Original Notice.

     Preproposal statement of inquiry was filed as WSR 00-15-014.

     Title of Rule: Chapter 388-78A WAC (entire chapter revision), Boarding home licensing rules.

     Purpose: The purpose of revising the boarding home licensing rules is to make the rules easier to understand, make them more applicable to the current residents of boarding homes to improve the quality of care and services to residents, make them more consistent with current practices in residential care, make them more focused on what occurs with residents, and to comply with the Governor's Executive Order 97-02.

     Statutory Authority for Adoption: RCW 18.20.090.

     Statute Being Implemented: Chapter 18.20 RCW.

     Summary: The proposed amendments:

•     Repeal all existing sections in chapter 388-78A WAC, and replace them with new sections in the same chapter.

•     Clarify and strengthen the assessment and care planning requirements for residents in boarding homes.

•     Outline the minimum level of support all boarding homes must provide to the residents.

•     Clarify and strengthen the nursing, medication and other health care support services available to residents in boarding homes.

•     Identify when specialized training for developmental disabilities, mental illness, and dementia is required in boarding homes.

•     Improve the requirements for boarding home administrators.

•     Revise all sections to make the requirements easier to understand.

     Reasons Supporting Proposal: See Explanation of Rule below.

     Name of Agency Personnel Responsible for Drafting: Denny McKee, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2590: Implementation and Enforcement: Patricia K. Lashway, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2401.

     Name of Proponent: Department of Social and Health Services, Aging and Disability Services Administration, governmental.

     Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: DSHS intends to adopt the proposed rules after March 12, 2003, and make them effective as of September 1, 2003.

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

     Explanation of Rule, its Purpose, and Anticipated Effects: Chapter 388-78A WAC is being revised to improve the care and services provided to boarding home residents by clarifying and strengthening the requirements for assessing residents, developing and implementing negotiated care plans, and more clearly outlining the expectations regarding nursing services, medication services, and health care support services in boarding homes. The rules also establish a minimum level of care and service a boarding home must provide, and improve the qualifications of boarding home administrators. The anticipated effects of this rule are the residents will receive more appropriate and individualized care and services in a boarding home.

     Proposal Changes the Following Existing Rules: The entire licensing chapter 388-78A WAC has been revised to make it easier to understand and strengthen requirements to improve care and services to boarding home residents. The proposed changes include:

•     Repealing all existing sections in chapter 388-78A WAC and replacing them with new sections in the same chapter.

•     Specifying the characteristics of persons that boarding homes may accept and retain in the boarding home.

•     Specifying the outcomes and timing of an initial resident assessment and what topics the assessment must include.

•     Specifying the process of developing negotiated care plans for residents, including the timing and content of these agreements.

•     Specifying the minimum level of services a boarding home must provide.

•     Specifying the requirements for medication assistance and medication administration, and storing and accounting for medications.

•     Specifying the requirements associated with providing intermittent nursing services, including coordinating health care services with outside providers.

•     Specifying the requirements for implementing negotiated care plans and monitoring residents' well-being.

•     Specifying the requirements for hiring and training sufficient staff for the boarding home, including requirements for criminal history background checks and testing for tuberculosis.

•     Specifying the qualifications and training requirements for boarding home administrators.

•     Specifying the administrative requirements of operating a boarding home, including use of management agreements, development of policies and procedures, infection control practices, and reporting requirements.

•     Specifying requirements for disaster preparedness and disclosing available services.

•     Specifying the licensee's responsibilities in a boarding home.

     A small business economic impact statement has been prepared under chapter 19.85 RCW.

     Residential care services (RCS) in Aging and Disability Services Administration (ADSA), Department of Social and Health Services is proposing amendments to chapter 388-78A WAC, Boarding homes.

     The purpose of these amendments is to:

•     Comply with Governor Locke's Executive Order 97-02 regarding regulatory improvement.

•     Make the rules easier to understand.

•     Make the rules more applicable to today's boarding home residents.

•     Make the rules more consistent with current practices in residential care.

•     Make the rules more focused on what occurs with residents ("outcome focused").

     The proposed amendments include repealing all existing sections in chapter 388-78A WAC, and replacing them with new sections, and specifying:

•     The characteristics of persons boarding homes may accept and retain in the boarding home;

•     The conditions under which a person may live in a building before it is licensed as a boarding home;

•     The outcomes and timing of an initial resident assessment, who is qualified to perform the assessment, and what topics the assessment must include;

•     The process of developing, and the timing and content of negotiated care plans for residents;

•     The minimum level of services a boarding home must provide;

•     The requirements for medication assistance and medication administration, and storing and accounting for medications;

•     The requirements for food services;

•     The requirements associated with providing intermittent nursing services, including coordinating health care services with outside providers;

•     The requirements for implementing negotiated care plans and monitoring residents' well-being;

•     The requirements for providing adult day care and dementia care, and the requirements for operating a unit with restricted egress;

•     The requirements associated with documenting resident care, and maintaining records regarding residents' care;

•     The requirements for hiring and training sufficient staff for the boarding home, including requirements for criminal history background checks and testing for tuberculosis;

•     The training requirements for staff;

•     The qualifications and training requirements for boarding home administrators;

•     The administrative requirements of operating a boarding home, including use of management agreements, development of policies and procedures, infection control practices, and reporting requirements;

•     Resident rights in boarding homes;

•     Requirements for disaster preparedness and disclosing available services;

•     The requirements for obtaining a boarding home license and the procedures for application;

•     The licensee's responsibilities in a boarding home;

•     The requirements for the building to be used as a boarding home;

•     The rights and responsibilities of the boarding home during the inspection process; and

•     The enforcement actions the department may take in response to a boarding home's noncompliance with rules, and the boarding home's appeal rights.

     SMALL BUSINESS ECONOMIC IMPACT STATEMENT: Chapter 19.85 RCW, The Regulatory Fairness Act, requires that the economic impact of proposed regulations be analyzed in relation to small businesses. Small businesses are defined in this statute as those for-profit businesses that employ fifty or fewer people and are independently owned.

     The statute outlines information that must be included in a small business economic impact statement (SBEIS). Preparation of an SBEIS is required when a proposed rule has the potential of placing a disproportionate economic impact on small businesses. This chapter impacts all licensed boarding homes in Washington.

     Residential care services (RCS) has analyzed the proposed amendments to their rules and has determined that small businesses will be impacted by these changes, and that a comprehensive SBEIS is required.

     INDUSTRY ANALYSIS: RCS is responsible for licensing boarding homes in Washington and investigating complaints regarding their operation. As part of their monitoring, RCS keeps a current internal database that identifies all licensed boarding homes. Since internal industry information can be obtained at a more accurate level than is required by chapter 19.85 RCW, it is unnecessary to conduct an industry analysis using the four-digit standard industrial classification (SIC) codes.

     Residential care services has determined that there are approximately three hundred thirty-three existing boarding homes that meet the criteria for small businesses under RCW 19.85.020.

     INVOLVEMENT OF SMALL BUSINESSES: Aging and Disability Services Administration began the process of obtaining public input on the development of this rule revision around March 2000 by holding meetings with a wide variety of stakeholders. The initial meetings were designed to identify the general problems that existed in current rules and the major topics that needed to be addressed. As a result of these first discussions, eight different work groups, composed of a variety of stakeholders, were created around the topics of:

•     Provision of nursing services and health care supports;

•     The process of assessing residents' needs;

•     Boarding homes disclosing to the public the services they provide;

•     Administrative issues in the boarding home;

•     Providing care to persons with dementia;

•     Enforcement issues;

•     The building and physical environment; and

•     Miscellaneous issues including the basic services that should be required in a boarding home.

     These eight work groups met a total of fifty-eight times and developed two hundred-six advisory recommendations to ADSA. These advisory recommendations served as recommended general concepts or guiding principles for inclusion in the revision of chapter 388-78A WAC. Further, these recommendations were posted on a publicized web-site with e-mail links to the department for other members of the public to provide input. ADSA management team reviewed each of these recommendations and accepted the vast majority of them. The accepted guiding principles or concepts were then embodied in this proposed rule.

     In addition to the multiple meetings of the different advisory work groups, on October 28, 2002, a draft of the revisions to chapter 388-78A WAC was distributed to various stakeholders, including the long-term care ombudsman program (LTCOP) and the three professional associations representing boarding home operators (Northwest Assisted Living Facilities Association - NorALFA; Washington Association of Housing and Services for the Aging - WAHSA; and Washington Health Care/Washington Center for Assisted Living - WHCA/WCAL). At the same time, LTCOP, NorALFA, WAHSA, and WHCA/WCAL were each invited to send three representatives to another meeting on December 4, 2002, to specifically discuss the costs associated with implementing the draft WAC.

     The invited participants were asked to:

•     Review the draft WAC;

•     Identify the requirements in the draft WAC that they perceived to be new requirements beyond current standards; and

•     Determine as near as possible the additional costs to the boarding home of implementing/complying with that requirement.

     A meeting was held from 9:00 a.m. - 3:30 p.m. on December 4, 2002, and was attended by six provider representatives, one representative from LTCOP, and two staff from ADSA. Additionally, one invited provider who was not able to attend the meeting submitted comments by fax. Provider representatives were asked to identify what they perceived as new requirements and the associated new costs, and to present them in order, starting with what the provider representatives considered to be the most costly. The department noted all of the new requirements that the provider representatives thought would have "more than minor costs."

     It was noted that the costs of complying with a new requirement could have a large variation across the industry because of the unique factors associated with each boarding home. However, as the result of discussion, approximate industry averages were agreed upon by attendees. It was also agreed upon that to the extent possible, the on-going costs associated with complying with the revised rules should be expressed in terms of dollars per resident-day. And it was further agreed upon that the "average" "small business" is best represented by a boarding home licensed for thirty-one beds, and that the "average" "large business" is best represented by a boarding home licensed for eighty-four beds.

     The one-time costs associated with achieving compliance are best expressed in cost per licensed bed.

     COST OF COMPLIANCE: To fairly consider costs of compliance, residential care services has elected to look at costs per licensed bed for the one-time costs associated with achieving compliance with the new rules, and costs per resident-day for on-going expenses associated with maintaining compliance. This is due to these facts:

     Boarding homes' revenues are based on the numbers of residents being served in the boarding home. Boarding homes generally prorate expenses over the average number of residents served.

     In order to fairly compare expenses between large and small businesses, the cost per resident-day provides a measure of the impact any change would have on each resident.

     GENERAL COSTS: The one-time costs associated with complying with the requirements of the proposed rule were estimated to be as follows:

Providers' Perceived One-time Costs	ADSA's Analysis for Small Businesses (Average thirty-one beds)	ADSA's Analysis for Large Businesses (Average eighty-four beds)
•     Cost for revising existing policies and procedures (100 hours @ $20/hour).	•     To the extent that the proposed amended rule reflects a different standard, providers will need to revise their operating policies and procedures. •     $32.26 total per bed in the first year only. (50 hours x $20/hr/31).	•     $11.09 total per bed in the first year only (50 hours x $20/hr/84).
•     Cost of additional in-service training on revised policies and procedures (4 hours training per direct care employee @ $12/hr and 8 hours training per professional staff @ $20/hr).	•     To the extent that the proposed amended rule reflects a different standard, providers will need to train their staffs. •     Assuming thirteen direct care staff and two professional staff, $30.45 total per bed in the first year only [(4 x $12 x 13)+ (8 x $20 x 2)]/31=$30.45.	•     To the extent that the proposed amended rule reflects a different standard, providers will need to train their staffs. •     Assuming twenty-six direct care staff and four professional staff, $22.48 total per bed in the first year only [(4 x $12 x 26)+ (8 x $20 x 4)]/84= $22.48.
•     Cost of obtaining a social history on current residents with dementia (1 hour @ $20/hr).	•     Obtaining a social history for residents with dementia is consistent with current standards of practice in successful boarding homes today, and is consistent with recommendations from work groups regarding the appropriate standards. •     No additional one-time costs are anticipated for current residents with dementia.	•     Obtaining a social history for residents with dementia is consistent with current standards of practice in successful boarding homes today, and is consistent with recommendations from work groups regarding the appropriate standards. •     No additional one-time costs are anticipated for current residents with dementia.
•     Total one-time first year costs per bed:	•     $62.71 per bed in first year only.	•     $33.57 per bed in first year only.

     At the meeting on December 4, 2002, the provider representatives identified what they believed to be the new on-going requirements of the draft rules and the associated costs. Aging and Disability Services Administration has analyzed these costs and associated requirements and has concluded that the on-going new costs imposed by the proposed amendments would be $.12 per resident-day in both small and large businesses:

Providers' Perceived New Costs	ADSA's Analysis
•     Assessment requirements would cost an additional $.22 per resident-day because of increased qualifications for assessor and specified elements of assessment (4 hours of additional time per resident per year @ $20/hr).	•     Current chapter 388-78A WAC and chapter 70.129 RCW presently require boarding homes to assess residents' needs and the proposed WAC does not create any new assessment requirement. The proposed new WAC only elaborates on existing assessment topics, such as health professional's diagnosis, and safety needs. This elaboration is consistent with current standards of practice in successful boarding homes today, and is consistent with recommendations from work groups regarding the appropriate standards. •     ADSA has reviewed the information submitted by providers regarding the draft rule that increased the time and qualifications of the person responsible for conducting the initial resident assessment (for needs or services other than nursing care). As a result of this analysis, ADSA has determined the increased costs to be $.12 per resident day (2.25 hours of additional time per resident per year @ $20/hr).
•     The requirements to develop the negotiated care plan would cost an additional $.24 per resident-day because of specified elements of the negotiated care plan, accommodating resident preferences, and developing plans with residents' families when they are involved in providing care or services to the resident (5 minutes more per resident per week @ $20/hr).	•     Current chapter 388-78A WAC and chapter 70.129 RCW require boarding homes to develop an individual's resident plan to address resident needs and accommodate residents' preferences, and the proposed WAC does not create a new requirement. •     The proposed WAC is consistent with current standards of practice in successful boarding homes today, and is consistent with recommendations from work groups regarding the appropriate standards. •     Any costs that may be related to changes in requirements for developing negotiated care plans are considered "minor" in amounts.
•     The requirements to provide a basic level of services in a boarding home would cost between $3.10 and $4.65 per resident day in a small business and between $2.86 and $4.29 per resident day in a large business (8-12 total additional direct care staff hours per day per 31 beds @ $12 per hour, and 20-30 total additional direct care staff hours per day per 84 beds @ $12 per hour).	•     Current chapter 388-78A WAC and chapter 70.129 RCW require boarding homes to provide the listed services, but do not specify the extent of services. By defining the exact level of services that are expected, in some cases it limits how much services may be required, and in other cases it more clearly describes the extent of services that are expected. •     No new costs are associated with these clarifying statements.
•     The requirements to provide a higher level of activities in a boarding home would cost between $3.10 per resident day in a small business and $2.29 per resident day in a large business (1 additional FTE in a small business @ $12/hr and 2 additional FTEs in a large business).	•     ADSA has reviewed the information submitted by providers regarding the draft rule that increased boarding homes' requirements to provide individualized activities daily. As a result of this analysis, ADSA concurs that the costs of this draft requirement outweighs the benefits. •     Additionally, since this requirement would have disproportionately impacted small businesses, the proposed rule will be changed to reflect existing requirements. The draft requirement to provide individualized activities on a daily basis is being withdrawn. •     Therefore no new costs will be incurred because the draft requirement is being withdrawn.
•     The expanded role of the registered nurse will cost more.	•     The proposed rule and role of the registered nurse is consistent with nursing practice as described in chapter 246-840 WAC. ADSA did not create the requirements regarding the role of the registered nurse and therefore this rule did not create any new requirement or expense.
•     There are a number of additional requirements that individually are very minor, but in the aggregate would cost @ $.25 per resident per day.	•     Other minor requirements not mentioned above are consistent with current standards of practice in successful boarding homes today, and are consistent with recommendations from work groups regarding the appropriate standards. •     A significant number of these requirements would only impact a fraction of the boarding homes on only an occasional basis, and therefore would not have a significant affect on the industry as a whole. •     Any costs that may be related to changes in other requirements are considered "minor" in amounts.
Summary:	•     ADSA has analyzed the costs associated with the on-going requirements of the draft rules and evaluated the probable benefits of them. In response to the boarding home industry's concerns, ADSA has deleted one major requirement from the draft rules: The requirement for individualized activities on a daily basis has been deleted from the proposed rules. •     New on-going costs associated with the proposed rules are considered to be $.12 per resident day.

     Disproportionate Economic Impact Analysis: When proposed rule changes cause more than minor costs to small businesses, the Regulatory Fairness Act requires an analysis that compares these costs between small businesses and 10% of the largest businesses. The on-going costs of $.12 per resident day are equal in a large business and a small business.

     However, the one-time costs associated with achieving compliance are disproportionate between small businesses and large businesses, since there are fewer licensed beds over which to spread the fixed costs in a small business. In the average small business boarding home, the first year cost of complying with the one-time expenses is estimated to be $62.71 per licensed bed. In the average large business boarding home, the first year cost of complying with the one-time expenses is estimated to be $33.57 per licensed bed.

     While the estimated time required for boarding homes to achieve compliance may be worth the amounts described above, it is most likely that boarding homes will not have to bear all this expense as an additional expenditure. It is expected that providers will shift some of the costs associated with staff time from other priorities. For example, staff may be trained on the new policies and procedures at times that were normally scheduled for staff training on other subjects. While there is no debate about the value of staff time, there in fact may not be a significant additional expenditure required for this training.

     Mitigating Expenses: Residential Care Services has plans for mitigating expenses for small businesses by delaying the effective date of the rules approximately one hundred-twenty days from the date of adoption. It is estimated that the adoption date will be no later than April 30, 2003. Consequently, the effective date for the rules has been set for September 1, 2003. This will allow both small businesses and large businesses to spread the costs of developing policies and presenting training over four months. This will help reduce the likelihood that additional actual expenditures would be required, such as having additional staff provide resident care services while other staff are being trained on new polices.

     Additionally, ADSA intends to present several training sessions around the state for providers to help them more quickly understand and implement the new rules. This will help keep the amount of time necessary to revise or develop new policies and procedures to a minimum.

     Finally, ADSA will not impose sanctions for a period of six months after the effective date of the rules, for a boarding home's failure to have written policies and procedures formally written and/or adopted regarding the following areas where new policies and procedures are required by WAC 388-78A-0600, subsection:

•     (2)(a) regarding what to do when a resident is not capable of making necessary decisions;

•     (2)(b) regarding what to do when a substitute decision maker is no longer appropriate;

•     (2)(k)(i) regarding how medications are to be ordered and brought into the boarding home;

•     (2)(k)(ii) regarding what to do if a resident's medications are not available;

•     (2)(k)(vi) regarding sending medications with a resident when the resident leaves the premises;

•     (2)(k)(viii) regarding inventorying schedule II and III drugs;

•     (2)(k)(x) regarding the use of medication organizers;

•     (2)(k)(xi) regarding what to do if a resident chooses not to take prescribed medications;

•     (2)(l) regarding nurse delegation; and

•     (2)(n) regarding the safe operation of boarding home vehicles.

     ADSA will continue to impose enforcement actions or sanctions for negative outcomes that a resident may experience beginning with the effective date of the rules. ADSA will withhold sanctions for six months only for the limited purposes of having such policies and procedures formally written or adopted by the boarding home. This will allow small businesses to concentrate their time and energies on meeting the requirements of the rule, and will provide an extended period to achieve compliance with the necessary documentation. The broader time frame for compliance will allow boarding home operators to further spread out the costs of complying with this rule.

     CONCLUSION: Residential care services has given careful consideration to the impact of proposed rules in chapter 388-78A WAC on small businesses. In accordance with the Regulatory Fairness Act, chapter 19.85 RCW, Residential care services has analyzed impacts on small businesses and proposed ways to mitigate those costs associated with the one-time requirements of developing new policies and procedures and training staff on them. Residential care services will delay the effective date of the rules, provide training, and suspend enforcement actions for specific violations for a period of six months following the effective date of the rules.

     A copy of the statement may be obtained by writing to Denny McKee, Residential Care Services, ADSA, P.O. Box 45600, Olympia, WA 98504-5600, e-mail mckeedd@dshs.wa.gov, phone (360) 725-2590, fax (360) 438-7903.

     RCW 34.05.328 applies to this rule adoption. A cost-benefit analysis has been prepared regarding this proposed rule. A copy of the cost-benefit analysis may be obtained by contacting Denny McKee, Residential Care Services, ADSA, P.O. Box 45600, Olympia, WA 98504-5600, e-mail mckeedd@dshs.wa.gov, phone (360) 725-2590, fax (360) 438-7903.

     Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on March 11, 2003, at 10:00 a.m.

     Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by March 7, 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., March 11, 2003.

     Date of Intended Adoption: Not earlier than March 12, 2003.

December 30, 2002

Bonita H. Jacques

for Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

[]

     "Abuse" means the willful action or inaction that inflicts injury, unreasonable confinement, intimidation, or punishment on a resident. In instances of abuse of a resident who is unable to express or demonstrate physical harm, pain, or mental anguish, the abuse is presumed to cause physical harm, pain, or mental anguish. Abuse includes sexual abuse, mental abuse, physical abuse, and exploitation of a resident, which have the following meanings:

     (1) "Mental abuse" means any willful action or inaction of mental or verbal abuse. Mental abuse includes, but is not limited to, coercion, harassment, inappropriately isolating a resident from family, friends, or regular activity, and verbal assault that includes ridiculing, intimidating, yelling, or swearing.

     (2) "Physical abuse" means the willful action of inflicting bodily injury or physical mistreatment. Physical abuse includes, but is not limited to, striking with or without an object, slapping, pinching, choking, kicking, shoving, prodding, or the use of chemical restraints or physical restraints.

     (3) "Sexual abuse" means any form of nonconsensual sexual contact, including but not limited to unwanted or inappropriate touching, rape, sodomy, sexual coercion, sexually explicit photographing, and sexual harassment. Sexual abuse includes any sexual contact between a staff person and a resident, whether or not it is consensual.

     (4) "Exploitation" means an act of forcing, compelling, or exerting undue influence over a resident causing the resident to act in a way that is inconsistent with relevant past behavior, or causing the resident to perform services for the benefit of another.

     (5) "Financial exploitation" means the illegal or improper use of the property, income, resources, or trust funds of the resident by any person for any person's profit or advantage.

     "Activities of daily living" means those tasks related to basic personal care such as bathing, toileting, dressing, grooming, hygiene, ambulation, and eating.

     "Adult day care" means care and services provided to individuals on the boarding home premises for a period of less than twenty-four continuous hours and does not involve an over-night stay.

     "Aged person" means, according to RCW 18.20.020, a person of the age of sixty-five years or more, or a person of less than sixty-five years who by reason of infirmity requires domiciliary care.

     "Ambulatory" means capable of walking or traversing a normal path to safety without the physical assistance of another individual:

     (1) "Nonambulatory" means unable to walk or traverse a normal path to safety without the physical assistance of another individual;

     (2) "Semi-ambulatory" means physically and mentally capable of traversing a normal path to safety with the use of mobility aids, but unable to ascend or descend stairs without the physical assistance of another individual.

     "Applicant" means the person, as defined in this section, that has submitted, or is in the process of submitting, an application for a boarding home license.

     "Bathing fixture" means a bathtub, shower or sit-down shower.

     "Bathroom" means a room containing at least one bathing fixture.

     "Board" means, in the definition of boarding home, the provision of meal service and lodging.

     "Boarding home" means any home or other institution, however named, which is advertised, announced, or maintained for the express or implied purpose of providing board and domiciliary care to seven or more aged persons not related by blood or marriage to the operator. However, a boarding home that is licensed to provide board and domiciliary care to three to six persons on July 1, 2000, may maintain its boarding home license as long as it is continually licensed as a boarding home. "Boarding home" does not include facilities certified as group training homes pursuant to RCW 71A.22.040, nor any home, institution or section thereof which is otherwise licensed and regulated under the provisions of state law providing specifically for the licensing and regulation of such home, institution or section thereof. Nor shall it include any independent senior housing, independent living units in continuing care retirement communities, or other similar living situations including those subsidized by the department of Housing and Urban Development.

     "Building code" means the building codes and standards adopted by the Washington State Building Code Council.

     "Construction review services" means the office of construction review services within the Washington state department of health.

     "Continuing care contract" means, as stated in RCW 70.38.025, a contract providing a person, for the duration of that person's life or for a term in excess of one year, shelter along with nursing, medical, health-related, or personal care services, which is conditioned upon the transfer of property, the payment of an entrance fee to the provider of such services, or the payment of periodic charges for the care and services involved. A continuing care contract is not excluded from this definition because the contract is mutually terminable or because shelter and services are not provided at the same location.

     "Continuing care retirement community" means, as stated in RCW 70.38.025, an entity which provides shelter and services under continuing care contracts with its members and which sponsors or includes a health care facility or a health service.

     "Contractor" means an agency or person who contracts with a licensee to provide resident care, services or equipment.

     "Department" means the Washington state department of social and health services.

     "Dietitian" means an individual certified under chapter 18.138 RCW.

     "Document" means to record, with signature, title, date and time:

     (1) Information about medication administration, medication assistance or disposal, a nursing care procedure, accident, occurrence or change in resident condition that may impact the care or needs of a resident; and

     (2) Processes, events or activities that are required by law, rule or policy.

     "Domiciliary care" means:

     (1) Assistance with activities of daily living provided by the licensee either directly or by contract; or

     (2) Assuming general responsibility for the safety and well-being of the resident; or

     (3) Intermittent nursing services, if provided by the licensee.

     "Enforcement remedy" means one or more of the department's responses to a boarding home's noncompliance with chapter 18.20 RCW and this chapter, authorized by RCW 18.20.190.

     "Exploitation" - see definition of "abuse."

     "Food service worker" means according to chapter 246-217 WAC an individual who works (or intends to work) with or without pay in a food service establishment and handles unwrapped or unpackaged food or who may contribute to the transmission of infectious diseases through the nature of his/her contact with food products and/or equipment and facilities. This does not include persons who simply assist residents with meals.

     "Harm" means a physical or mental or emotional injury or damage to a resident and may include violations of a resident's rights.

     "Infectious" means capable of causing infection or disease by entrance of organisms into the body, which grow and multiply there, including but not limited to bacteria, viruses, protozoans, and fungi.

     "Independent living unit" means an apartment, condominium or other self-sufficient dwelling unit occupied by an individual or individuals not receiving domiciliary care.

     "Independent senior housing" means an independent living unit occupied by an individual or individuals sixty or more years of age.

     "Infirmity" means a disability that materially limits normal activity without requiring inpatient medical or nursing care. An infirmity may be based on conditions, including but not limited to physical handicap, mental illness, developmental disability, mental confusion, disability or disturbance.

     "Intermittent nursing services" means the provision of both scheduled and nonscheduled nursing tasks to meet the needs of residents who do not require the frequent presence or frequent evaluation of a registered nurse.

     "Licensee" means the person, as defined in this chapter, to whom the department issues the boarding home license.

     "Licensed resident bed capacity" means the resident occupancy level requested by the licensee and approved by the department. All residents receiving domiciliary care and their roommates count towards the licensed resident bed capacity. Adult day care clients do not count towards the licensed resident bed capacity.

     "Manager" means the person, as defined in this chapter, providing services under a management agreement.

     "Management agreement" means a written, executed agreement between the licensee and the manager regarding the provision of certain services in a boarding home.

     "Maximum facility capacity" means the maximum number of individuals that the boarding home may serve at any one time, as determined by the department.

     (1) The maximum facility capacity includes all residents and respite care residents and adult day care clients.

     (2) The maximum facility capacity is equal to the lesser of:

     (a) The sum of the number of approved bed spaces for all resident rooms; or

     (b) Twice the seating capacity of the dining area(s) consistent with WAC 388-78A-0270; or

     (c) The number of residents permitted by calculating the ratios of toilets, sinks, and bathing fixtures to residents consistent with WAC 388-78A-1010; or

     (d) For boarding homes licensed on or before December 31, 1988, the total day room area in square feet divided by ten square feet, consistent with WAC 388-78A-1030; or

     (e) For boarding homes licensed after December 31, 1988, the total day room area in square feet divided by twenty square feet, consistent with WAC 388-78A-1030.

     "Medication administration" means the act of a practitioner, family member, or nursing assistant acting under the delegation of a registered nurse, giving medication to a resident in accordance with the laws and regulations governing such acts and entails:

     (1) Comparing the label on the container with the prescriber's order;

     (2) Removing an individual dose from a previously dispensed, properly labeled container;

     (3) Giving an individual dose to the proper resident; and

     (4) Properly recording the medication, dose, and time given in the resident record.

     "Medication assistance" means assistance with self-administration of medication rendered by a nonpractitioner to a resident of a boarding home in accordance with chapter 246-888 WAC.

     "Medication organizer" means a container with separate compartments for storing oral medications organized in daily doses.

     "Neglect" means:

     (1) A pattern of conduct or inaction resulting in the failure to provide the goods and services that maintain physical or mental health of a resident, or that fails to avoid or prevent physical or mental harm or pain to a resident; or

     (2) An act or omission that demonstrates a serious disregard of consequences of such a magnitude as to constitute a clear and present danger to the resident's health, welfare, or safety.

     "Nonpractitioner" means any individual who is not a practitioner as defined in WAC 388-78A-0020 and chapter 69.41 RCW.

     "Noteworthy change" means a change in a resident's physical, emotional, or mental functioning that is a departure from the resident's customary range of functioning, or a recurring condition in a resident's physical, emotional, or mental functioning that has previously required intervention by others.

     "Nurse" means an individual currently licensed under chapter 18.79 RCW as either a:

     (1) "Licensed practical nurse" (LPN); or

     (2) "Registered nurse" (RN).

     "Over-the-counter (OTC) medication" means any medication that may be legally purchased without a prescriptive order, including but not limited to vitamin, mineral, or herbal preparations.

     "Person" means any individual, firm, partnership, corporation, company, association, or joint stock association.

     "Physician" means an individual licensed under chapter 18.57 or 18.71 RCW.

     "Practitioner" includes a licensed physician, osteopathic physician, podiatric physician, pharmacist, licensed practical nurse, registered nurse, advanced registered nurse practitioner, dentist, and physician assistant. Refer to chapter 69.41 RCW for a complete listing of practitioners.

     "Prescribed medication," means any medication (legend drug, controlled substance, and over-the-counter) that is prescribed by an authorized practitioner.

     "Prescriber" means a health care practitioner authorized by Washington state law to prescribe drugs.

     "Problem" means a violation of any WAC or RCW applicable to the operation of a boarding home:

     (1) "Recurring problem" means that the department has cited a violation of WAC or RCW and the circumstances of (a) or (b) of this subsection are present:

     (a) The department previously imposed an enforcement remedy for a violation of the same section of WAC or RCW for substantially the same problem following any type of inspection within a period of time that represents twice the licensing interval specified in RCW 18.20.110; or

     (b) The department previously cited a violation under the same section of WAC or RCW for substantially the same problem following any type of inspection or two occasions within a period of time that represents twice the licensing interval specified in RCW 18.20.110.

     (c) When the same WAC or RCW is cited three times within a period of time that represents twice the licensing interval specified in RCW 18.20.110, and there has been a change in licensees between the first and the second or third citation, the third citation may not be considered a "recurring problem."

     (2) "Serious problem" means:

     (a) There has been a violation of a WAC or RCW, and

     (b) Significant actual harm has occurred to a resident, or

     (c) It is likely that death or significant actual harm will occur to a resident.

     (3) "Uncorrected problem" means the department has cited a violation of WAC or RCW following any type of inspection and the violation remains uncorrected at the time the department makes a subsequent inspection for the specific purpose of verifying whether such violation has been corrected.

     "Prospective resident" means an individual who demonstrates an interest, intends, or applies to move into a boarding home but has not signed an admission agreement or moved in.

     "RCW" means Revised Code of Washington.

     "Records" means:

     (1) "Active records" means the current, relevant documentation regarding residents necessary to provide care and services to residents; or

     (2) "Inactive records" means historical documentation regarding the provision of care and services to residents that is no longer relevant to the current delivery of services and has been thinned from the active record.

     "Resident" means:

     (1) An individual who:

     (a) Lives in a boarding home, including those receiving respite care;

     (b) Is not related by blood or marriage to the operator of the boarding home; and

     (c) By reason of age or infirmity, requires domiciliary care.

     (2) The roommates of individuals who require domiciliary care.

     "Resident-care staff person" means any boarding home employee, temporary employee, volunteer, or contractor who provides hands-on personal care or nursing care to a resident, including but not limited to cuing, reminding, or supervision of a resident on behalf of a boarding home, except "resident-care staff person" does not include volunteers who are supervised by an employee, temporary employee or contractor who is on the premises and is quickly and easily available to the volunteer while the volunteer is performing volunteer activities.

     "Resident's representative" means:

     (1) An individual legally appointed, or designated by the resident in writing, to act in the resident's behalf; or

     (2) If the resident is not competent, an individual authorized to provide informed consent on behalf of the resident consistent with RCW 7.70.065.

     "Respite care" means short-term care for any period in excess of twenty-four continuous hours for an aged person to temporarily relieve the family or other caregiver of providing that care.

     "Restraint" means any method or device used to prevent or limit free body movement, including but not limited to:

     (1) Confinement, unless agreed to as provided in WAC 388-78A-0380;

     (2) "Chemical restraint" means a psychopharmacologic drug that is used for discipline or convenience and not required to treat the resident's medical symptoms; and

     (3) "Physical restraint" means a manual method, obstacle, or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that restricts freedom of movement or access to his or her body, is used for discipline or convenience, and not required to treat the resident's medical symptoms.

     "Room" means a space set apart by floor to ceiling partitions on all sides with all openings provided with doors or windows.

     (1) "Sleeping room" means a room where a resident is customarily expected to sleep and contains a resident's bed.

     (2) "Resident living room" means the common space in a resident unit that is not a sleeping room, bathroom or closet.

     "Significant change" means a change in a resident's health status or physical, emotional or mental functioning that requires the intervention of a physician, a physician assistant as defined in WAC 246-918-005, or an advanced registered nurse practitioner as defined in WAC 246-840-299.

     "Special needs" means a developmental disability, mental illness, or dementia.

     "Stable and predictable condition" means the resident's clinical and behavioral status is known through initial and on-going assessments to be nonfluctuating and consistent, and does not require the frequent presence and frequent evaluation of a registered nurse. As long as the boarding home has the capacity to meet the resident's identified needs, a resident in a stable and predictable condition also includes:

     (1) A terminally ill resident, whose deteriorating condition is predictable; and

     (2) A resident with an acute, time-limited illness of brief duration.

     "Staff person" means any boarding home employee, temporary employee, volunteer, or contractor, whether employed or retained by the licensee or any management company.

     "Toilet" means a disposal apparatus fitted with a seat and flushing device used for urination and defecation.

     "Volunteer" means an individual who regularly provides planned and organized services within the boarding home without reimbursement, but does not mean an individual who visits residents socially or provides occasional entertainment.

     "Vulnerable adult" means "vulnerable adult" as defined in chapter 74.34 RCW, except that for the purposes of requesting and receiving background checks pursuant to RCW 43.43.832, it shall also include adults of any age who lack the functional, mental, or physical ability to care for themselves.

     "WAC" means Washington Administrative Code.

     "WISHA" means the Washington Industrial Safety and Health Act, chapter 49.17 RCW administered by the Washington state department of labor and industries.

[]

[]

     (2) The boarding home must have its building approved by the Washington State Fire Marshal, Fire Protection Bureau in order to be licensed.

[]

     (1) The boarding home can meet the individual's needs;

     (2) The individual's health care condition is stable and predictable, as determined jointly by the boarding home and the resident or the resident's representative if appropriate. When the resident requires the services of a licensed nurse on the boarding home premises, the registered nurse responsible for assessing the resident's nursing needs must specifically assess if the resident's health care condition is stable and predictable;

     (3) The individual is ambulatory, unless the boarding home is approved by the Washington State Director of Fire Protection to care for semi-ambulatory or nonambulatory residents; and

     (4) The individual meets the acceptance criteria the boarding home described in the boarding home's disclosure information.

[]

     (1) The prospective licensee does not represent or advertise the building as a licensed boarding home or other licensed facility;

     (2) The prospective licensee does not provide any assistance with activities of daily living to the individuals living in the building whether directly or through a contractor;

     (3) The prospective licensee does not provide any nursing services or other health care to individuals living in the building;

     (4) The prospective licensee does not assume any responsibility for the safety or well-being of the individuals in the boarding home, other than those associated with customary landlord-tenant relations; and

     (5) All of the individuals living in the building are either totally independent, or are able to make arrangements with community resources to meet their service needs without the assistance of the prospective licensee.

[]

     (1) To gain a comprehensive understanding of the individual's:

     (a) Needs,

     (b) Capabilities, and

     (c) Preferences.

     (2) To determine if the boarding home has the necessary resources, including staff, facilities, and equipment to provide the required care and services; and

     (3) To develop a preliminary care plan that adequately addresses the individual's needs, capabilities, and preferences.

[]

[]

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

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

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

     (d) Is a physician with a valid state license to practice medicine; or

     (e) Has three years of successful experience in a licensed boarding home, acquired prior to September 1, 2003, assessing prospective boarding home residents.

     (2) The boarding home must ensure a registered nurse is responsible for the assessment of the nursing needs of each prospective resident who requires the services of a nurse while on the boarding home premises.

[]

     (1) Individual's recent medical history, including, but not limited to:

     (a) Health professional's diagnosis (unless the resident objects for religious reasons);

     (b) Chronic, current, and potential skin conditions;

     (c) Known allergies to foods, medications, or other considerations for providing care or services.

     (2) Currently necessary and contraindicated medications and treatments for the individual, including:

     (a) What prescribed medications, and what over-the-counter medications commonly taken by the individual, the individual is able to independently self-administer, or safely and accurately direct others to administer to him/her;

     (b) What prescribed medications, and what over-the-counter medications commonly taken by the individual, the individual is able to self-administer when he/she has the assistance of a resident-care staff person; and

     (c) What prescribed medications, and what over-the-counter medications commonly taken by the individual, the individual is not able to self-administer, and needs to have administered to him or her.

     (3) The individual's nursing needs when the individual requires the services of a nurse on the boarding home premises. The boarding home must ensure a registered nurse is responsible for the nursing assessment of each current and prospective resident who requires a nursing assessment;

     (4) Individual's sensory abilities, including:

     (a) Vision, and

     (b) Hearing.

     (5) Individual's communication abilities, including:

     (a) Modes of expression,

     (b) Ability to make self understood, and

     (c) Ability to understand others.

     (6) Significant known behaviors or symptoms of the individual causing concern or requiring special care, including:

     (a) History of substance abuse.

     (b) History of harming self, others, or property or other conditions that may require behavioral intervention strategies.

     (c) Individual's ability to leave the boarding home unsupervised; and

     (d) Other safety considerations that may pose a danger to the individual or others, such as use of medical devices or the individual's ability to smoke unsupervised, if smoking is permitted in the boarding home.

     (7) Individual's special needs, by evaluating available information, or selecting and using an appropriate tool, to determine the presence of symptoms consistent with, and implications for care and services of:

     (a) Mental illness, or needs for psychological or mental health services, except where protected by confidentiality laws;

     (b) Developmental disability;

     (c) Dementia, using the DSHS 13-692; or

     (d) Other conditions affecting cognition, such as traumatic brain injury.

     (8) Individual's level of personal care needs, including:

     (a) Ability to perform activities of daily living;

     (b) Medication management ability, including:

     (i) The individual's ability to obtain and appropriately use over-the-counter medications; and

     (ii) How the individual will obtain prescribed medications for use in the boarding home.

     (9) Individual's activities, typical daily routines, habits and service preferences;

     (10) Individual's cultural and ethnic identity and lifestyle and the manner in which they are expressed, including preferences regarding other important issues such as food, community contacts, hobbies, spiritual preferences, or other sources of pleasure and comfort; and

     (11) Who has decision making authority for the individual, including:

     (a) The presence of any advance directive, or other legal document that will establish a substitute decision maker in the future;

     (b) The presence of any legal document that establishes a current substitute decision maker; and

     (c) The scope of decision-making authority of any substitute decision maker.

[]

     (1) Complete a full re-assessment addressing the elements set forth in WAC 388-78A-0100 for each resident at least annually;

     (2) Complete an assessment of identified problems and related issues within a reasonable time, consistent with the resident's condition, following a noteworthy or significant change in each resident's physical, mental, or emotional functioning;

     (3) Complete an assessment of identified problems and related issues whenever a resident's negotiated care plan no longer adequately or appropriately addresses the resident's current needs;

     (4) Determine the qualifications of the staff person responsible for performing the on-going assessments of current residents in the boarding home;

     (5) Ensure the staff person performing the on-going assessments is competent to perform them; and

     (6) Ensure a registered nurse is responsible for the assessment or re-assessment of the nursing needs of each current resident who requires the services of a licensed nurse while on the boarding home premises.

[]

[]

     (1) Develop a preliminary care plan that is a negotiated service agreement, based upon discussions with the resident and the resident's representative if the resident has one, and the assessment of a qualified assessor, before a resident moves into a boarding home;

     (2) Integrate the assessment information provided by the department's case manager into the negotiated care plan for each resident whose care is partially or wholly funded by the department;

     (3) Develop a negotiated care plan for each resident by reviewing and updating each resident's preliminary negotiated care plan, based upon additional information obtained after the resident moves in, within thirty days of the resident moving in;

     (4) Review and update each resident's negotiated care plan as necessary:

     (a) Within a reasonable time consistent with the needs of the resident following any noteworthy or significant change in the resident's physical, mental, or emotional functioning; and

     (b) Whenever the negotiated care plan no longer adequately addresses the resident's current assessed needs and preferences.

     (5) Review each resident's negotiated care plan following a complete annual re-assessment and update the plan as necessary;

     (6) Involve the following persons in the process of developing a negotiated care plan to the extent they are willing and capable:

     (a) The resident or prospective resident, to the greatest extent he or she is able to participate;

     (b) The resident's representative, if the resident has one;

     (c) The resident's family, if desired and approved by the resident;

     (d) Other individuals the resident wants included;

     (e) Any public or private case manager, if available; and

     (f) Boarding home staff.

     (7) Ensure:

     (a) Individuals participating in developing the resident's negotiated care plan:

     (i) Discuss the resident's assessed needs, capabilities, and preferences; and

     (ii) Negotiate and agree upon the care and services to be provided to support the resident.

     (b) A registered nurse develops the nursing component of the negotiated care plan for any resident who needs licensed nursing services on the boarding home premises; and

     (c) Staff persons document in the negotiated care plan the agreed upon plan for services.

[]

     (1) The care and services necessary to meet the resident's needs, including:

     (a) The plan to monitor the resident and address interventions for identified risks to the resident's health and safety;

     (b) The plan to provide assistance with activities of daily living;

     (c) The plan to provide necessary intermittent nursing services, if provided by the boarding home;

     (d) The resident's preferences for how services will be provided; and

     (e) The plans to accommodate the resident's preferences.

     (2) Clearly defined respective roles and responsibilities of the resident, the boarding home staff, and resident's family or other significant persons in meeting the resident's needs and preferences. If a person other than a resident-care staff person is to be responsible for providing care or services to the resident in the boarding home, the boarding home must specify in the negotiated care plan:

     (a) The method by which the boarding home will confirm that care or service is provided in a timely manner and as needed by the resident;

     (b) How often the boarding home will review the care or services provided by persons other than resident care staff; and

     (c) An alternate plan for providing care or service to the resident in the event the necessary services are not provided. The boarding home may develop an alternate plan:

     (i) Exclusively for the individual resident, or

     (ii) Based on standard policies and procedures in the boarding home.

     (3) The times services will be delivered, including frequency and approximate time of day, as appropriate;

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

     (5) Appropriate behavioral interventions, if needed;

     (6) A communication plan, if special communication needs are present; and

     (7) The resident's ability to leave the boarding home premises unsupervised.

[]

     (1) The resident, or the resident's representative if the resident has one and is unable to sign or chooses not to sign;

     (2) A representative of the boarding home duly authorized by the boarding home to sign on its behalf; and

     (3) Any public or private case manager for the resident, if available.

[]

     (a) Health, well-being and safety are maintained and protected;

     (b) Rights are protected; and

     (c) Dignity and individuality are recognized and respected.

     (2) The boarding home must provide to each resident, at a minimum, assistance as needed, with:

     (a) Activities -- Arranging for social, recreational, religious, or other activities in the boarding home and in the community, based on the resident's assessed abilities and preferences and consistent with the resident's negotiated care plan;

     (b) Arranging transportation -- Assisting the resident with arranging transportation to medical appointments, but the boarding home is not required to directly provide transportation;

     (c) Bathing -- Assisting the resident with washing, including supervising the resident who is able to bathe when cued and encouraged, and assisting the resident with difficult tasks such as getting in or out of the tub or washing areas hard to reach, such as the resident's legs, feet, and back;

     (d) Dressing -- Setting up clothes and cuing and monitoring the resident, and providing the physical assistance necessary for the resident to be dressed appropriately;

     (e) Eating -- Cuing, encouraging, and supervising the resident as needed when the resident is eating, and assisting the resident with tasks that are difficult for the resident, such as cutting food or buttering bread;

     (f) Functional aids and equipment--Assisting the resident in obtaining and maintaining functional aids and equipment, including but not limited to glasses, hearing aids, dentures, canes, crutches, walkers, wheelchairs, and assistive communication devices;

     (g) Housework -- Maintaining safe, clean and comfortable personal living quarters for the resident;

     (h) Laundry -- Keeping the resident's clothing clean and in good repair, and providing on a weekly basis or more often as necessary to maintain cleanliness, clean towels, washcloths, bed sheets and pillow case;

     (i) Locomotion -- Assisting the resident with walking and wheel chair mobility, including cuing, monitoring, and providing standby assistance and the physical assistance necessary to enable residents to take part in services and activities available in the boarding home, and to safely evacuate in emergencies;

     (j) Personal hygiene -- Assisting the resident with care of hair, teeth, dentures, shaving, filing of nails, and other basic personal hygiene and grooming needs, including supervising the resident when the resident is performing the tasks, assisting the resident to care for his/her own appearance, and performing grooming tasks for the resident when the resident is unable to care for his/her own appearance;

     (k) Preparing for necessary health care services -- Cuing and monitoring the resident to follow instructions regarding food, drink, medications, dress and other necessary activities prior to medical or laboratory services;

     (l) Self-administration of medication -- Self-administration (of medications) with assistance as described in chapter 246-888 WAC;

     (m) Self-administration of treatments -- Assisting the resident with self-administration of prescribed treatments to the degree that does not require a licensed professional's intervention;

     (n) Therapeutic diets -- Providing prescribed modified and therapeutic diets and assisting the resident with following them;

     (o) Toilet use -- Assisting the resident with bladder and bowel functions, including guidance when the resident is able to care for his/her own toileting needs, helping the resident to and from the bathroom, assisting the resident with incontinent products, cuing the resident to wash hands, and performing occasional perineal care, but the boarding home is not required to provide continuous or routine perineal care;

     (p) Transferring -- Monitoring and providing one-person standby assistance, guiding and steadying the resident when the resident is able to assist in his/her own transfers including, but not limited to, getting into and out of bed, wheelchair, vehicle, and onto and off of a toilet/commode or shower chair.

     (3) The boarding home must have the capacity to deliver the basic boarding home services on a nonscheduled basis, and provide them as needed by residents.

     (4) The boarding home must:

     (a) Provide care and services to each resident by staff persons who are able to communicate with the resident in a language the resident understands; or

     (b) Make provisions for communications between staff persons and residents to ensure an accurate exchange of information.

     (5) The boarding home must ensure each resident is able to obtain individually preferred personal care items when:

     (a) The preferred personal care items are reasonably available, and

     (b) The resident is willing and able to pay for obtaining the preferred items.

     (6) The boarding home must ensure that all basic boarding home services as described under this section are appropriately provided to each resident, notwithstanding the agreement of a resident's family member or other persons to perform services on behalf of the resident according to WAC 388-78A-0320.

     (7) The boarding home may provide more extensive services than the basic boarding home services, consistent with the boarding home's disclosure statement and WAC 388-78A-0050.

[]

     (1) Provide space and staff support necessary for:

     (a) Each resident to engage in independent or self-directed activities that are appropriate to the setting, consistent with the resident's assessed interests, functional abilities, preferences, and negotiated care plan; and

     (b) Group activities at least three times per week that may be planned and facilitated by resident-care staff persons consistent with the collective interests of a group of residents.

     (2) Make available supplies and equipment necessary for activities described in subsection (1) of this section.

[]

     (a) Residents who are able to self-administer their own medications when they have the assistance of a resident-care staff person; and

     (b) Residents who are unable to self-administer medications and need to have their medications administered to them, if the boarding home provides medication administration services.

     (2) The boarding home must provide medication assistance, consistent with applicable statutes and administrative rules, to residents who need and desire this service.

[]

     (a) A prescription label completed by a licensed pharmacy,

     (b) A written order from the prescriber,

     (c) A facsimile or other electronic transmission of the order from the prescriber, or

     (d) Written documentation by a nurse of a telephone order from the prescriber.

     (2) The documentation required above in subsection (1) of this section must include the following information:

     (a) The name of the resident,

     (b) The name of the medication,

     (c) The dosage and dosage frequency of the medication, and

     (d) The name of the prescriber.

[]

     (a) If there is a staff person available who, acting within his or her scope of practice, is able to evaluate the significance of the resident not getting his or her medication, such staff person must conduct an evaluation and take the appropriate action. Appropriate action includes, but is not limited to notifying the prescriber or primary care practitioner when there is a consistent pattern of the resident choosing to not take his or her medications.

     (b) If no such staff person meeting the criteria in (a) of this subsection is available, the boarding home must notify the prescriber or primary care practitioner of the resident not getting his or her medication. The boarding home must ensure staff persons:

     (i) Inform the prescriber or primary care practitioner if the staff person is not a nurse, and

     (ii) Not exceed his or her scope of practice regarding any directives issued from the prescriber or primary care practitioner in response to the notification.

     (2) When a resident who is receiving medication assistance or medication administration services chooses to not take his or her medications, the boarding home must respect the resident's right to choose to not take the medication and document the time, date and medication the resident did not take.

[]

     (2) When prescribed medications are not available for a resident requiring medication assistance or medication administration services from the boarding home and the responsibility for obtaining the resident's medications remains with the resident, the resident's family or other individual acting on behalf of the resident, the boarding home must:

     (a) If there is a staff person available who, acting within his or her scope of practice, is able to evaluate the significance of the resident not getting his or her medication, such staff person must conduct an evaluation and take the appropriate action.

     (b) If no such staff person meeting the criteria in (a) of this subsection is available, the boarding home must notify the prescriber or primary care practitioner that the medication is not available for the resident. The boarding home must ensure staff persons:

     (i) Inform the prescriber or primary care practitioner if the staff person is not a nurse, and

     (ii) Not exceed his or her scope of practice regarding any directives issued from the prescriber or primary care practitioner in response to the notification.

     (3) Review and modify as necessary the plan for obtaining the resident's prescribed medications with the resident and those responsible for obtaining the medications on the resident's behalf.

[]

     (a) The resident is unable or unwilling to take the medications in their normal form;

     (b) The boarding home has documentation that a practitioner acting within his or her scope of practice has determined that it is safe and appropriate to alter the medication in a specified manner;

     (c) The boarding home has informed the resident that the medication is being offered or administered in an altered form before taken by the resident; and

     (d) The resident agrees to take the medications in the altered form.

     (2) The boarding home must ensure any staff persons who alter medications in the boarding home are acting within their scope of practice and applicable statutes and rules regarding the practice of pharmacy and nursing.

[]

     (2) The boarding home must ensure all medications under the boarding home's control are properly stored:

     (a) In containers with pharmacist-prepared label or original manufacturer's label;

     (b) Together for each resident and physically separated from other residents' medications;

     (c) Separate from food or toxic chemicals;

     (d) In a locked compartment that is accessible only to designated responsible staff persons or appropriate resident; and

     (e) In environments recommended on the medication label.

     (3) The boarding home must have two staff persons inventory and document no less than once per day, all drugs under the boarding home's control described as schedule II and III drugs in chapter 246-887 WAC.

[]

     (2) The boarding home must allow the following residents, who are capable of responsibly securing their own medications, to control and secure the medications that they self-administer, and the medications they direct others to administer:

     (a) Residents who are capable of independently self-administering specific medications of their own; and

     (b) Residents who are capable of safely directing others to administer their medications.

[]

     (a) The resident is fully knowledgeable of the medications that have been prescribed for him or her; and

     (b) The resident is totally independent with self-administration of medications when using a medication organizer, except for the physical assistance required to fill the medication organizer, or the resident can safely direct others to administer his or her medications; and

     (c) Staff persons have no further responsibility for:

     (i) Storing the resident's medication; or

     (ii) Providing any additional medication assistance to the resident beyond filling the medication organizer; or

     (iii) Providing medication administration services to the resident.

     (d) The medication organizer carries a label that clearly identifies:

     (i) The name of the resident,

     (ii) The name of the medications in the organizer, and

     (iii) The frequency of the dosage.

     (2) Consistent with subsections (1) and (3) of this section, the boarding home must not use a medication organizer for a resident, filled by anyone other than a licensed pharmacy, any time the boarding home is:

     (a) Involved in the storing the resident's medications;

     (b) Providing medication assistance to the resident; or

     (c) Providing medication administration services to the resident.

     (3) Residents may use medication organizers only when they store and secure their own medications and are capable of either:

     (a) Independently self-administering their own medications, or

     (b) Safely directing others to administer their medications.

[]

     (a) The boarding home jointly develops a plan for medication assistance with the resident, and the responsible family member(s), and includes a back-up plan in the event the family does not provide the medication services; and

     (b) The boarding home clearly delineates and documents in the resident's negotiated care plan, each party's respective responsibilities, including:

     (i) How the boarding home will verify the medication services are provided; and

     (ii) How often the boarding home will review the assistance provided by the family.

     (2) The boarding home must ensure that whenever a resident's family provides medication assistance or medication administration services, the resident's medications remain on the boarding home premises whenever the resident is on the boarding home premises.

[]

     (a) Provide a minimum of three meals a day:

     (i) At regular intervals;

     (ii) With no more than fourteen hours between the evening meal and breakfast, unless the boarding home provides a nutritious snack between the evening meal and breakfast.

     (b) Provide sufficient time and staff support for residents to consume meals;

     (c) Ensure all menus:

     (i) Are written at least one week in advance and posted where residents can see them, except as specified in (f) of this subsection;

     (ii) Indicate the date, day of week, month and year;

     (iii) Include all food and snacks served that contribute to nutritional requirements;

     (iv) Are retained at least six months;

     (v) Provide a variety of foods; and

     (vi) Are not repeated for at least three weeks.

     (d) Prepare on site, or provide through a contract with a food service establishment located in the vicinity and that meets the requirements of chapter 246-215 WAC, palatable, attractively served meals and nourishments that meet the current recommended Dietary Allowances established by the Food and Nutrition Board, National Research Council, adjusted for:

     (i) Age, sex and activities, unless medically contraindicated; and

     (ii) Individual and ethnic preferences to the extent reasonably possible.

     (e) Substitute foods, when changes in the current day's menu are necessary, of equal nutrient value and record changes on the original menu;

     (f) Make available and known to residents alternate choices in entrees for midday and evening meals that are of comparable quality and nutritional value. The boarding home is not required to post alternate choices in entrees on the menu one week in advance, but must record alternate choices in entrees that are served;

     (g) Develop, make known to residents, and implement a process for residents to express their views and comment on the food services; and

     (h) Maintain a dining area or areas approved by the department with a seating capacity for fifty percent or more of the residents per meal setting, or ten square feet times the licensed resident bed capacity, whichever is greater.

     (2) The boarding home must plan in writing, prepare on site or provide through a contract with a food service establishment located in the vicinity that meets the requirements of chapter 246-215 WAC, and serve as ordered:

     (a) Resident specific, modified or therapeutic diets according to a diet manual, when and as prescribed by a health care practitioner. The boarding home must ensure the diet manual is:

     (i) Available to and used by staff persons responsible for food preparation,

     (ii) Approved by a dietitian, and

     (iii) Reviewed and updated at least every five years.

     (b) Nutrient concentrates and supplements when prescribed in writing by a health care practitioner.

     (3) The boarding home must manage food, and maintain any on site food service facilities in compliance with chapter 246-215 WAC, Food service sanitation, except the boarding home may:

     (a) Serve home-canned jams, jellies and fruit with a pH of less than 4.6; and

     (b) In boarding homes licensed for sixteen or fewer beds, use domestic or home-type kitchen appliances, provided that:

     (i) If a home-type mechanical dishwasher was installed before September 1, 2003, the boarding home must:

     (A) Operate it according to manufacturer directions; and

     (B) Ensure the dishwasher heats the water to 160°F or more.

     (ii) If a home-type mechanical dishwasher is installed after September 1, 2003, the boarding home must ensure the dishwasher has:

     (A) A high temperature final rinse water at a minimum of 180° F measured by the gauge;

     (B) A high temperature final rinse resulting in a minimum of 160° F measured at the surface of the utensil; or

     (C) An automatically dispensed approved concentration of chemical sanitizer as described in 21 C.F.R. Part 178.

     (4) The boarding home must ensure employees working as food service workers obtain a food worker card according to chapter 246-217 WAC.

     (5) The boarding home must ensure a resident obtains a food worker card according to chapter 246-217 WAC whenever:

     (a) The resident is routinely or regularly involved in the preparation of food to be served to other residents;

     (b) The resident is paid for helping to prepare food; or

     (c) The resident is preparing food to be served to other residents as part of an employment-training program.

[]

     (a) Each resident who requires nursing services in the boarding home receives the nursing services as required; or

     (b) Residents are transferred to an appropriate setting if necessary nursing services are not provided in the boarding home.

     (2) The boarding home must provide intermittent nursing services to provide direct nursing care or coordinate the nursing care with nursing resources external to the boarding home, if any resident receives nursing services on the boarding home premises from:

     (a) A nurse employed by the boarding home or acting on the boarding home's behalf; or

     (b) A nurse from resources external to the boarding home that has been arranged by the resident or a person acting on behalf of the resident.

     (3) The boarding home must provide needed intermittent nursing services consistent with any disclosure statements made to the public.

[]

     (a) Independently and safely manage:

     (i) Maintenance of the tube insertion site;

     (ii) Necessary medication administration through the tube; and

     (iii) Feeding administration through the tube; or

     (b) Arrange for an outside resource to provide:

     (i) Maintenance of the tube insertion site;

     (ii) Necessary medication administration through the tube; and

     (iii) Feeding administration through the tube.

     (2) The boarding home is not required to provide intermittent nursing services to a resident simply because the resident requires tube feeding if the resident can either independently manage or arrange for an outside resource to perform the tasks specified in subsection (1)(a) and (b) of this section.

[]

     (1) Hire a registered nurse on staff;

     (2) Contract directly with an individual registered nurse; or

     (3) Contract with an agency, organization or service to provide registered nurse supervision.

[]

     (1) Supervises the system of providing nursing services in the boarding home;

     (2) Ensures nursing services and nurse delegation are provided consistent with applicable statutes and administrative rules, including, but not limited to:

     (a) Chapter 18.79 RCW, Nursing care,

     (b) Chapter 18.88A RCW, Nursing assistants,

     (c) Chapter 246-840 WAC, Practical and registered nursing,

     (d) Chapter 246-841 WAC, Nursing assistants, and

     (e) Chapter 246-888 WAC, Medication assistance.

     (3) Ensures a registered nurse:

     (a) Is responsible for the nursing assessments and reassessments of the nursing needs of current and prospective residents who require licensed nursing services on the boarding home premises;

     (b) Develops or amends as necessary the nursing portion of the negotiated care plans for residents who require licensed nursing services on the boarding home premises;

     (c) Supervises the implementation of residents' nursing plans;

     (d) Coordinates between boarding home staff and outside health resources, the nursing services provided to each resident;

     (e) Is available in person, by pager, or by telephone and can respond to residents' needs on the boarding home premises as necessary, consistent with the boarding home's disclosure statement regarding the extent of nursing services the boarding home provides.

[]

     (a) Title 18 RCW regulating health care professions;

     (b) The boarding home's policies and procedures; and

     (c) The boarding home's disclosure statement.

     (2) The boarding home must coordinate resident-arranged health care services consistent with WAC 388-78A-0330.

     (3) If a resident arranges for on-site health care services from a community provider, the boarding home must ensure a registered nurse coordinates the resident arranged services with the provision of other services listed in the resident's negotiated care plan.

[]

     (2) The boarding home must develop, implement, and make known to residents the boarding home's policies regarding how the boarding home interacts with external health care providers, including:

     (a) The conditions under which health care information regarding a resident will be shared with external health care providers, consistent with chapter 70.02 RCW;

     (b) How residents' rights to privacy will be protected, including provisions for residents to authorize the release of health care information; and

     (c) How services between the boarding home and external health care providers will be coordinated.

     (3) The boarding home may disclose health care information about a resident to external health care providers without the resident's authorization if the conditions in RCW 70.02.050 are met.

     (4) If the conditions in RCW 70.02.050 are not met, the boarding home must request, but may not require, a resident to authorize the boarding home and the external health care provider to share the resident's health care information when:

     (a) The boarding home becomes aware that a resident is receiving health care services from a source other than the boarding home; and

     (b) The resident has not previously authorized the boarding home to release health care information to an external health care provider.

     (5) When a resident authorizes the release of health care information or resident authorization is not required under RCW 70.02.050, the boarding home must contact the external health care provider and coordinate services.

     (6) When authorizations to release health care information are not obtained, or when an external health care provider is unresponsive to the boarding home's efforts to coordinate services, the boarding home must:

     (a) Document the boarding home's actions to coordinate services;

     (b) Provide notice to the resident of the risks of not allowing the boarding home to coordinate care with the external provider; and

     (c) Address known associated risks in the resident's negotiated care plan.

     (7) When coordinating care or services, the boarding home must take appropriate action when there are observable, reported or unanticipated changes in the resident's physical, mental, or emotional functioning that are not adequately addressed by the external health care provider.

[]

[]

     (2) The boarding home must document any noteworthy or significant changes in each resident's physical, emotional, and mental functioning that may warrant a change in the resident's negotiated care plan.

     (3) The boarding home must ensure each resident is adequately assessed when the boarding home identifies a noteworthy or significant change in the resident's physical, emotional, and mental functioning that may warrant a change in the resident's negotiated care plan.

     (4) The boarding home must take appropriate action in response to each resident's changing assessed needs.

[]

     (2) If adult day care is provided, the boarding home must ensure:

     (a) Each adult day care client receives appropriate supervision, care and needed services during the time spent in the day care program, including:

     (i) Assistance with activities of daily living,

     (ii) Medication assistance,

     (iii) Intermittent nursing care as needed,

     (iv) Appropriate meals and prescribed nutritional supplements, and

     (v) Activity programs appropriate to clients' needs and preferences.

     (b) The care and services provided to adult day care clients do not compromise the care and services provided to boarding home residents; and

     (c) The total number of residents plus adult day care clients does not exceed the boarding home's maximum facility capacity;

     (d) Only accept adult day care clients who are appropriate for boarding home care and services, consistent with WAC 388-78A-0050;

     (e) Provide sufficient furniture for the comfort of day care adults, in addition to furniture provided for residents, including:

     (i) Sturdy, comfortable chairs, appropriate for the age and physical condition of the adult day care clients; and

     (ii) Napping furniture such as lounge chairs, recliners, or couches, if needed or requested, which are placed three or more feet apart.

     (f) Notify appropriate individuals specified in the client's record and consistent with WAC 388-78A-0630 when there is a significant change in the condition of an adult day care client;

     (g) Investigate and document incidents and accidents involving adult day care clients consistent with WAC 388-78A-0680;

     (h) Maintain a separate register of adult day care clients; and

     (i) Maintain a resident record for each adult day care client consistent with record keeping requirements for residents specified in this chapter.

[]

     (a) Information regarding the resident's significant life experiences, including:

     (i) Parents, step-parents, siblings, and step-siblings;

     (ii) Current and former spouses, children, and step-children or other significant relationships;

     (iii) Education and training;

     (iv) Employment and career experiences;

     (v) Religious or spiritual preferences;

     (vi) Familiar roles or sources of pride and pleasure.

     (b) Information regarding the resident's ability or inability to:

     (i) Articulate his or her personal needs; and

     (ii) Initiate activity.

     (c) Information regarding any patterns of resident behavior that express the resident's needs or concerns that the resident is not able to verbalize. Examples of such behaviors include, but are not limited to:

     (i) Agitation;

     (ii) Wandering;

     (iii) Resistance to care;

     (iv) Social isolation; and

     (v) Aggression.

     (2) The boarding home, in consultation with the resident's family or others familiar with the resident, must evaluate the significance and implications of the information obtained per subsection (1) of this section and integrate appropriate aspects into an individualized negotiated care plan for the resident.

[]

     (1) Each resident, or a person authorized under RCW 7.70.065 to provide consent on behalf of the resident, consents to living in such unit or building.

     (2) Each resident assessed as being cognitively and physically able to safely leave the boarding home is able to do so without restriction.

     (3) Each resident, assessed as being cognitively able to safely leave the boarding home but has physical challenges that make exiting difficult, is able to leave the boarding home when the resident desires and in a manner consistent with the resident's negotiated care plan.

     (4) Residents who are assessed as being unsafe to leave the boarding home unescorted are able to leave the boarding home consistent with their negotiated care plans.

     (5) Areas from which egress is restricted are equipped throughout with an approved automatic fire detection system and automatic fire sprinkler system electrically interconnected with a fire alarm system that transmits an alarm off site to a twenty-four hour monitoring station.

     (6) Installation of special egress control devices in all proposed construction issued a project number by Construction Review Services on or after September 1, 2003 must conform to standards adopted by the state building code council.

     (7) Installation of special egress control devices in all construction issued a project number by Construction Review Services prior to September 1, 2003 must conform to the following:

     (a) The egress control device must automatically deactivate upon activation of either the sprinkler system or the smoke detection system.

     (b) The egress control device must automatically deactivate upon loss of electrical power to any one of the following:

     (i) The egress control device itself;

     (ii) The smoke detection system; or

     (iii) The means of egress illumination.

     (c) The egress control device must be capable of being deactivated by a signal from a switch located in an approved location.

     (d) An irreversible process which will deactivate the egress control device must be initiated whenever a manual force of not more than fifteen pounds is applied for two seconds to the panic bar or other door-latching hardware. The egress control device must deactivate within an approved time period not to exceed a total of fifteen seconds. The time delay must not be field adjustable.

     (e) Actuation of the panic bar or other door-latching hardware must activate an audible signal at the door.

     (f) The unlatching must not require more than one operation. A sign must be provided on the door located above and within twelve inches of the panic bar or other door-latching hardware reading:

     "Keep pushing. The door will open in fifteen seconds. Alarm will sound."

     Sign letter must be at least one inch in height and must have a stroke of not less than one-eighth inch.

     Regardless of the means of deactivation, relocking of the egress control device must be by manual means only at the door.

     (8) The boarding home must have a system in place to inform and permit visitors, staff persons and appropriate residents how they can exit without sounding the alarm.

     (9) Units or buildings from which egress is restricted are equipped with a secured outdoor space for walking which:

     (a) Is accessible to residents without staff assistance;

     (b) Is surrounded by walls or fences at least seventy-two inches high;

     (c) Has areas protected from direct sunshine and rain throughout the day;

     (d) Has walking surfaces that are firm, stable, slip-resistant and free from abrupt changes and are suitable for individuals using wheelchairs and walkers;

     (e) Has suitable outdoor furniture; and

     (f) Has plants that are not poisonous or toxic to humans.

[]

     (1) To effectively provide the care and services agreed upon with the resident; and

     (2) To respond appropriately in emergency situations.

[]

     (1) Maintain a systematic and secure method of identifying and filing resident records for easy access;

     (2) Maintain resident records and preserve their confidentiality in accordance with applicable state and federal statutes and rules, including chapters 70.02 and 70.129 RCW;

     (3) Allow authorized representatives of the department and other authorized regulatory agencies access to resident records;

     (4) Provide any resident or other individual or organization access to resident records upon written consent of the resident or the resident's representative, unless state or federal law provide for broader access;

     (5) Allow authorized agents, such as a management company, to use resident records solely for the purpose of providing care and services to residents and ensure that agents do not disclose such records except in a manner consistent with law; and

     (6) Maintain ownership and control of resident records, except that resident records may be transferred to a subsequent person licensed by the department to operate the boarding home.

[]

     (1) Resident identifying information, including resident's:

     (a) Name,

     (b) Birth date,

     (c) Move-in date, and

     (d) Sleeping room identification.

     (2) Current name, address, and telephone number of:

     (a) Resident's primary health care provider;

     (b) Resident's representative, if the resident has one;

     (c) Individual(s) to contact in case of emergency, illness or death; and

     (d) Family members or others, if any, the resident requests to be involved in the development or delivery of services for the resident.

     (3) Resident's written acknowledgment of receipt of:

     (a) Required disclosure information prior to moving into the boarding home, and relevant updates; and

     (b) Long-term care resident rights per RCW 70.129.030.

     (4) The resident's assessment and reassessment information.

     (5) Clinical information such as admission weight, height, blood pressure, temperature, blood sugar and other laboratory tests required by the negotiated care plan.

     (6) The resident's negotiated care plan, including any orders for medications, treatments, and modified or therapeutic diets.

     (7) Provision of medical and nursing services for a resident, including:

     (a) A record of providing medication assistance and medication administration, which contains:

     (i) The medication name, dose, and route of administration;

     (ii) The time and date of any medication assistance or administration;

     (iii) The signature or initials of the person providing any medication assistance or administration; and

     (iv) Documentation of a resident choosing to not take his or her medications.

     (b) A record of any nursing treatments provided by the boarding home including the signature or initials of the person providing them.

     (8) Dates and descriptions of a resident's:

     (a) Accidents,

     (b) Incidents,

     (c) Injuries, and

     (d) Noteworthy and significant changes in condition.

     (9) Staff interventions or responses to subsection (8) of this section, including any modifications made to the resident's negotiated care plan.

     (10) Notices of and reasons for relocation as specified in RCW 70.129.110.

     (11) The individuals who were notified of a significant change in the resident's condition and the time and date of the notification.

     (12) When available, a copy of any legal documents in which:

     (a) The resident has appointed another individual to make his or her health care, financial, or other decisions;

     (b) The resident has created an advance directive or other legal document that establishes a surrogate decision maker in the future and/or provides directions to health care providers; and

     (c) A court has established guardianship on behalf of the resident.

[]

[]

     (2) The boarding home may remove outdated information from the resident's active records that is no longer significant or relevant to the resident's current service and care needs, and maintain it in an inactive record.

     (3) The boarding home must maintain all documentation filed in an inactive record pertaining to a resident on the boarding home premises for six months after the date the resident leaves the boarding home and on the boarding home premises or another location for five years after the date the resident leaves the boarding home.

     (4) All active and inactive records must be available for review by department staff and other authorized persons.

     (5) If a boarding home ceases to operate as a licensed boarding home, the most recent licensee must make arrangements to ensure that the former residents' records are retained according to the times specified in this section and are available for review by department staff and other authorized individuals.

[]

[]

     (2) The boarding home must make this roster immediately available to:

     (a) Authorized department staff;

     (b) Representatives of the long-term care ombudsman's office; and

     (c) Representatives of the Washington State Fire Protection Bureau when conducting fire safety inspections.

     (3) The boarding home must maintain a readily available permanent, current book, computer file, or register with entries in ink or typewritten, of all former boarding home residents within the past five years, including:

     (a) Date of moving in;

     (b) Full name;

     (c) Date of birth;

     (d) Date of moving out;

     (e) Reason for moving out; and

     (f) New address if known.

[]

     (a) Furnish the services and care needed by each resident consistent with the boarding home's disclosure statements provided according to WAC 388-78A-0690;

     (b) Maintain the boarding home free of safety hazards; and

     (c) Implement fire and disaster plans.

     (2) The boarding home must:

     (a) Develop and maintain written job descriptions for the administrator and each staff position and provide each staff person with a copy of his or her job description before or upon the start of employment;

     (b) Verify staff persons' work references prior to hiring;

     (c) Verify required credentialing is current and in good standing for licensed, certified, and registered staff persons;

     (d) Document and retain for twelve weeks, weekly staffing schedules, as planned and worked;

     (e) Ensure all resident care and services are provided only by appropriately qualified staff persons;

     (f) Ensure at least one resident-care staff person, who is eighteen years of age or older and has current cardiopulmonary resuscitation and first-aid cards, is present and available to assist residents at all times:

     (i) When one or more residents are present on the boarding home premises;

     (ii) During boarding home activities off of the boarding home premises; and

     (iii) When staff persons transport a resident.

     (g) Ensure resident-care staff persons provide on site supervision of any resident voluntarily providing services for the boarding home;

     (h) Provide staff orientation and appropriate training for expected duties, including:

     (i) Organization of boarding home;

     (ii) Physical boarding home layout;

     (iii) Specific duties and responsibilities;

     (iv) How to report resident abuse and neglect consistent with chapter 74.34 RCW and boarding home policies and procedures;

     (v) Policies, procedures, and equipment necessary to perform duties;

     (vi) Needs and service preferences identified in the negotiated care plans of residents with whom the resident-care staff persons will be working; and

     (vii) Resident rights, including without limitation, those specified in chapter 70.129 RCW.

     (i) Develop and implement a process to ensure resident care staff persons:

     (i) Acquire the necessary information from the assessment and negotiated care plan relevant to providing services to each resident with whom the staff person works;

     (ii) Are informed of changes in the negotiated care plan of each resident with whom the staff person works; and

     (iii) Are given an opportunity to provide information to responsible staff regarding the resident when assessments and negotiated care plans are updated for each resident with whom the staff person works.

     (j) Ensure all resident-care staff persons have access to resident records relevant to effectively providing care and services to the resident.

     (3) The boarding home must:

     (a) Ensure that staff persons meet the training requirements specified in chapter 388-112 WAC;

     (b) Protect all residents by ensuring any staff person suspected or accused of abuse does not have access to any resident until the boarding home investigates and takes action to ensure resident safety to the satisfaction of the department;

     (c) Not interfere with the investigation of a complaint, coerce a resident or staff person regarding cooperating with a complaint investigation, or conceal or destroy evidence of alleged improprieties occurring within the boarding home;

     (d) Prohibit staff persons from being directly employed by a resident or a resident's family during the hours the staff person is working for the boarding home;

     (e) Maintain the following documentation on the boarding home premises, during employment, and at least two years following termination of employment:

     (i) Staff orientation and training pertinent to duties, including but not limited to:

     (A) Training required by chapter 388-112 WAC, including as appropriate for each staff person, orientation, basic training or modified basic training, specialty training, nurse delegation core training, and continuing education;

     (B) Cardiopulmonary resuscitation;

     (C) First-aid; and

     (D) HIV/AIDS training.

     (ii) Criminal history disclosure and background checks as required in WAC 388-78A-0470; and

     (iii) Verification of contacting work references and professional licensing and certification boards as required by subsection (1) of this section.

     (4) The boarding home is not required to keep on the boarding home premises, staff records that are unrelated to staff performance of duties. Such records include, but are not limited to pay records, and health and insurance benefits for staff.

[]

     (a) Not hire or retain, directly or by contract, any individual having unsupervised access to residents, except as provided in RCW 43.43.842 and subsection (1)(h) of this section, if that individual has been:

     (i) Convicted of a crime against persons as defined in RCW 43.43.830;

     (ii) Convicted of a crime relating to financial exploitation as defined in RCW 43.43.830;

     (iii) Found in any disciplinary board final decision to have abused a vulnerable adult under RCW 43.43.830;

     (vi) The subject in a protective proceeding under chapter 74.34 RCW;

     (v) Convicted of criminal mistreatment; or

     (vi) Found by the department to have abused, neglected, or exploited a vulnerable person in any matter in which an administrative hearing due process right is offered and the finding is upheld through the hearing process or the individual failed to timely appeal the finding.

     (b) Inform each individual identified below who is associated with the boarding home and who will have unsupervised access to residents in the boarding home, of the requirement for a criminal history background check:

     (i) Employees,

     (ii) Managers,

     (iii) Volunteers who are not residents,

     (iv) Contractors,

     (v) Students, and

     (vi) Any other nonresident individuals associated with the boarding home having unsupervised access to residents.

     (c) Require the individuals identified in subsection (1)(b) of this section to complete and sign a DSHS background authorization form prior to the individual having unsupervised access to residents;

     (d) Submit all criminal history background check authorization forms to the department's:

     (i) Aging and disability services administration with the initial application for licensure, and

     (ii) Background Check Central Unit every two years for each individual identified in subsection (1)(b) of this section. A background check result is only valid for two years from the date it is conducted, at which point a new criminal history background check must be conducted.

     (e) Except as provided in subsection (1)(h) of this section, not hire an individual who may have unsupervised access to residents prior to receiving favorable results of the background check.

     (f) Verbally inform the named individual of his/her individual background check results and offer to provide him or her a copy of the background check results within ten days of receipt;

     (g) Ensure that all disclosure statements and background check results are:

     (i) Maintained on site in a confidential and secure manner;

     (ii) Used for employment purposes only;

     (iii) Not disclosed to any individual except:

     (A) The individual named on the background check result;

     (B) Authorized state and federal employees;

     (C) The Washington State Patrol auditor; and

     (D) As otherwise authorized in chapter 43.43 RCW; and

     (iv) Retained and available for department review:

     (A) During the individual's employment or association with a facility, and

     (B) At least two years following termination of employment or association with a facility.

     (h) The boarding home may conditionally employ, contract with, accept as a volunteer or associate, an individual having unsupervised access to residents pending a background inquiry, provided the boarding home:

     (i) Obtains a criminal history background check authorization form from the individual prior to the individual beginning to work or perform volunteer activities; and

     (ii) Submits the criminal history background check authorization form to the department no later than one business day after the individual started working or volunteer activity.

     (2) The department may require the boarding home or any other individual associated with the boarding home who has unsupervised access to residents to complete additional disclosure statements or background inquiries if the department has reason to believe that offenses specified under RCW 43.43.830 have occurred since completion of the previous disclosure statement or background inquiry.

[]

     (a) A staff person must have a baseline two-step skin test within three days of being hired unless the staff person meets the requirements in (b) or (c) of this subsection. The skin test must be:

     (i) Given no more than one to three weeks apart;

     (ii) By intradermal (Mantoux) administration of purified protein derivative (PPD);

     (iii) Read in forty-eight to seventy-two hours of administration, by trained personnel; and

     (iv) Recorded in millimeters of induration.

     (b) A staff person needs to have only a one-step skin test within three days of being hired if:

     (i) There is documented history of a negative result from previous two-step testing, or

     (ii) There was a documented negative result from one-step skin testing in the previous twelve months.

     (c) A staff person does not need to be skin tested for tuberculosis if he/she has:

     (i) Documented history of a previous positive skin test consisting of ten or more millimeters of induration; or

     (ii) Documented evidence of adequate therapy for active disease; or

     (iii) Documented evidence of adequate preventive therapy for infection.

     (d) A staff person must have one-step skin test annually unless he/she has a documented history of a previous positive skin test;

     (e) If a skin test results in a positive reaction, the boarding home must:

     (i) Ensure that the staff person has a chest X-ray within seven days;

     (ii) Report positive chest x-rays to the appropriate public health authority; and

     (iii) Follow precautions ordered by a physician or public health authority.

     (2) The boarding home must:

     (a) Retain in the boarding home for the duration of the staff person's employment, and at least two years following termination of employment, records of:

     (i) Tuberculin test results,

     (ii) Reports of x-ray findings, and

     (iii) Physician or public health official orders.

     (b) Provide staff persons with a copy of the records specified in (a) of this subsection:

     (i) During the time the staff person is employed in the boarding home, limited to one copy per report; and

     (ii) When requested by the staff person.

     (3) The boarding home must ensure that resident-care staff persons caring for a resident with suspected tuberculosis comply with the WISHA standard for respiratory protection.

[]

     (1) A person who meets the eligibility criteria for services defined in chapter 388-825 WAC; or

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

     (a) The condition was manifested before the person reached eighteen;

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

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

     (i) Self-care,

     (ii) Understanding and use of language,

     (iii) Learning,

     (iv) Mobility,

     (v) Self-direction, and

     (vi) Capacity for independent living.

[]

     (1) Who has received the diagnosis or treatment within the previous two years; and

     (2) Whose diagnosis was made by, or treatment provided by, one of the following:

     (a) A licensed physician,

     (b) A mental health professional,

     (c) A psychiatric advanced registered nurse practitioner, or

     (d) A licensed psychologist.

[]

     (2) If the boarding home determines while screening a resident for dementia, that the resident has short-term memory loss, the boarding home must:

     (a) Base the determination upon objective evidence, and

     (b) Document the evidence in the resident's record.

[]

     (2) The licensee must only appoint as a boarding home administrator an individual who meets at least one of the following qualifications listed in (a) through (f) below:

     (a) The individual was actively employed as a boarding home administrator and met existing qualifications on September 1, 2003;

     (b) The individual holds a current state nursing home administrator license in good standing;

     (c) Prior to assuming duties as a boarding home administrator, the individual has met the qualifications listed in both (i) and (ii) below:

     (i) Obtained certification of completing administrator training, or certification of passing an administrator examination, from a department-recognized national accreditation health or personal care organization such as:

     (A) The American Association of Housing and Services for the Aging, or

     (B) The American Health Care Association, or

     (C) The Assisted Living Federation of America, or

     (D) The National Association of Board of Examiners of Long Term Care Administrators.

     (ii) Three years paid experience:

     (A) Providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living; and/or

     (B) Managing persons providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living.

     (d) The individual holds an associate degree in a related field of study such as health, social work, or business administration and meets the qualifications listed in either (i) or (ii) or (iii) below:

     (i) Obtains certification of completing administrator training, or certification of passing an administrator examination, within six months of beginning duties as the administrator, from a department-recognized national accreditation health or personal care organization such as:

     (A) The American Association of Housing and Services for the Aging, or

     (B) The American Health Care Association, or

     (C) The Assisted Living Federation of America, or

     (D) The National Association of Board of Examiners of Long Term Care Administrators.

     (ii) Has two years paid experience:

     (A) Providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living; and/or

     (B) Managing persons providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living.

     (iii) Has completed a qualifying administrator training program supervised by a qualified administrator according to WAC 388-78A-0530.

     (e) The individual holds a bachelors degree in a related field of study such as health, social work, or business administration and meets the qualifications listed in either (i) or (ii) or (iii) below:

     (i) Obtains certification of completing administrator training, or certification of passing an administrator examination, within six months of beginning duties as the administrator, from a department-recognized national accreditation health or personal care organization such as:

     (A) The American Association of Housing and Services for the Aging, or

     (B) The American Health Care Association, or

     (C) The Assisted Living Federation of America, or

     (D) The National Association of Board of Examiners of Long Term Care Administrators.

     (ii) Has one year paid experience:

     (A) Providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living; and/or

     (B) Managing persons providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living.

     (iii) Has completed a qualifying administrator training program supervised by a qualified administrator according to WAC 388-78A-0530.

     (f) Prior to assuming duties as an administrator, the individual has five years of paid experience:

     (i) Providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living; and/or

     (ii) Managing persons providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living.

[]

     (1) The department was notified of the beginning date of the administrator training program;

     (2) The administrator training program was at least six months in duration following notification of the department;

     (3) Only training, supervision, and experience occurring following notification of the department were credited to the qualifying training;

     (4) The supervising administrator met the qualifications to be an administrator specified in WAC 388-78A-0520;

     (5) The trainee was a full-time employee of a boarding home and spent at least forty percent of his/her time for six months of the training program performing administrative duties customarily assigned to boarding home administrators or included in the job description of the administrator for the boarding home in which the training occurred;

     (6) The supervising administrator was present on site at the boarding home during the time the trainee performed administrator duties;

     (7) The supervising administrator spent a minimum of one hundred direct contact hours with the trainee during the six months supervising and consulting with the trainee;

     (8) Both the trainee and supervising administrator signed documentation of the trainee's qualifying experience and the supervising administrator's performance of required oversight duties; and

     (9) The individual completing the qualifying administrator training program maintains the documentation of completing the program.

[]

     (1) Meets the training requirements of chapter 388-112 WAC; and

     (2) Completes department training of Washington state statutes and administrative rules related to the operation of a boarding home.

     (a) The training must include, but is not limited to, an overview of:

     (i) Chapter 18.20 RCW, Boarding homes,

     (ii) Chapter 43.43 RCW, Criminal history background checks,

     (iii) Chapter 74.34 RCW, Abuse of vulnerable adults,

     (iv) Chapter 70.129 RCW, Long-term care resident rights,

     (v) Chapter 388-78A WAC, and

     (vi) Chapter 388-112 WAC, Long-term care services training.

     (b) The introduction to the training must be completed within two weeks of assuming duties as a boarding home administrator.

[]

     (1) Training required per chapter 388-112 WAC, Long-term care services training;

     (2) Department training in an overview of Washington state statutes and administrative rules related to the operation of a boarding home;

     (3) As applicable, certification from a department-recognized national accreditation health or personal care organization; and

     (4) As applicable, the qualifying administrator-training program.

[]

     (1) Adequately directs and supervises the overall twenty-four-hour-per-day operation of the boarding home;

     (2) Ensures residents receive adequate care and services that meet the standards of this chapter;

     (3) Is readily accessible to meet with residents;

     (4) Complies with the boarding home's policies;

     (5) When the administrator is not available on the premises, either:

     (a) Is available in person or by telephone or electronic pager, or

     (b) Designates a person approved by the licensee to act in place of the administrator. The designee must be:

     (i) Qualified by experience to assume designated duties, and

     (ii) Authorized to make decisions and direct operations of the boarding home that are necessary during the administrator's absence.

[]

[]

     (1) The licensee assumes general responsibility for the safety and well-being of the individual;

     (2) The individual requiring such services is not able to receive them in his or her own home and is required to move to another room as a condition for receiving such services;

     (3) The individual receiving such services is required to receive them from the licensee as a condition for residing in the building, and is not free to receive such services from any appropriately licensed provider of his or her choice; or

     (4) The licensee provides other care or services to the individual, that falls under the jurisdiction of boarding home licensing and this chapter.

[]

     (2) The licensee may enter into a management agreement only if the management agreement creates a principal/agent relationship between the licensee and the manager.

     (3) The licensee must ensure the manager acts in conformance with a department-approved management agreement with the boarding home licensee.

     (4) A licensee must not delegate the following to a manager:

     (a) The licensee's responsibility to ensure that the boarding home is operated in a manner consistent with all laws and rules applicable to boarding homes;

     (b) The licensee's responsibility to review, acknowledge and sign all boarding home initial and renewal license applications.

     (5) The licensee must ensure that its manager does not represent itself as, or give the appearance that it is the licensee.

     (6) A duly authorized manager may execute resident leases or agreements on behalf of the licensee, but all such resident leases or agreements must be between the licensee and the resident.

     (7) The licensee must notify the department of its use of a manager and provide a copy of any written management agreement to the department upon the following:

     (a) Initial application for a license;

     (b) Retention of a manager following initial application;

     (c) Change of managers; or

     (d) Modification of existing management agreement.

[]

     (a) Maintain or enhance the quality of life for residents;

     (b) Provide the necessary care and services for residents, including those with special needs; and

     (c) Safely operate the boarding home.

     (2) The boarding home must develop, implement and train staff persons on policies and procedures to address what staff persons must do:

     (a) When there is reason to believe a resident is not capable of making necessary decisions and no substitute decision-maker is available;

     (b) When a substitute decision-maker is no longer appropriate because:

     (i) The resident's condition has changed; or

     (ii) The substitute decision-maker is not acting according to chapters 7.70, 11.88, 11.92, 11.94, or 70.122 RCW, or other applicable statutes or rules.

     (c) When a resident stops breathing or a resident's heart appears to stop beating, including the action staff persons must take:

     (i) Related to cardio-pulmonary resuscitation (CPR);

     (ii) Related to calling 911;

     (iii) When a resident has documents related to Emergency Medical Services (EMS) No CPR Guidelines consistent with chapter 43.70 RCW and chapter 246-976 WAC;

     (iv) To provide EMS personnel with a copy of the resident's advance directive when the resident has executed an advance directive;

     (v) When a resident has a do-not-resuscitate (DNR) order/ directive from a health professional;

     (vi) When a resident has a full code directive;

     (vii) When a resident has not made known his or her decision or preferences about CPR;

     (viii) When a resident is incompetent and not able to make a decision about CPR; and

     (ix) When a resident is in a hospice program.

     (d) When a resident does not have a personal physician or health care provider;

     (e) In response to medical emergencies;

     (f) When there are urgent situations in the boarding home requiring additional staff support;

     (g) In the event of an internal or external disaster, consistent with WAC 388-78A-0680;

     (h) To supervise and monitor residents, including accounting for residents who leave the premises;

     (i) To appropriately respond to aggressive or assualtive residents, including but not limited to:

     (i) Actions to take if a resident becomes violent,

     (ii) Actions to take to protect other residents, and

     (iii) When and how to seek outside intervention.

     (j) To prevent and limit the spread of infections consistent with WAC 388-78A-0610;

     (k) To manage residents' medications, consistent with WAC 388-78A-0180 through 388-78A-0260, including:

     (i) How medications will be ordered and brought into the boarding home;

     (ii) Actions to take if a resident's medications are not available;

     (iii) Recording and documenting prescriber's orders;

     (iv) Providing and documenting medication assistance;

     (v) Providing and documenting medication administration, if this service is provided in the boarding home;

     (vi) Sending medications with a resident when the resident leaves the premises;

     (vii) Safe and secure storage of medications;

     (viii) Inventory of schedule II and III drugs;

     (ix) Disposing of discontinued and/or outdated medications;

     (x) Use of medication organizers; and

     (xi) Actions to take when a resident chooses not to take prescribed medications.

     (l) When services related to medications and treatments are provided under the delegation of registered nurse consistent with chapter 246-840 WAC;

     (m) Related to food services consistent with chapter 246-215 WAC, including:

     (i) Food service sanitation,

     (ii) Procuring and storing food,

     (iii) Food preparation, and

     (iv) Modified diets and nutritional supplements.

     (n) Regarding the safe operation of any boarding home vehicles used to transport residents, and the qualifications of the drivers.

     (3) The boarding home must make the policies and procedures specified in subsection (2) of this section available to staff persons at all times and residents and residents' representatives upon request.

[]

     Reviser's note: The spelling 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 388-78A-0605   Pets.   If a boarding home allows pets to live on the premises, the boarding home must:

     (1) Develop and implement policies regarding:

     (a) The types of pets that are permitted in the boarding home, and

     (b) The conditions under which pets may be in the boarding home.

     (2) Ensure animals living on the boarding home premises:

     (a) Have regular examinations and immunizations, appropriate for the species, by a veterinarian licensed in Washington state;

     (b) Are certified by a veterinarian to be free of diseases transmittable to humans;

     (c) Are restricted from:

     (i) Central food preparation areas; and

     (ii) Residents who object to the presence of pets.

[]

     (2) The boarding home must:

     (a) Develop and implement a system to identify and manage infections;

     (b) Restrict a staff person's contact with residents when the staff person has a known communicable disease in the infectious stage that is likely to be spread in the boarding home setting or by casual contact;

     (c) Provide staff persons with the necessary supplies, equipment and protective clothing for preventing and controlling the spread of infections;

     (d) Provide all resident care and services according to current acceptable standards for infection control;

     (e) Perform all housekeeping, cleaning, laundry, and management of infectious waste according to current acceptable standards for infection control;

     (f) Report communicable diseases in accordance with the requirements in chapter 246-100 WAC.

[]

     (a) Makes a report to the department consistent with chapter 74.34 RCW in all cases where the staff person has reasonable cause to believe that abandonment, abuse, financial exploitation, or neglect of a vulnerable adult has occurred; and

     (b) Makes an immediate report to the appropriate law enforcement agency and the department consistent with chapter 74.34 RCW of all incidents of suspected sexual abuse or physical abuse of a resident.

     (2) The boarding home must prominently post so it is readily visible to staff, residents and visitors, the department's toll-free telephone number for reporting resident abuse and neglect.

[]

     (a) There is a significant change in the resident's condition;

     (b) The resident is relocated to a hospital or other health care facility; or

     (c) The resident dies.

     (2) The boarding home must notify any agency responsible for paying for the resident's care and services as soon as possible whenever:

     (a) The resident is relocated to a hospital or other health care facility; or

     (b) The resident dies.

     (3) Whenever the conditions in subsections (1) or (2) of this section occur, the boarding home must document in the resident's records:

     (a) The date and time each individual was contacted; and

     (b) The individual's relationship to the resident.

     (4) In case of a resident's death, the boarding home must notify the coroner if required by RCW 68.50.010.

[]

     (1) Any fire in the boarding home;

     (2) Any unusual incident having an actual or potential negative impact on residents and that could or did require implementation of the boarding home's disaster plan, including any evacuation of all or part of the residents to another area of the boarding home or to another address; and

     (3) Circumstances which threaten the boarding home's ability to ensure continuation of services to residents.

[]

     (1) Comply with chapter 70.129 RCW, Long-term care residents rights;

     (2) Ensure all staff persons are knowledgeable of the requirements of chapter 70.129 RCW and provide care and services to each resident consistent with chapter 70.129 RCW;

     (3) Not use restraints on any resident;

     (4) Promote and protect the residents' exercise of all rights granted under chapter 70.129;

     (5) Provide care and services to each resident in compliance with applicable state statutes related to substitute health care decision-making, including chapters 7.70, 70.122, 11.88, 11.92, and 11.94 RCW; and

     (6) Reasonably accommodate residents consistent with applicable state and/or federal law.

[]

     (1) The resident freely volunteers to perform the services without coercion or pressure from staff persons;

     (2) Resident-care staff persons provide on-site supervision of the resident's performance of any services;

     (3) The resident performing services does not supervise, or is not placed in charge of, other residents; and

     (4) If the resident regularly performs voluntary services for the benefit of the boarding home, the volunteer activity is addressed in the resident's negotiated care plan.

[]

     (a) Any audio monitoring on the boarding home premises; or

     (b) Any audio monitoring used in combination with video monitoring.

     (2) The boarding home may video monitor and/or video record activity on the boarding home premises, without an audio component, only in the following areas:

     (a) Boarding home entrances and exits if the camera(s) is:

     (i) Focused only on the entrance/exit doorways, and

     (ii) Not focused on areas where residents may congregate.

     (b) Areas used exclusively by staff persons such as, but not limited to, medication storage areas or food preparation areas, if residents do not go into these areas;

     (c) Outdoor areas not commonly used by residents, such as, but not limited to, delivery areas; and

     (d) Designated smoking areas excluding resident rooms, subject to the following conditions:

     (i) When the area is being used by residents assessed as needing supervision for smoking, a staff person must watch the video monitor at any time the area is being used by such residents for smoking;

     (ii) The video camera must be placed in a clearly visible area;

     (iii) The video monitor must be placed where it cannot be viewed by the general public; and

     (iv) All residents in the facility must be notified of the use of the video monitoring.

[]

     (2) If a resident requests video or audio monitoring in his/her sleeping room or apartment, before any monitoring occurs the boarding home must ensure:

     (a) Appropriate actions are taken to ensure monitoring is consistent with and does not violate chapter 9.73 RCW;

     (b) The resident has identified a threat to his or her safety or health, or the safety of his or her possessions, and has requested electronic monitoring;

     (c) The resident's roommate has provided written consent to the monitoring, if the resident has a roommate; and

     (d) The resident and the boarding home have agreed upon a specific duration for the use of the monitoring, and the boarding home has documented this.

     (3) The boarding home must re-evaluate the need for resident-initiated electronic monitoring with the resident at least quarterly or more often as appropriate.

     (4) The boarding home must discontinue the use of resident-initiated electronic monitoring immediately if:

     (a) The resident no longer desires it,

     (b) The roommate objects to the use, or

     (c) The resident becomes unable to give consent.

[]

     (2) The boarding home must:

     (a) Maintain the premises free of hazards;

     (b) Maintain any vehicles used for transporting residents in a safe condition;

     (c) Investigate and document investigative actions and findings for any alleged or suspected neglect or abuse or exploitation, accident or incident jeopardizing or affecting a resident's health or life. The boarding home must:

     (i) Determine the circumstances of the event; and

     (ii) Institute and document appropriate measures to prevent similar future situations if the alleged incident is substantiated.

     (d) Provide appropriate hardware on doors of storage rooms, closets and other rooms to prevent residents from being accidentally locked in;

     (e) Provide, and advise staff persons of, a means of emergency access to resident-occupied bedrooms, toilet rooms, bathing rooms, and other rooms;

     (f) Provide emergency lighting or flashlights in all areas of the boarding home. For all boarding homes first issued a project number by Construction Review Services on or after September 1, 2003 the boarding home must provide emergency lighting in all areas of the boarding home;

     (g) Make sure first-aid supplies are:

     (i) Readily available and not locked,

     (ii) Clearly marked,

     (iii) Able to be moved to the location where needed, and

     (iv) Stored in containers that protect them from damage, deterioration, or contamination.

     (h) Make sure first-aid supplies are appropriate for:

     (i) The size of the boarding home,

     (ii) The services provided,

     (iii) The residents served, and

     (iv) The response time of emergency medical services.

     (i) Develop and maintain a current disaster plan describing measures to take in the event of internal or external disasters, including but not limited to:

     (i) On-duty staff persons' responsibilities;

     (ii) Provisions for summoning emergency assistance;

     (iii) Plans for evacuating residents from area or building;

     (iv) Alternative resident accommodations;

     (v) Provisions for essential resident needs, supplies and equipment including water, food, and medications; and

     (vi) Emergency communication plan.

[]

     (2) The boarding home must provide services in the boarding home consistent with the information the boarding home disclosed to the public on the department's approved disclosure forms.

     (3) The boarding home must notify potential residents of their right to execute a health care directive consistent with chapter 70.122 RCW, before or at the time the individual moves into the boarding home.

[]

     (a) In response to a request by a prospective resident or his or her representative for written information about the boarding home's services and capabilities; or

     (b) If no such request for written information was previously made by the resident or his or her representative, at the time the boarding home provides an application for residency at the boarding home and with any admission agreements or contracts, if not previously received by the prospective resident.

     (2) The boarding home is not required to provide the detailed disclosure of services contained on the department's approved disclosure forms:

     (a) In advertisements;

     (b) In general marketing information to the public; or

     (c) To persons seeking preliminary information regarding residential care resources in the community.

[]

     (1) If the department finds any person unqualified as specified in WAC 388-78A-1190, the department must deny, terminate, or not renew the license.

     (2) If the department finds any person unqualified as specified in WAC 388-78A-1160, the department may deny, terminate, or not renew the license.

[]

     (1) Information in the application; and

     (2) Other documents and information the department deems relevant, including inspection and complaint investigation findings for each facility with which the applicant or any partner, officer, director, managerial employee, or owner of five percent or more of the entity applicant has been affiliated.

[]

     (1) Submit to the department a complete license application on forms designated by the department at least ninety days prior to the proposed effective date of the license;

     (2) Submit all relevant attachments specified in the application;

     (3) Submit criminal history background requests as required in WAC 388-78A-0470;

     (4) Sign the application;

     (5) Submit the license fee as specified in WAC 388-78A-1240;

     (6) Submit verification that construction plans have been approved by construction review services;

     (7) Submit a revised application before the license is issued if any information has changed since the initial license application was submitted;

     (8) Submit a revised application containing current information about the proposed licensee or any other persons or entities named in the application, if a license application is pending for more than one year; and

     (9) If the licensee's agent prepares an application on the licensee's behalf, the licensee must review, sign and attest to the accuracy of the information contained in the application.

[]

     (1) Ensure the person who wants to become the new licensee:

     (a) Submits a completed license application on forms designated by the department, at least ninety days prior to the proposed effective date of a change in the licensee;

     (b) Signs the application;

     (c) Submits the annual license fee, if a licensing fee is due;

     (d) Submits evidence of control of the real estate on which the boarding home is located, such as a purchase and sales agreement, lease contract, or other appropriate document;

     (e) Submits a revised application if any information included on the original application is no longer accurate; and

     (f) Completes and submits a revised application if requested by the department.

     (2) Notify the department and all residents of the proposed change in licensee at least sixty days prior to the proposed date of transfer, including the following information;

     (a) Name of the present licensee and prospective licensee;

     (b) Name and address of the boarding home being transferred;

     (c) Date of proposed transfer; and

     (d) If the boarding home contracts with the department or other public agencies that may make payments for residential care on behalf of residents, the anticipated effect the change of licensee will have on residents whose care and services are supported through these contracts.

     (3) Send a letter to the department stating the licensee's intent to relinquish the boarding home license on the effective date of change in licensee.

[]

     (1) Submit a completed license renewal application on forms designated by the department, at least thirty days prior to the license expiration date;

     (2) Sign the application;

     (3) Submit the annual renewal license fee as specified in WAC 388-78A-1240; and

     (4) If the licensee's agent prepares a renewal application on the licensee's behalf, the licensee must review, sign and attest to the accuracy of the information contained on the renewal application.

[]

     (a) The operation of the boarding home;

     (b) Complying with the requirements of this chapter, chapter 18.20 RCW, and other applicable laws and rules; and

     (c) The care and services provided to the boarding home residents.

     (2) The licensee must:

     (a) Maintain the occupancy level at or below the licensed resident bed capacity of the boarding home;

     (b) Maintain and post in a size and format that is easily read, in a conspicuous place on the boarding home premises:

     (i) A current boarding home license,

     (ii) The name, address and telephone number of:

     (A) The department,

     (B) The local legal services program,

     (C) Appropriate resident advocacy groups, and

     (D) State and local long-term care ombudsman with a brief description of ombudsman services.

     (iii) A copy of the report and plan of correction of the most recent full inspection conducted by the department;

     (c) Ensure any party responsible for holding or managing residents' personal funds is bonded, or obtains insurance in sufficient amounts, to specifically cover losses of resident funds; and provides proof of bond or insurance to the department.

     (3) The licensee must not delegate to any person responsibilities that are so extensive that the licensee is relieved of responsibility for the daily operations and provisions of services in the boarding home.

     (4) The licensee must act in accord with any department-approved management agreement, if the licensee has entered into a management agreement.

     (5) The licensee must appoint the boarding home administrator consistent with WAC 388-78A-0520.

[]

     (a) The licensee's form of legal organization is changed (e.g., a sole proprietor forms a partnership or corporation);

     (b) The licensee transfers ownership of the boarding home business enterprise to another party regardless of whether ownership of some or all of the real property and/or personal property assets of the boarding home is also transferred;

     (c) The licensee dissolves, or consolidates or merges with another legal organization and the licensee's legal organization does not survive;

     (d) If, during any continuous twenty-four-month period, fifty percent or more of the "licensed entity" is transferred, whether by a single transaction or multiple transactions, to:

     (i) A different party (e.g., new or former shareholders), or

     (ii) A person that had less than a five percent ownership interest in the boarding home at the time of the first transaction; or

     (e) Any other event or combination of events that results in a substitution, elimination, or withdrawal of the licensee's control of the boarding home. "Control" as used in this section means the possession, directly or indirectly, of the power to direct the management, operation and/or policies of the licensee or boarding home, whether through ownership, voting control, by agreement, by contract or otherwise.

     (2) The licensee is not required to change when the following, without more, occur:

     (a) The licensee contracts with a party to manage the boarding home enterprise as the licensee's agent pursuant to an agreement as specified in WAC 388-78A-0590; or

     (b) The real property or personal property assets of the boarding home are sold or leased, or a lease of the real property or personal property assets is terminated, as long as there is not a substitution or substitution of control of the licensee or boarding home.

[]

     (1) Submit a completed request for approval to the department at least thirty days before the intended change;

     (2) Submit the prorated fee required according to WAC 388-78A-1240; and

     (3) Obtain an amended license indicating the new bed capacity.

[]

     (1) Obtain construction review services' review and approval of the additional rooms or beds, and related auxiliary spaces, if not previously reviewed and approved; and

     (2) Ensure the increased licensed bed capacity does not exceed the maximum facility capacity as determined by the department.

[]

     (1) Design plans according to the building code, local codes and ordinances, and this chapter;

     (2) Submit construction documents, including any change orders and addenda to:

     (a) Construction review services per WAC 388-78A-0830, and

     (b) Local county or municipal building departments per local codes to obtain necessary building permits.

     (3) Conform to the approved construction documents during construction in accordance with chapter 18.20 RCW;

     (4) Obtain written approval from construction review services prior to deviating from approved construction documents;

     (5) Provide construction review services with a:

     (a) Written notice of completion date,

     (b) Copy of reduced floor plan(s), and

     (c) Copy of certificate of occupancy issued by the local building department.

     (6) Obtain authorization from department prior to providing domiciliary care in the new construction area.

[]

     (2) If the licensee provides contracted Enhanced Adult Residential Care services in the building converted from a licensed nursing home into a licensed boarding home, the boarding home licensing requirements for the physical structure are considered to be met if the most recent nursing home inspection report for the nursing home building demonstrates compliance, and compliance is maintained, with safety standards and fire regulations:

     (a) As required by RCW 18.51.140; and

     (b) Specified in the applicable building code, as required by RCW 18.51.145, including any waivers that may have been granted, except that the licensee must ensure the building meets the licensed boarding home standards, or their functional equivalency, for:

     (i) Resident to bathing fixture ratio required per WAC 388-78A-1010,

     (ii) Resident to toilet ratio required per WAC 388-78A-1010,

     (iii) Corridor call system required per WAC 388-78A-0910,

     (iv) Resident room door closures, and

     (v) Resident room windows required per WAC 388-78A-0990.

     (3) If the licensee does not continue to provide contracted enhanced adult residential care services in the boarding home converted from a licensed nursing home, the licensee must meet all boarding home licensing requirements specified in this chapter and chapter 18.20 RCW.

[]

     (a) All of the buildings are located on the same property with the same legal description; or

     (b) All of the buildings are located on contiguous properties undivided by:

     (i) Public streets, not including alleyways used primarily for delivery services or parking, or

     (ii) Other land that is not owned and maintained by the owners of the property on which the boarding home is located.

     (2) The licensee must have separate boarding homes licenses for buildings that are not located on the same or contiguous properties.

     (3) Buildings that construction review services reviewed only as an addition to, or a remodel of, an existing boarding home must not have separate boarding home licenses.

[]

     (a) A new building to be used as a boarding home or part of a boarding home;

     (b) An addition of, or modification or alteration to an existing boarding home, including but not limited to, the boarding home's:

     (i) Physical structure;

     (ii) Electrical fixtures or systems;

     (iii) Mechanical equipment or systems;

     (iv) Plumbing fixtures or systems;

     (v) Fire alarm fixtures or systems;

     (vi) Fire sprinkler fixtures or systems; and

     (vii) Kitchen or laundry equipment.

     (c) A change in the department approved use of an existing boarding home or portion of a boarding home; and

     (d) An existing building or portion thereof to be converted for use as a boarding home.

     (2) A person or boarding home does not need to notify construction review services of the following:

     (a) Repair or maintenance of equipment, furnishings or fixtures;

     (b) Replacement of equipment, furnishings or fixtures with equivalent equipment, furnishings or fixtures;

     (c) Repair or replacement of damaged construction if the repair or replacement is performed according to construction documents approved by construction review services within eight years preceding the current repair or replacement;

     (d) Painting, wall papering, and carpeting; or

     (e) Cosmetic changes that do not affect resident activities, services, or care and are performed in accordance with the current edition of Chapter 8 of the building code.

     (3) The boarding home must include in its notification to construction review services, the likely adverse impacts of the construction process on current boarding home residents.

     (4) The boarding home must submit plans to construction review services as directed by construction review services prior to beginning any construction. The plans must provide an analysis of likely adverse impacts on current boarding home residents and plans to eliminate or mitigate such adverse impacts.

[]

     (a) Notify the department at least thirty days prior to the anticipated move date, of the boarding home's plans for relocating residents, including:

     (i) How the residents will be informed of the required move and their options consistent with chapter 70.129 RCW;

     (ii) The location to which the residents will be relocated;

     (iii) The boarding home's plans for providing care and services during the relocation;

     (iv) The boarding home's plans for returning residents to the building; and

     (v) The projected time frame for completing the construction.

     (b) Obtain the department's approval for the relocation plans prior to relocating residents.

     (2) If the boarding home moves out all of the residents from the boarding home without first obtaining the department's approval of the relocation plans, the boarding home is closed for business and the department may revoke the licensee's boarding home license.

[]

[]

     (1) Notify construction review services:

     (a) In writing,

     (b) Thirty days or more before the intended change in use, and

     (c) Describe the current and proposed use of the room.

     (2) Obtain the written approval of construction review services for the new use of the room.

[]

     (a) Obtain approval by construction review services, of final construction documents prior to starting any construction, except for fire alarm plans, fire sprinkler plans, and landscaping plans.

     (b) Obtain approval by construction review services, of landscaping, fire alarm and fire sprinkler plans prior to their installation.

     (2) The department will not issue a boarding home license unless construction review services:

     (a) Notifies the department that construction has been completed;

     (b) Provides the department:

     (i) A copy of the certificate of occupancy granted by the local building official;

     (ii) A copy of the Functional Program; and

     (iii) A reduced copy of the approved floor plan indicating room numbers or names and the approved use.

[]

     (1) Specification data on materials used in construction, for the life of the product;

     (2) Stamped "approved" set of construction documents.

[]

     (2) Existing licensed boarding homes must continue to meet the building codes in force at the time of their initial licensing.

[]

     (a) Storage and handling of clean and sterile nursing equipment and supplies; and

     (b) Cleaning and disinfecting soiled nursing equipment.

     (2) For all boarding homes first issued a project number by Construction Review Services on or after September 1, 2003 in which intermittent nursing services are provided, or upon initiating intermittent nursing services within an existing boarding home, the boarding home must provide the following two separate rooms in each boarding home building, accessible only by staff persons:

     (a) A "clean" utility room for the purposes of storing and preparing clean and sterile nursing supplies, equipped with:

     (i) A work counter or table;

     (ii) Hand washing sink, with soap and paper towels or other approved hand-drying device; and

     (iii) Locked medication storage, if medications are stored in this area, that is separate from all other stored items consistent with WAC 388-78A-0230.

     (b) A "soiled" utility room for the purposes of storing soiled linen, cleaning and disinfecting soiled nursing care equipment, and disposing of refuse infectious waste, equipped with:

     (i) A work counter or table;

     (ii) A two-compartment sink for hand washing and equipment cleaning and sanitizing;

     (iii) A clinical service sink or equivalent for rinsing and disposing of waste material;

     (iv) Soap and paper towels or other approved hand-drying device; and

     (v) Locked storage for cleaning supplies, if stored in the area.

[]

     (a) Provides residents and staff with the means to summon on-duty staff assistance from:

     (i) Resident units;

     (ii) Common areas accessible to residents;

     (iii) Corridors accessible to residents; and

     (iv) All bathrooms and all toilet rooms in boarding homes issued a project number by Construction Review Services on or after September 1, 2003.

     (b) Provides residents, families, and other visitors with the means to contact staff inside the building from outside the building after hours.

     (2) The boarding home must provide one or more non-pay telephones:

     (a) In each building located for ready access by staff; and

     (b) On the premises for reasonable access and privacy by residents.

     (3) In boarding homes issued a project number by Construction Review Services on or after September 1, 2003, the boarding home must equip each resident room with:

     (a) An intercom system with a mechanism that allows a resident to control:

     (i) Whether or not announcements are broadcast into the resident's room, and

     (ii) Whether or not voices or conversations within the resident's room can be monitored or listened to by persons outside the resident's room.

     (b) Two telephone lines that are compatible with:

     (i) Telecommunication devices for the deaf equipment, and

     (ii) Telephones that have:

     (A) Visual signals for ringing, and

     (B) Voice amplification.

     (c) Television cable access where available in the community.

[]

     (1) A resident initiates the contact; or

     (2) Staff persons announce to the resident that the intercom has been activated at the time it is activated, and:

     (a) The resident and any others in the room agree to continue the contact,

     (b) A visible signal is activated in the resident's room at all times the intercom is in operation, and

     (c) The boarding home deactivates the intercom when the conversation is complete.

[]

     (1) Provide water meeting the provisions of chapter 246-290 WAC, Group A public water supplies or 246-291 WAC, Group B public water systems;

     (2) Maintain the boarding home water systems free of cross-connections as specified in Cross-Connection Control Manual, 6th Edition, published by the Pacific Northwest Section of the American Water Works Association;

     (3) Provide hot and cold water under adequate pressure readily available throughout the boarding home;

     (4) Provide all sinks and bathing fixtures used by residents with hot water between 105 and 120° F at all times;

     (5) Label or color code nonpotable water supplies "unsafe for domestic use"; and

     (6) Meet laundry and dishwashing water temperature requirements consistent with WAC 388-78A-1020 and 388-78A-0270.

[]

     (1) Ensure all sewage and waste water drain into a municipal sewage disposal system if available; or

     (2) Provide on-site sewage disposal systems designed, constructed, and maintained as required by chapter 246-272 and 173-240 WAC, and local ordinances; and

     (3) Provide a grease interceptor when the boarding home has an on-site commercial kitchen.

[]

     (1) Provide an adequate number of garbage containers to store refuse generated by the boarding home:

     (a) Located in a storage area convenient for resident and staff use;

     (b) Constructed of nonabsorbent material;

     (c) Cleaned and maintained to prevent:

     (i) Entrance of insects, rodents, birds, or other pests;

     (ii) Odors; and

     (iii) Other nuisances.

     (2) Assure garbage and waste containers are emptied frequently to prevent hazards and nuisances; and

     (3) Provide for safe and sanitary collection and disposal of:

     (a) Garbage and refuse,

     (b) Infectious waste, and

     (c) Waste grease from the kitchen.

[]

     (2) The boarding home must maintain lighting in common areas that meets Illuminating Engineering Society (IES) recommendations as follows:

AVERAGE MAINTAINED FOOTCANDLES
Area	Ambient Light	Task Light
Toilet, Bathing and Laundry Facilities	30	50
Dining/Day Rooms	50	NA
Corridors, Hallways, and Stairways	30	NA
Janitor's Closet and Utility Rooms	30	NA

     (3) The boarding home must provide enough lighting in each resident's room to meet the resident's needs, preferences and choices.

[]

     (1) Equip each resident-occupied building with an approved heating system capable of maintaining a minimum temperature of 75° F per the building code.

     (2) Equip each resident-occupied building with a mechanical air cooling system or equivalent capable of maintaining a temperature of 75° F in communities where the design dry bulb temperature exceeds 85° F for one hundred seventy-five hours per year or two percent of the time, as specified in the latest edition of "Recommended Outdoor Design Temperatures--Washington State," published by Puget Sound chapter of American Society of Heating, Refrigeration, and Air-Conditioning Engineers;

     (3) Equip each boarding home issued a project number by Construction Review Services on or after September 1, 2003 with a backup source of heat in enough common areas to keep all residents adequately warm during interruptions of normal heating operations;

     (4) Prohibit the use of portable space heaters unless approved in writing by the Washington state director of fire protection; and

     (5) Equip each resident sleeping room and resident living room in boarding homes issued a project number by Construction Review Services on or after September 1, 2003 with individual temperature controls located between thirty and forty-eight inches above the floor capable of maintaining room temperature plus or minus three degrees Fahrenheit from setting, within a range of minimum 60 degrees to maximum 85° F.

[]

     (1) Ventilate rooms to:

     (a) Prevent excessive odors or moisture, and

     (b) Remove smoke.

     (2) Designate and ventilate smoking areas, if smoking is permitted in the boarding home, to prevent air contamination throughout the boarding home;

     (3) Provide intact sixteen mesh screens on operable windows and openings used for ventilation; and

     (4) Prohibit screens that may restrict or hinder escape or rescue through emergency exit openings.

[]

     (a) Eighty or more square feet of usable floor space in a one-person sleeping room;

     (b) Seventy or more square feet of usable floor space per individual in a sleeping room occupied by two or more individuals, except:

     (i) When a resident sleeping room is located within a private apartment; and

     (ii) The private apartment includes a resident sleeping room, a resident living room, and a private bathroom; and

     (iii) The total square footage in the private apartment equals or exceeds two hundred twenty square feet excluding the bathroom; and

     (iv) There are no more than two residents living in the apartment; and

     (v) Both residents mutually agree to share the resident sleeping room; and

     (vi) All other requirements of this section are met, then the two residents may share a sleeping room with less than one hundred forty square feet.

     (c) A maximum sleeping room occupancy of:

     (i) Four individuals if the boarding home was licensed before July 1, 1989, and licensed continuously thereafter; and

     (ii) Two individuals if the boarding home, after June 30, 1989:

     (A) Applied for initial licensure, or

     (B) Applied to increase the number of resident sleeping rooms, or

     (C) Applied to change the use of rooms into sleeping rooms.

     (d) Unrestricted direct access to a hallway, living room, outside, or other common-use area;

     (e) One or more outside windows with:

     (i) Window sills at or above grade, with grade extending horizontally ten or more feet from the building; and

     (ii) Adjustable curtains, shades, blinds, or equivalent for visual privacy.

     (f) One or more duplex electrical outlets per bed if the boarding home was initially licensed after July 1, 1983;

     (g) A light control switch located by the entrance for a light fixture in the room;

     (h) An individual towel and washcloth rack or equivalent, except when there is a private bathroom attached to the resident sleeping or living room, the individual towel and washcloth rack may be located in the attached private bathroom;

     (i) In all boarding homes issued a project number by Construction Review Services on or after September 1, 2003, and when requested by a resident in a boarding home licensed on or prior to September 1, 2003, provide a lockable drawer, cupboard or other secure space measuring at least one-half cubic foot with a minimum dimension of four inches;

     (j) Storage facilities in or immediately adjacent to the resident's sleeping room to adequately store a reasonable quantity of clothing and personal possessions;

     (k) A configuration to permit all beds in the resident sleeping room to be spaced at least three feet from other beds unless otherwise requested by all affected residents.

     (2) The boarding home must ensure each resident sleeping room contains:

     (a) A comfortable bed for each resident, except when two residents mutually agree to share a bed. The bed must be thirty-six or more inches wide for a single resident and fifty-four or more inches wide for two residents, appropriate for size, age and physical condition of the resident and room dimensions, including but not limited to:

     (i) Standard household bed,

     (ii) Studio couch,

     (iii) Hide-a-bed,

     (iv) Day bed, or

     (v) Water bed, if structurally and electrically safe.

     (b) A mattress for each bed which:

     (i) Fits the bed frame,

     (ii) Is in good condition, and

     (iii) Is at least four inches thick unless otherwise requested or necessary for resident health or safety.

     (c) One or more comfortable pillows for each resident;

     (d) Bedding for each bed, in good repair; and

     (e) Lighting at the resident's bedside when requested by the resident.

     (3) The boarding home must not allow a resident sleeping room to be used as a passageway or corridor.

     (4) The boarding home may use or allow use of carpets and other floor coverings only when the carpet is:

     (a) Securely fastened to the floor or provided with nonskid backing; and

     (b) Kept clean and free of hazards, such as curling edges or tattered sections.

     (5) The boarding home must ensure each resident has either a sleeping room or resident living room that contains a sturdy, comfortable chair appropriate for the age and physical condition of the resident. This requirement does not mean a boarding home is responsible for supplying specially designed orthotic or therapeutic chairs, including those with mechanical lifts or adjustments.

[]

     (1) Including:

     (a) Areas under moveable furniture; and

     (b) Areas of door swings and entry ways into the sleeping room.

     (2) Excluding:

     (a) Areas under ceilings less than seven feet six inches high;

     (b) Closet space and built-in storage;

     (c) Areas under counters, sinks, or appliances; and

     (d) Bathrooms and toilet rooms.

[]

     (2) The boarding home must provide each toilet room and bathroom with:

     (a) Water resistant, smooth, low gloss, non-slip and easily cleanable materials;

     (b) Washable walls to the height of splash or spray;

     (c) Grab bars installed and located to minimize accidental falls including one or more grab bars at each:

     (i) Bathing fixture, and

     (ii) Toilet.

     (d) Plumbing fixtures designed for easy use and cleaning and kept in good repair; and

     (e) Adequate mechanical ventilation to the outside of the boarding home.

     (3) The boarding home must provide each toilet room with a:

     (a) Toilet with a clean, nonabsorbent seat free of cracks;

     (b) Hand washing sink in or adjacent to the toilet room. For boarding homes issued a project number by Construction Review Services on or after September 1, 2003, the hand washing sink must be in the toilet room or in an adjacent private area that is not part of a common use area of the boarding home; and

     (c) Suitable mirror with adequate lighting for general illumination.

     (4) For boarding homes approved for construction or initially licensed after August 1, 1994, the boarding home must provide a toilet and hand washing sink in, or adjoining, each bathroom.

     (5) When providing common-use toilet rooms and bathrooms, the boarding home must provide toilets and hand washing sinks for residents in the ratios of one toilet and one hand washing sink for every eight residents as listed in the following table:

Number of Residents	Number of Toilets*	Number of Hand Washing Sinks
1-8	1	1
9-16	2	2
17-24	3	3
25-32	4	4
33-40	5	5
41-48	6	6
49-56	7	7
57-64	8	8
65-72	9	9
73-80	10	10
81-88	11	11
89-96	12	12
97-104	13	13
105-112	14	14
113-120	15	15
121-128	16	16
129-136	17	17
137-144	18	18
145-152	19	19
153-160	20	20
161-168	21	21
169-176	22	22
177-184	23	23

*When two or more toilets are contained in a single bathroom, they are counted as one toilet.

     (6) When providing common-use toilet rooms and bathrooms, the boarding home must provide bathing fixtures for residents in the ratio of one bathing fixture for every twelve residents as listed in the following table:

Number of Residents	Number of Bathing Fixtures
1-12	1
13-24	2
25-36	3
37-48	4
49-60	5
61-72	6
73-84	7
85-96	8
97-108	9
109-120	10
121-132	11
133-144	12
145-160	13
161-172	14
173-184	15
185-196	16

     (7) When providing common-use toilet rooms and bathrooms, the boarding home must:

     (a) Designate toilet rooms containing more than one toilet for use by men or women;

     (b) Designate bathrooms containing more than one bathing fixture for use by men or women;

     (c) Equip each toilet room and bathroom designed for use by, or used by, more than one person at a time, in a manner to ensure visual privacy for each person using the room. The boarding home is not required to provide additional privacy features in private bathrooms with a single toilet and a single bathing fixture located within a private apartment;

     (d) Provide a hand-washing sink with soap and single use or disposable towels, blower or equivalent hand-drying device in each toilet room, except that single use or disposable towels or blowers are not required in toilet rooms or bathrooms that are located within a private apartment;

     (e) Provide reasonable access to bathrooms and toilet rooms for each resident by:

     (i) Locating a toilet room on the same floor or level as the sleeping room of the resident served;

     (ii) Locating a bathroom on the same floor or level, or adjacent floor or level, as the sleeping room of the resident served; and

     (iii) Providing access without passage through any kitchen, pantry, food preparation, food storage, or dishwashing area, or from one bedroom through another bedroom.

     (8) In boarding homes issued a project number by Construction Review Services on or after September 1, 2003, the boarding home must ensure fifty percent of all the bathing fixtures in the boarding home are roll-in type showers that have:

     (a) One half inch or less threshold;

     (b) A minimum size of thirty-six inches by forty-eight inches; and

     (c) Single lever faucets located within thirty-six inches of the seat so it is in within reach of persons seated in the shower.

[]

     (2) The boarding home must handle, clean, and store linen according to acceptable methods of infection control. The boarding home must:

     (a) Provide separate areas for handling clean laundry and soiled laundry;

     (b) Ensure clean laundry is not processed in, and does not pass through, areas where soiled laundry is handled;

     (c) Ensure areas where clean laundry is stored are not exposed to contamination from other sources; and

     (d) Ensure all staff wears gloves and use other appropriate infection control practices when handling soiled laundry.

     (3) The boarding home must use washing machines that have hot water with a temperature of one hundred forty degrees Fahrenheit measured at the washing machine intake, or that automatically dispense a chemical sanitizer as specified by the manufacturer, whenever the boarding home washes:

     (a) Boarding home laundry;

     (b) Boarding home laundry combined with residents' laundry into a single load; or

     (c) More than one resident's laundry combined into a single load.

     (4) The boarding home or a resident washing an individual resident's personal laundry, separate from other laundry, may wash the laundry at temperatures below 140° F and without the use of a chemical sanitizer.

     (5) The boarding home must ventilate laundry rooms and areas to the outside of the boarding home, including areas or rooms where soiled laundry is held for processing by off-site commercial laundry services.

     (6) The boarding home must locate laundry equipment in rooms other than those used for open food storage, food preparation or food service.

     (7) For all boarding homes issued a project number by Construction Review Services on or after September 1, 2003, the boarding home must provide a laundry area where residents' may do their personal laundry that is:

     (a) Equipped with:

     (i) A utility sink;

     (ii) A table or counter for folding clean laundry;

     (iii) At least one washing machine and one clothes dryer; and

     (iv) Mechanical ventilation to the outside of the boarding home.

     (b) Is arranged to reduce the chances of soiled laundry contaminating clean laundry.

     (8) The boarding home may combine areas for soiled laundry with other areas when consistent with WAC 388-78A-1090.

     (9) The boarding home may combine areas for handling and storing clean laundry with other areas when consistent with WAC 388-78A-1100.

[]

     (a) Solariums;

     (b) Enclosed sun porches;

     (c) Recreation rooms;

     (d) Dining rooms; and

     (e) Living rooms.

     (2) The boarding home must provide a total minimum floor space for day room areas of:

     (a) One hundred fifty square feet, or ten square feet per resident, whichever is larger, in boarding homes licensed on or before December 31, 1988; or

     (b) One hundred fifty square feet, or twenty square feet per resident, whichever is larger, in boarding homes licensed after December 31, 1988.    

     (3) The boarding home must provide day room areas with comfortable furniture and furnishings that meet the residents' needs.

[]

     (1) Provide adequate storage space for supplies, equipment and linens;

     (2) Provide separate, locked storage for disinfectants and poisonous compounds; and

     (3) Maintain storage space to prevent fire or safety hazards.

[]

[]

     (a) In halls and corridors, if necessary for resident safety;

     (b) On each side of interior and exterior stairways with more than one step riser, unless the department approves in writing having a handrail on one side only; and

     (c) On each side of interior and exterior ramps with slopes greater than one to twenty.

     (2) The boarding home must install guardrails if the department determines guardrails are necessary for resident safety.

[]

     (a) Provide a safe, sanitary and well maintained environment for residents;

     (b) Keep exterior grounds, boarding home structure, and component parts safe, sanitary and in good repair;

     (c) Keep facilities, equipment and furnishings clean and in good repair;

     (d) Ensure each resident or staff person maintains the resident's quarters in a safe and sanitary condition; and

     (e) Equip a housekeeping supply area on the premises with:

     (i) A utility sink or equivalent means of obtaining and disposing of mop water, away from food preparation and service areas;

     (ii) Storage for wet mops, ventilated to the outside of the boarding home; and

     (iii) Locked storage for cleaning supplies.

     (2) For boarding homes issued a project number by Construction Review Services on or after September 1, 2003, the boarding home must provide housekeeping supply room(s):

     (a) Located on each floor of the boarding home;

     (b) In proximity to laundry and kitchen areas; and

     (c) Equipped with:

     (i) A utility sink or equivalent means of obtaining and disposing of mop water, away from food preparation and service areas;

     (ii) Storage for wet mops;

     (iii) Locked storage for cleaning supplies; and

     (iv) Mechanical ventilation to the outside of the boarding home.

[]

     (1) The residents' characteristics and needs;

     (2) The degree of hazardousness or toxicity posed by the supplies or equipment;

     (3) Whether or not the supplies and equipment are commonly found in a private home, such as hand soap or laundry detergent; and

     (4) How residents with special needs are individually protected without unnecessary restrictions on the general population.

[]

     (a) A two-compartment sink for hand washing and sanitizing;

     (b) A clinical service sink or equivalent for rinsing and disposing of waste material;

     (c) A work counter or table;

     (d) Mechanical ventilation to the outside of the boarding home; and

     (e) Locked storage for cleaning supplies, if stored in the area.

     (2) The boarding home must ensure that any work or function performed in or around a combined utility area as described in subsection (1) of this section is performed without significant risk of contamination to:

     (a) Storing or handling clean or sterile nursing supplies or equipment;

     (b) Storing or handling clean laundry;

     (c) Providing resident care;

     (d) Food storage, preparation, or service; or

     (e) Other operations, services of functions in the boarding home sensitive to infection control practices.

[]

     (1) Equips the area with:

     (a) A hand washing sink, and

     (b) A work counter or table.

     (2) Ensures that any work or function performed in the area is performed without significant risk of contamination from other sources; and

     (3) Stores medications separate from all other stored items consistent with WAC 388-78A-0230.

[]

[]

     (a) All records and information related to the operation of the boarding home that is requested, except that the boarding home is not required to provide financial records to department licensing staff or complaint investigators that are not relevant to the provision of care or services to residents;

     (b) Staff personnel records directly related to licensing requirements consistent with WAC 388-78A-0460, including but not limited to:

     (i) Staff hiring and training;

     (ii) Criminal history background checks;

     (iii) Staff job descriptions;

     (iv) Staff schedules as planned and as worked;

     (v) TB testing for staff;

     (vi) Verification of contacting work references for newly hired staff; and

     (vii) Verification of professional credentials.

     (c) A current roster of all residents receiving domiciliary care and their roommates and the rooms in which they reside/sleep consistent with WAC 388-78A-0450;

     (d) Facilitated access to:

     (i) The boarding home premises; and

     (ii) The boarding home residents and the rooms in which they reside.

     (2) The licensee must ensure the boarding home administrator or the administrator's designee is available during any inspection or complaint investigation to respond to questions or issues identified by department staff.

[]

     (a) The department is not required to disclose information to boarding homes when doing so would compromise the inspection process or complaint investigation.

     (b) Department staff shall make every effort to schedule such meeting if desired by the licensee. However, failure to hold a daily communication meeting is not grounds for nullifying or voiding any citation, statement of deficiencies, or enforcement remedies imposed by the department.

     (2) The boarding home may designate a staff person to accompany department licensers or complaint investigators during inspections of the boarding home, except that boarding home staff persons may not be present:

     (a) During interviews with residents unless requested by the resident; or

     (b) When their presence may inhibit others from providing information to department licensers or complain investigators;

     (c) When department licensers or complaint investigators are investigating an issue that, if prematurely disclosed to boarding home staff, may compromise the investigation.

     (3) The department will make every effort to hold an exit conference when the department staff has finished collecting data on site, if such a meeting is desired by the licensee. However, failure to hold an exit conference is not grounds for nullifying or voiding any citation, statement of deficiencies, or enforcement remedies imposed by the department. During the exit conference:

     (a) The department will present to the boarding home the preliminary factual findings representing violations that may be cited on a statement of deficiencies;

     (b) The department will identify the rules that may have been violated:

     (i) Department staff will identify the relevant section(s) of rule that address the potential violations.

     (ii) Department staff is not required to identify the specific subsection of the rule that may be cited in a statement of deficiencies.

     (c) The boarding home should be given an opportunity to:

     (i) Question department staff regarding their findings, and

     (ii) Provide the department additional factual information that may refute the presented facts or affect the determination of a deficiency.

[]

     (1) Notify the boarding home of the additional issues or amended conclusions; and

     (2) Provide the boarding home an opportunity to respond to the additional information:

     (a) By telephone,

     (b) In writing, or

     (c) By facsimile transmission.

[]

     (2) The licensee must respond to a statement of deficiencies by submitting to the department within a time acceptable to the department, a signed written plan of correction for each deficiency stated in the report. The licensee must include in the plan of correction, for each cited deficiency:

     (a) A specific plan of what will be or was done to correct the violation,

     (b) A description of what will be done to prevent future violations of this type,

     (c) Who will be responsible for monitoring the corrections to ensure the violations do not recur, and

     (d) The date by which lasting correction will be achieved.

[]

     (2) The department may also suspend admissions to a boarding home, impose conditions on the boarding home license, or impose civil penalties of not more than one hundred dollars per day per violation per resident for infractions described in WAC 388-78A-1170(1).

[]

     (a) A history of significant noncompliance with federal or state regulations in providing care or services to frail elders, vulnerable adults or children, whether as a licensee, contractor, managerial employee or otherwise. Evidence of significant noncompliance may include, without limitation:

     (i) Citations for violation of regulations imposed by regulating entities;

     (ii) Sanctions for violation of regulations imposed by regulating entities;

     (iii) Involuntary termination, cancellation, suspension, or non-renewal of a Medicaid contract or Medicare provider agreement, or any other agreement with a public agency for the care or treatment of children, frail elders or vulnerable adults;

     (iv) Being denied a license application relating to the care of frail elders, vulnerable adults or children; or

     (v) Relinquishing or failing to renew a license relating to care of frail elders, vulnerable adults or children following written notification of the licensing agency's initiation of denial, suspension, cancellation or revocation of a license.

     (b) Failed to provide appropriate care to frail elders, vulnerable adults or children under a contract, or having such contract terminated or not renewed by the contracting agency due to such failure;

     (c) Been convicted of a felony or a crime against a person if the conviction reasonably relates to the competency of the person to operate a boarding home;

     (d) Failed or refused to comply with the requirements of chapter 18.20 RCW, applicable provisions of chapter 70.129 RCW or this chapter;

     (e) Retaliated against a staff person, resident or other individual for:

     (i) Reporting suspected abuse or other alleged improprieties;

     (ii) Providing information to the department during the course of the department conducting an inspection of the boarding home; or

     (iii) Providing information to the department during the course of the department conducting a complaint investigation in the boarding home.

     (f) Operated a facility for the care of children or adults without a current, valid license or under a defunct or revoked license;

     (g) Been convicted of a crime, permitted, aided or abetted an illegal act on a boarding home premises, or engaged in the illegal use of drugs or the excessive use of alcohol;

     (h) Abused, neglected or exploited a vulnerable adult or knowingly failed to report alleged abuse, neglect or exploitation of a vulnerable adult as required by chapter 74.34 RCW;

     (i) Failed to exercise fiscal accountability and responsibility involving a resident, the department, public agencies, or the business community; or has insufficient financial resources or unencumbered income to sustain the operation of the boarding home;

     (j) Knowingly or with reason to know, made false statements of material fact in the application for the license or the renewal of the license or any data attached thereto, or in any matter under investigation by the department;

     (k) Interfered with any inspection or investigation by the department or refused to allow department representatives to examine any part of the licensed premises including records required under this chapter;

     (l) Moved all residents out of the boarding home without the department's approval and is no longer operating as a boarding home; or

     (m) Demonstrated any other factors that give evidence the applicant lacks the appropriate character, suitability and competence to provide care or services to vulnerable adults.

     (2) This section applies to any boarding home:

     (a) Applicant;

     (b) Partner, officer or director;

     (c) Manager or managerial employee; or

     (d) Owner of five percent or more of the entity applicant:

     (i) Who is involved in the management or operation of the boarding home;

     (ii) Who may have direct access to boarding home residents;

     (iii) Who controls or supervises the provision of care of services to boarding home residents; or

     (iv) Who exercises control over daily operations of the boarding home.

[]

     (1) A serious problem, a recurring problem, or an uncorrected problem;

     (2) Discriminated or retaliated in any manner against a resident, employee, or any other person because that person or any other person made a complaint or provided information to the department, the attorney general, a law enforcement agency, or the long-term care ombudsman; or

     (3) Willfully interfered with the performance of official duties by a long-term care ombudsman.

[]

     (a) Convicted of a crime against a person or a crime related to financial exploitation as defined under RCW 43.43.830 or 43.43.842; or

     (b) Found by a court in a protection proceeding or in a civil damages lawsuit under chapter 74.34 RCW to have abused, neglected, abandoned or exploited a vulnerable adult; or

     (c) Found in any dependency action under chapter 13.34 RCW to have sexually assaulted, neglected, exploited, or physically abused any minor; or

     (d) Found by a court in a domestic relations proceeding under Title 26 RCW to have sexually abused, exploited, or physically abused any minor; or

     (e) Certified by a lending agency and reported to the department for nonpayment or default on a federally or state-guaranteed educational loan or service-conditional scholarship; or

     (f) Certified pursuant to RCW 74.20A.320 by the department as a person who is not in compliance with a support order or a residential or visitation order; or

     (g) Found in any final decision issued by a disciplinary board to have sexually or physically abused or neglected or exploited any minor or any vulnerable adult, or has a stipulated finding of fact, conclusion of law, an agreed order, or finding of fact, conclusion of law, or final order issued by a disciplining authority, a court of law, or entered into a state registry finding him or her guilty of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW.

     (2) This section applies to any boarding home:

     (a) Applicant;

     (b) Partner, officer or director;

     (c) Manager or managerial employee; or

     (d) Owner of five percent or more of the entity applicant:

     (i) Who is involved in the operation of the boarding home, or

     (ii) Who may have direct access to the boarding home residents, or

     (iii) Who controls or supervises the provision of care or services to the boarding home residents, or

     (iv) Who exercises control over daily operations.

[]

     (a) May require a plan of correction from the licensee; and

     (b) May impose conditions on the boarding home license.

     (2) The department may impose a stop-placement on a boarding home when:

     (a) There is a reasonable probability, at the time the stop-placement is imposed, that at least a moderate degree of harm will occur or recur as a result of a single problem or by a combination of problems; and

     (b) The threatening problem is more than an isolated event or occurrence.

     (3) The department may summarily suspend a boarding home's license when:

     (a) There is an imminent threat that a serious degree of harm may occur to residents as a result of a single problem or a combination of problems; and

     (b) The threatening problem is more than an isolated event or occurrence.

     (4) The department may revoke a boarding home's license when:

     (a) The department has cause to summarily suspend the boarding home's license;

     (b) There is a current problem with the boarding home and the boarding home has a history of having enforcement remedies imposed by the department;

     (c) There is a current problem with the boarding home and the boarding home has a history of noncompliance representing problems that were at least moderate in nature and moderate in scope;

     (d) The licensee has moved all residents out of the boarding home without the department's approval and is no longer operating as a boarding home; or

     (e) There is a very serious current problem, which may not warrant a summary suspension, with the boarding home that does not have a history of non-compliance. Examples of the types of serious current problems that may warrant license revocation include, but are not limited to:

     (i) The licensee has been found or convicted by a court of competent jurisdiction to have engaged in fraudulent activity, or

     (ii) The licensee is experiencing significant financial problems resulting in poor care and possible business failure.

[]

     (1) The department's field manager who supervises the staff that conducted the disputed inspection or complaint investigation, or

     (2) Another department field manager assigned to the same department region in which the boarding home is located.

[]

     (2) Orders of the department imposing licensing suspension, stop placement, or conditions for continuation of a license are effective immediately upon notice and shall continue pending any hearing.

[]

     (1) Submit an annual license fee of seventy-nine dollars per bed of the licensed resident bed capacity;

     (2) Submit an additional one hundred fifty dollars when billed by the department for:

     (a) A third on-site visit resulting from the boarding home's failure to adequately respond to a statement of deficiencies; and

     (b) A complete on-site survey resulting from a substantiated complaint.

     (3) Submit an additional late fee in the amount of ten dollars per day from the license renewal date until the date of mailing the fee, as evidenced by the postmark; and

     (4) Submit to construction review services a fee for the review of the construction documents per the review fee schedule that is based on the project cost.

[]

     The following sections of the Washington Administrative Code are repealed:

WAC 388-78A-010	Definitions.
WAC 388-78A-020	Licensure -- Initial, renewal, day care approval respite care, modifications.
WAC 388-78A-030	Responsibilities and rights -- Licensee and department.
WAC 388-78A-040	Administrator.
WAC 388-78A-045	Criminal history, disclosure, and background inquiries.
WAC 388-78A-050	Staff.
WAC 388-78A-055	Policies and procedures.
WAC 388-78A-060	HIV/AIDS education and training.
WAC 388-78A-070	Construction.
WAC 388-78A-080	Communication system.
WAC 388-78A-090	Water supply.
WAC 388-78A-100	Sewage and liquid waste disposal.
WAC 388-78A-110	Garbage and refuse disposal.
WAC 388-78A-120	Lighting.
WAC 388-78A-130	Heating -- Temperature.
WAC 388-78A-140	Ventilation.
WAC 388-78A-150	Resident room -- Room furnishings -- Storage.
WAC 388-78A-160	Toilet rooms and bathrooms.
WAC 388-78A-170	Food and nutrition services.
WAC 388-78A-180	Day rooms.
WAC 388-78A-190	Laundry.
WAC 388-78A-200	Storage space.
WAC 388-78A-210	Stairs -- Ramps.
WAC 388-78A-220	Guardrails -- Handrails.
WAC 388-78A-230	Maintenance and housekeeping.
WAC 388-78A-240	Criteria for accepting and retaining residents.
WAC 388-78A-250	Resident rights.
WAC 388-78A-260	Resident services.
WAC 388-78A-265	Limited nursing services.
WAC 388-78A-268	Health care services -- Resident-arranged.
WAC 388-78A-280	Notification -- Change in resident's condition.
WAC 388-78A-290	Safety measures and quality assurance.
WAC 388-78A-300	Medication services.
WAC 388-78A-310	Resident register.
WAC 388-78A-320	Resident health record.
WAC 388-78A-330	Adult day care.
WAC 388-78A-335	Residents -- Dementia care.
WAC 388-78A-340	Exemptions.
WAC 388-78A-990	Fees.

© Washington State Code Reviser's Office