children.

     (7) Group receiving centers must supervise children who help with activities involving food preparation, based on their age and skills.

     (8) Preschool children and children with severe developmental disabilities must not be left unattended in a bathtub or shower at a group receiving center.

     (9) Staff and others caring for children at a group receiving center must provide the children with:

     (a) Appropriate adult supervision;

     (b) Emotional support;

     (c) Personal attention; and

     (d) Structured daily routines and living experiences.

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     (a) Be able to communicate to the department the roles, expectations and purposes of the program; and

     (b) Work with representatives of other agencies.

     (2) They must also meet one of these education or experience requirements:

     (a) Have a bachelor's degree in business management or administration, or related field from an accredited school; or

     (b) Have a minimum of two years of successful, full-time relevant experience.

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     (2) The director serves as the administrator of the center.

     (3) The director must ensure the group receiving center complies with the licensing requirements contained in this chapter.

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     (1) A bachelor's degree in a social service or closely related field from an accredited school; or

     (2) Five years of successful full-time experience in a relevant field; and

     (3) Supervisory abilities that promote effective staff performance; and

     (4) Relevant experience, training, and demonstrated skills in each area that he or she will be supervising.

     (5) The same person may have the responsibilities of the executive director and the on-site program manager if that person meets the qualifications for both positions.

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     (1) Coordinates the day-to-day operations of the program;

     (2) Supervises the child care staff;

     (3) Oversees the completion of each child's assessment or plan of care.

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     (1) Be at least twenty-one years old;

     (2) Exception: Child care staff may be eighteen to twenty years old if enrolled and participating in an internship or practicum program with an accredited college or university; and supervised by staff twenty-one years or older;

     (3) Have a high school diploma or GED;

     (4) Have one year of experience working with children;

     (5) Have the skills and abilities to work successfully with the challenging behaviors of children in care; and

     (6) Have effective communication and problem solving skills.

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     (2) The director and program manager may also serve as child care staff when the role does not interfere with the director's or program manager's responsibilities.

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     (2) If temporarily absent (for two hours or less) from the center, the director and program manager must leave a competent, designated staff person in charge. This person must meet the qualifications of child care staff person.

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     (a) Presentation of the group receiving centers policies and procedures as well and the standards contained in this chapter;

     (b) Behavior management techniques;

     (c) Crisis intervention techniques;

     (d) Family dynamics and family intervention techniques;

     (e) Child abuse and neglect reporting requirements;

     (f) Youth supervision requirements; and

     (g) HIV/AIDS/Blood-borne pathogen training.

     (2) Staff working at a group receiving center must complete a minimum of twenty-four hours of on-going education and in-service training annually. This training must include:

     (a) Crisis intervention techniques, including verbal de-escalation, positive behavior support, and physical response/restraint training as approved by the department;

     (b) Behavior management techniques;

     (c) Substance abuse;

     (d) Suicide assessment and intervention;

     (e) Family intervention techniques;

     (f) Cultural diversity;

     (g) Mental health issues and interventions;

     (h) Mediation skills;

     (i) Conflict management/problem-solving skills;

     (j) Physical and sexual abuse;

     (k) Characteristics and management of sexually aggressive and physically assaultive behavior;

     (l) Monthly fire drill practice and disaster training for each staff.

     (3) You must record the amount of time and type of training provided to staff.

     (4) This information must be kept in each employee's file or in a separate training file.

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     (2) You must ensure the group receiving center's activity program allows time for children to have daily opportunities for small and large muscle activities and outdoor play.

     (3) You must operate the group receiving center's activity program under a regular schedule of activities with allowances for a variety of special events.

     (4) You must provide a planned program of activities and have a current, written activity schedule.

     (5) You must provide appropriate supervision for the number of children participating is any activity.

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     (a) Child-initiated and staff-initiated activities;

     (b) Free play and organized events;

     (c) Individual and group activities; and

     (d) Quiet and active experiences.

     (2) You must ensure that children at a group receiving center are grouped to ensure the safety of children.

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     (2) You must have toys that relate to the different developmental stages of the children you serve at a group receiving center.

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© Washington State Code Reviser's Office