Original Notice.

     Preproposal statement of inquiry was filed as WSR 01-15-079.

     Title of Rule: Chapter 388-145 WAC, Emergency respite center licensing requirements.

     Purpose: This chapter establishes licensing rules for emergency respite centers (ERCs), also known as crisis nurseries. The legislature passed chapter 230, Laws of 2001 that included an amendment to RCW 74.15.020 defining center-based ERCs and adding RCW 74.15.280 authorizing the department to adopt licensing rules.

     Statutory Authority for Adoption: RCW 74.15.020 and chapter 230, Laws of 2001.

     Statute Being Implemented: RCW 74.15.280 and 74.15.020, chapter 230, Laws of 2001.

     Summary: This chapter establishes licensing rules for emergency respite centers (ERCs), also know as crisis nurseries. Licensing will be required of all center-based programs providing crisis respite to families in their communities. The chapter provides consistent standards for the health and safety of children placed by their parents at a respite center.

     Reasons Supporting Proposal: The 2001 session of the legislature passed chapter 230, Laws of 2001 that included an amendment to RCW 74.15.020 defining center-based ERCs and RCW 74.15.280 authorizing the department to adopt licensing rules. The rules outline health and safety standards for the protection of children placed at respite centers.

     Name of Agency Personnel Responsible for Drafting and Implementation: Jean L. Croisant, P.O. Box 45710, Olympia, WA 98504-5710, (360) 902-7992; and Enforcement: Division of Licensed Resources, Office of Foster Care Licensing, Children's Administration, Department of Social and Health Services.

     Name of Proponent: Department of Social and Health Services, Children's Administration, governmental.

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

     Explanation of Rule, its Purpose, and Anticipated Effects: The purpose of this chapter is to define the basic licensing standards for emergency respite centers and to ensure children experience safe and healthy care while placed in centers. Some of the rules were drawn from appropriate child care center and child group care licensing requirements. Additionally, new sections specific to ERCs were developed. In part, the chapter includes:

•     Licensing process;

•     Facility or building fire safety requirements;

•     Health and environment safety regarding medication management, first-aid supplies, food/menus, and physical facility maintenance;

•     Staff qualifications and training;

•     Staffing ratios and child supervision; and

•     Program activities and toys.

     The anticipated effect of the new rules will be consistent standards of care for children placed away from their home and family by their parents. The inspections by the Office of the State Fire Marshal and Department of Health help to ensure that the physical safety of each child is in place. The rules provide adequate staffing levels and standards of supervision to promote the health and safety of the children.

     Proposal does not change existing rules. The proposed rules do not change current permanent rules. When adopted as permanent, the proposed WAC 388-145-0010 through 388-145-1220 will replace emergency new WAC 388-148-1205 through 388-148-1300 that were filed previously as WSR 02-23-064, 02-15-132, and 02-08-031.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. Children's Administration has analyzed the proposed rules and concluded that no small businesses will be impacted.

     RCW 34.05.328 applies to this rule adoption. Since the proposed new regulations "make significant changes to a policy or regulatory program" (see RCW 34.05.328 (5)(c)(iii)), Children's Administration has determined the proposed rules to be "significant" as defined by the legislature. As required by RCW 34.05.328 (1)(c), Children's Administration has analyzed the probable costs and probably benefits of the proposed new requirements, taking into account both the qualitative and quantitative benefits and costs. This cost-benefit analysis is available by contacting the person above.

     Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on February 25, 2003, at 10:00 a.m.

     Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by February 21, 2003, phone (360) 664-6094, TTY (360) 664-6178, e-mail fernaax@dshs.wa.gov.

     Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., February 25, 2003.

     Date of Intended Adoption: Not earlier than February 26, 2003.

Bonita H. Jacques

for Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

     The department is committed to ensuring that children who receive emergency respite care 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.

     "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:

     (1) Under eighteen years old, including expectant mothers under eighteen years old; or

     (2) Up to twenty-one years of age with developmental disabilities.

     "Child-placing agency" means an agency licensed to place children for temporary care, continued care, or adoption.

     "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.

     "DCCEL" means the division of child care and early learning. DCCEL licenses child care homes and child care centers.

     "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.

     "ERC" or "emergency respite center" is an agency that may be commonly known as a crisis nursery that provides emergency or crisis care for children to prevent child abuse or neglect.

     "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.

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

     "I" refers to anyone who operates or owns emergency respite 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.

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

     (1) Approves licenses or certifications for foster homes and group facilities; and

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

     "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.

     "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.

     "Respite" means brief, relief care provided to parents or legal guardians with the child care provider fulfilling some or all of the functions of the care-taking responsibilities of the parent or guardian.

     "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.

     "Universal precautions" is a term relating to procedures designed to prevent transmission of bloodborne pathogens in health care and other settings. Under universal precautions (sometimes call standard precautions), blood or other potentially infectious materials of all patients 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 an emergency respite center.

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     (1) The provision of direct child care;

     (2) A family assessment;

     (3) Appropriate community service referrals; and/or

     (4) Family support services.

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     (1) Crisis residential centers;

     (2) HOPE centers; or

     (3) Any other services required under chapter 13.32A (Family reconciliation services) or 13.34 RCW (Child welfare).

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     (2) There is one situation when an emergency respite center may provide care for a person eighteen through twenty years of age. That situation is when an eighteen through twenty-year old person is developmentally disabled and admitted with a sibling who is under eighteen.

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     (2) The department does not require licenses for people providing care in any of the situations defined in RCW 74.15.020(2). Examples are relatives, school nurseries, and hospitals.

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

     (3) 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) of this section, then DLR may deny the application or revoke the license.

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     (2) With the application form, you must send the following information:

     (a) Written verification for each applicant and staff person of completion of:

     (i) A tuberculosis test or x-ray unless you can demonstrate medical reasons prohibiting the test;

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

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

     (b) A completed background check form for each applicant, staff person, board member, intern or volunteer on the premises who:

     (i) Is at least sixteen years old; and

     (ii) Has unsupervised access to children (emergency respite centers must comply with chapter 388-06 WAC regarding background checks).

     (3) If you, any staff person, board member, intern, or volunteer has lived in Washington state less than three years and will have unsupervised access to children, you must provide us with a completed FBI fingerprint form.

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     (a) Basic standard first aid; and

     (b) Age-appropriate cardiopulmonary resuscitation (CPR).

     (2) Approved first aid and CPR training must be in accordance with a nationally recognized standard.

     (3) A person with first aid and CPR training must be on the premises of an emergency respite center at all times, when children are present.

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

     (5) 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 use 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 an emergency respite 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 educational, recreational, and any therapeutic 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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     (2) The licensee must meet the requirements for both licenses and the have written approval for both licenses from each division.

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     (a) Physical accommodations in the center;

     (b) The number of staff, family members 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 than your facility could house.

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     (a) Must regard only nonsafety requirements.

     (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 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 have been found to have committed child abuse or neglect, or you treat, permit or assist in treating children in your care with cruelty, indifference, abuse, neglect, 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 an emergency respite 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 tells you what you may do if you disagree with the decision of the department to deny, suspend or revoke your emergency respite 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 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 an emergency respite 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) Emergency respite 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.

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

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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 388-145-0380   What fire safety procedures do center staff need to know?   You and your staff at an emergency respite center must be familiar with:

     (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 an emergency respite 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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     (1) Maintain your buildings, premises, and equipment in a clean and sanitary condition, free of hazards, and in good repair.

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

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

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

     (5) 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.

     (6) 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.

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

     (8) 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 the department decides that hazardous conditions are present at the emergency respite 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 or auditory 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) You must lock 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. The pool must be inaccessible to children when not in use.

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

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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) Emergency respite 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;

     (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) Staff with a reportable communicable disease in an infectious stage, as defined by the department of health, must not be on duty until they have a physician's approval for returning to work.

     (3) Each center that cares for medically fragile children must have an infection control program supervised by a registered nurse.

     (4) 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 previously having a positive skin test;

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

     (5) 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.

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

     (7) The department does not require retesting at the time of license renewal, unless the licensee or staff person believes they have been exposed to someone with tuberculosis or if testing is recommended by their health care provider.

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     (1) Only you or another authorized care provider may give or have access to medications for the child under your care.

     (2) Only you or another authorized care provider may give prescription and nonprescription medications. Written approval of the child's parent or legal guardian is required to give the child any medication.

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

     (4) You or another authorized care provider must contact a pharmacist or the department of health regarding the proper disposal of medications that are not returned to the parent or legal guardian of the child.

     (5) You must give certain classifications of non-prescribed medications, only with the dose and directions on the manufacturer's label for the age and /or weight of the child needing the medication. These nonprescribed medications include but are not limited to:

     (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; and

     (h) Sun screen (for children over six months of age).

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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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     (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) You may not serve the following types of milk to any child under twenty-four months of age unless you have written permission by a physician, or parent or legal guardian:

     (a) Skim milk;

     (b) Reconstituted nonfat dry milk; and

     (c) One and two percent butterfat milk.

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     (1) If more than one child is bottle-fed, all formulas must be in sanitized bottles with nipples and labeled with the child's name and date prepared.

     (2) You must refrigerate filled bottles if the bottles are not used immediately. Contents must be discarded if not used within twenty-four hours.

     (3) If you reuse bottles and nipples, you must sanitize them.

     (4) Infants who are six months of age or over may hold their own bottles as long as an adult remains in the room, within eyesight. You must take bottles from the child when the child finishes feeding, or when the bottle is empty.

     (5) You must not prop a bottle when feeding an infant.

     (6) To prevent uneven heating, formula must not be warmed in a bottle used for feeding in a microwave oven.

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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.ROOM REQUIREMENTS
NEW SECTION
WAC 388-145-0660   Are there room requirements?   (1) You must provide rooms that are ample in size and properly furnished for the number of children you serve at an emergency respite center.

     (2) With more than twelve 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) 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 (see 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 under six years of age are sleeping.

     (2) Any room used for sleeping must be at least thirty-five square feet per child.

     (3) Bedrooms must have both:

     (a) Adequate ceiling height for the safety and comfort of the occupants (normally, 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.

     (4) The number of beds allowed at an emergency respite center is established in consultation with the DOH surveyor for each facility.

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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 children.

     (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. The licensee 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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     (2) Cribs must have no more than two and three-eighths inches space between vertical slats when used for infants less than six months of age.

     (3) Cribs, infant beds, bassinets, and playpens must:

     (a) Have clean, firm, snug fitting mattresses covered with waterproof material that is easily sanitized; and

     (b) Be made of wood, metal, or approved plastic with secure latching devices

     (4) Crib bumpers, stuffed toys, and pillows must not be used in cribs, infant beds, bassinets, or playpens.

     (5) You must follow the recommendation of the American Academy of Pediatrics, 1-800-505-CRIB, placing infants on their backs each time for sleep.

     (6) The distance between each crib/bed must provide enough space for exiting and allow staff access to children. Normally, this would be thirty inches.

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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 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 1:8.

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

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     (2) Emergency respite 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) An emergency respite center must provide a minimum of one hand washing sink:

     (a) For every fifteen children normally on site during the day; and

     (b) For every eight children normally on site overnight.

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     (a) For every fifteen children normally on site during the day; and

     (b) For every eight children normally on site overnight.

     (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 toilet.

     (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 play 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 play area must adjoin directly the indoor premises or be reachable by a safe route and method.

     (5) The outdoor play 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 play area at the same time, you may reduce the outdoor play area size by the number of children normally using the play 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 play 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) Daily attendance logs;

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

     (d) Names, address and home and business telephone numbers of parents or persons to be contacted in case of emergency;

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

     (f) Medications and treatments given at the center;

     (g) Facility and/or daily logs must have the signature of the person making the written entry;

     (h) Health screening information including any allergy information; and

     (i) Other information determined relevant by the department.

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

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

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     (1) Permission from the child's parent or guardian authorizing the placement of their child;

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

     (3) Basic family information, including address, telephone numbers, and emergency contact; and

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

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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.

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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 methods that interfere with a child's basic needs. These include, but are not limited to:

     (a) Depriving the child of sleep;

     (b) Providing inadequate 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 to control that child's behavior prescribes the medication.

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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) 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.

     (3) You and the staff may use restraining techniques:

     (a) If your emergency respite center provides care to school-age children only; and

     (b) Is approved by DLR for the use of physical restraint. You and your staff must be trained in accordance with the DLR behavior management policy before restraining a child in a nonemergency situation.

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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) Unexpected or emergent health problems that require off-site medical treatment;

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

     (k) Serious property damage that is a safety hazard and is not immediately corrected.

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

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

     (b) Unexpected health problems that do not require professional medical treatment;

     (c) Any 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; and

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

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     (1) At least two staff on duty when children are present; and

     (2) One child care staff providing visual or auditory supervision for every four children in care.

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     (2) In emergency respite centers, children must be within visual and auditory range at all times.

     (3) Emergency respite centers must supervise children who help with activities involving food preparation, based on their age and skills.

     (4) Preschool children and children with severe developmental disabilities must not be left unattended in a bathtub or shower at an emergency respite center.

     (5) Staff, volunteers, and others caring for children at an emergency respite 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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     (2) The director serves as the administrator of the center.

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

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Position	Qualifications	Background Check	TB Test	Food Handlers Permit	First Aid and CPR	HIV/AIDS and Bloodborne Pathogens Training
Director or program supervisor	•Twenty-one years of age; •Bachelor's degree; or •Five years of experience in child development, social service or related field.	X	X	X	X	X
Primary child care worker	•Twenty-one years of age; •High school diploma or GED; •Two years of experience caring for children; or •Twenty hours training child development.	X	X	X	X	X
Child care assistant	•Eighteen years of age; •High school diploma or GED; •One year of experience caring for children; or •Twenty hours training if obtained within first year of employment.	X	X	X	X	X
Work study students	•Sixteen years of age; •Involved in an education-related program; and •Supervised by primary or child care assistant.	X	X	X	X	X
Case manager	Bachelor's degree in social services, child development, or related field; recommended position, not required.	X	X	X	X	X
Volunteers	•Sixteen years of age. •Supervised at all times.	X	X	X	Recommended training	X

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

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

     (3) During evening, overnight, and weekend shifts, at least one of the staff on the premises must be a primary child care worker when children are present. The other staff may be a child care assistant. The director, program supervisor, or case manager must be on-call and able to respond by telephone within fifteen minutes.

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     (2) No person under eighteen years of age may be assigned sole responsibility for a group of children at an emergency respite center.

     (3) Any child care assistant under twenty-one years old may care for a child or group of children without direct supervision for up to fifteen minutes.

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     (a) The training, experience, knowledge and demonstrated skills in each area that he or she will be advising;

     (b) The ability to ensure that your staff develop their skills and understanding needed to effectively manage their cases;

     (c) Knowledge of mandatory child abuse and neglect reporting requirements; and

     (d) Training and experience in early childhood education.

     (2) Consultants and case managers may be hired as staff or operate under a contract with an emergency respite center.

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     (2) If you have five or more employees or volunteers, your training plan must be in writing.

     (3) You must discuss with the staff your policies and procedures as well as the rules contained in this chapter.

     (4) You must provide or arrange for your staff to have training for the services that you provide to children under your care.

     (5) Your training on behavioral management must be approved by DLR and must include nonphysical age-appropriate methods of redirecting and controlling behavior, as described in the department's behavior management policy.

     (6) Your training must include monthly practice of fire drills and disaster training for each staff.

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

     (8) 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 emergency respite center's activity program allows time for children to have daily opportunities for small and large muscle activities and outdoor play.

     (3) You must provide a written outline of planned activities, allowing flexibility for special events and specific child circumstances.

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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 an emergency respite 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 an emergency respite center.

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© Washington State Code Reviser's Office