Date of Adoption: July 29, 2003.

     Purpose: The boarding home licensing rules (chapter 388-78A WAC) are being revised to make them more applicable to the residents currently living in boarding homes in order to improve the quality of care and services for them; to make the rules more consistent with current practices in boarding homes; and to focus the rule more on what occurs with residents. These rules place more emphasis on the boarding home assessing residents' needs, developing and implementing a negotiated service agreement, monitoring residents consistent with their service agreements, and providing a minimum level of services. These rules also expand the scope of services that are allowed in boarding homes. Upon the effective date of this order, all current sections of chapter 388-78A WAC will be repealed and be replaced with new rules in this chapter.

     Citation of Existing Rules Affected by this Order: Repealing WAC 388-78A-010 Definitions, 388-78A-020 Licensure -- Initial, renewal, day care approval respite care, modifications, 388-78A-030 Responsibilities and rights -- Licensee and department, 388-78A-040 Administrator, 388-78A-045 Criminal history, disclosure, and background inquiries, 388-78A-050 Staff, 388-78A-055 Policies and procedures, 388-78A-060 HIV/AIDS education and training, 388-78A-070 Construction, 388-78A-080 Communication system, 388-78A-090 Water supply, 388-78A-100 Sewage and liquid waste disposal, 388-78A-110 Garbage and refuse disposal, 388-78A-120 Lighting, 388-78A-130 Heating -- Temperature, 388-78A-140 Ventilation, 388-78A-150 Resident room -- Room furnishings -- Storage, 388-78A-160 Toilet rooms and bathrooms, 388-78A-170 Food and nutrition services, 388-78A-180 Day rooms, 388-78A-190 Laundry, 388-78A-200 Storage space, 388-78A-210 Stairs -- Ramps, 388-78A-220 Guardrails -- Handrails, 388-78A-230 Maintenance and housekeeping, 388-78A-240 Criteria for accepting and retaining residents, 388-78A-250 Resident rights, 388-78A-260 Resident services, 388-78A-265 Limited nursing services, 388-78A-268 Health care services -- Resident-arranged, 388-78A-280 Notification -- Change in resident's condition, 388-78A-290 Safety measures and quality assurance, 388-78A-300 Medication services, 388-78A-310 Resident register, 388-78A-320 Resident health record, 388-78A-330 Adult day care, 388-78A-335 Residents -- Dementia care, 388-78A-340 Exemptions, and 388-78A-990 Fees.

     Statutory Authority for Adoption: RCW 18.20.090.

     Other Authority: Chapter 18.20 RCW.

      Adopted under notice filed as WSR 03-03-018 on January 7, 2003.

     Changes Other than Editing from Proposed to Adopted Version:

WAC 388-78A-0020 Definitions.
	•	Deleted definition of "aged person" because it was replaced by "resident."
	•	Changed the definition of "boarding home" to be consistent with RCW 18.20.020 as amended by SSB 5579.
	•	Changed definition of "domiciliary care" to be consistent with definition in RCW 18.20.020 as amended by SSB 5579.
	•	Added definition of "general responsibility for the safety and well-being of the resident" to be consistent with definition in RCW 18.20.020 as amended by SSB 5579.
	•	Changed definitions of "harm" and "independent living unit" to improve clarity.
	•	Deleted definition of "intermittent nursing services" because it is not used in final rule, which simply addresses nursing services in general.
	•	Changed definition of "medication administration" as recommended and to be more consistent with RCW 69.41.010.
	•	Deleted definition of "noteworthy change" as recommended. The concept of this type of change is now reflected in WAC 388-78A-0350.
	•	Changed definition of "recurring problem" and "uncorrected problem" to address changes in licensees between initial citation and subsequent citations, and specified the time frames considered when addressing "recurring problems."
	•	Changed the definition of "serious problem" for added clarity.
	•	Changed the definition of "resident" to be consistent with definition in RCW 18.20.020 as amended by SSB 5579.
	•	Changed the definition of "respite care" to reflect use of the term "resident" versus "aged person."
WAC 388-78A-0030 Applicability.
	•	Added provisions to when a boarding home license is and is not required consistent with RCW 18.20.030 as amended by SSB 5579.
WAC 388-78A-0050 Resident characteristics.
	•	Subsection (1), changed in response to comments to include requirements for specialty training.
	•	Subsection (2), changed in response to comments to clarify when a registered nurse must specifically determine and document a resident's condition is stable and predictable.
WAC 388-78A-0070 Initial assessment.
	•	Subsection (1), changed in response to comments to clarify the assessment must result in an "adequate" understanding rather than a "comprehensive" understanding.
	•	Subsection (2), changed in response to comments to clarify, and to specify boarding homes may meet a resident's needs by arranging for services from outside resources.
	•	Subsection (3), changed the use of "care plan" to "service agreement."
WAC 388-78A-0080 Timing of initial assessment.
	•	Changed in response to comments to allow 5 calendar days to complete an assessment for emergency admissions.
WAC 388-78A-0090 Qualified assessor.
	•	Subsection (1)(c), changed in response to comments so a nurse acting consistent with chapter 18.79 RCW may complete an initial assessment.
	•	Subsection (1)(e), changed the effective date to 2004.
WAC 388-78A-0100 Assessment topics.
	•	Subsection (10), changed in response to comments to focus more on personal identity, rather than cultural or ethnicity, and to recognize some individuals may not be comfortable or willing to disclose personal information or preferences.
WAC 388-78A-0110 On-going assessments.
	•	Subsection (2), changed to clarify the extent of an on-going assessment, when it is necessary, and eliminated the term "noteworthy change," but referenced WAC 388-78A-0350 to reflect how on-going assessments are linked to monitoring residents' well being.
WAC 388-78A-0130 Service agreement planning.
	•	Changed in this section, and throughout the rule in response to comments, from the term "negotiated care plan" to "negotiated service agreement."
	•	Subsection (4)(a), deleted reference to noteworthy and significant changes and referred to WAC 388-78A-0350.
	•	Subsection (6)(a) and (f), edited for clarity.
	•	Subsection (7)(c), corrected in response to comments so documentation is made in the resident's record.
WAC 388-78A-0140 Negotiated service agreement contents.
	•	Subsection (1)(a), edited for clarity in response to comments.
	•	Subsection (1)(c), the term "intermittent nursing services" was deleted throughout the rule.
	•	Subsection (2)(a) and (b), deleted since they implied the boarding home would need to supervise the provision of services by outside resources, contrary to SSB 5579.
	•	Subsection (8), added in response to comments to include emphasis on not permitting boarding homes to ask or require residents to sign waivers of rights.
WAC 388-78A-0150 Signing negotiated service agreement.
	•	Changed term to "negotiated service agreement."
WAC 388-78A-0160 Basic boarding home services.
	•	Subsection (1), changed to reflect requirements of SSB 5579.
	•	Changed term to "negotiated service agreement."
	•	Reorganized, edited for clarity, and separated assistance with activities of daily living from other basic services to reflect requirements of SSB 5579.
	•	Added statutory reference to RCW 69.41.010 for self-administration of medication.
	•	Clarified in response to comments that services may be provided on both a scheduled and nonscheduled basis.
	•	Clarified disclosure requirement in response to comments by referencing WAC 388-78A-0690.
WAC 388-78A-0170 Activities.
	•	Changed term to "negotiated service agreement."
WAC 388-78A-0180 Medication services.
	•	Subsection (1)(a) and (b), edited in response to comments, to clarify.
WAC 388-78A-0200 Medication refusal .
	•	Edited in response to comments, to clarify, and to allow for physicians' directions on how to respond to medication refusals.
WAC 388-78A-0210 Nonavailability of medications.
	•	Edited in response to comments to clarify and require notification within a reasonable time.
WAC 388-78A-0230 Storing, securing, and accounting for medications.
	•	Subsection (3), edited in response to comments to clarify what drugs must be inventoried.
WAC 388-78A-0250 Medication organizers.
	•	Subsection (1)(a), changed in response to comments so a resident must understand the use of a medication instead of requiring the resident to be "fully knowledgeable" of the medication before a nurse may fill the resident's medication organizer.
	•	Subsection (3), edited to clarify that residents are allowed to receive other medication assistance or administration and still be able to use a medication organizer for those medications they could self-administer or direct others to administer.
WAC 388-78A-0270 Food and nutrition services.
	•	Subsection (1)(c)(i), changed in response to comments to permit menus to be delivered to residents' rooms instead of posting the menus.
	•	Subsection (1)(c)(vi), changed in response to comments so a three-week menu cycle would not be required for breakfasts when there were a variety of choices.
	•	Subsection (1)(f), edited to clarify where the boarding home must record alternate choices in entrees.
	•	Subsection (2)(a)(iii), edited to clarify the diet manual must be reviewed and updated as necessary.
	•	Subsection (3), added in response to comments to clarify boarding homes may provide special diets at a resident's request and consistent with the resident's negotiated service agreement.
	•	Subsection (4)(b)(i) and (ii), changed the effective date to 2004.
	•	Subsection (4)(b)(i)(B) and (4)(b)(ii)(C), changed so dishwashing operations and temperatures reflect current standards.
WAC 388-78A-0280 Need to provide nursing services.
	•	Clarified in response to comments that providing nursing services is an optional service for boarding homes.
	•	Subsection (1), clarified that residents who need nursing services must receive the required services or be discharged from the boarding home.
	•	Subsection (2), deleted the requirement for a registered nurse to coordinate resident-arranged nursing care.
WAC 388-78A-0290 Tube feeding.
	•	Changed term to "negotiated service agreement" and deleted "intermittent" from nursing services.
WAC 388-78A-0300 Supervision of nursing services.
	•	Deleted "intermittent" from nursing services.
WAC 388-78A-0310 Responsibilities of nursing supervisor.
	•	Clarified the supervising nurse in the boarding home is only required to supervise nursing services provided by the boarding home.
	•	Subsection (3)(b), changed term to "negotiated service agreement."
	•	Subsection (3)(d), deleted the requirement for a registered nurse to coordinate outside health care.
WAC 388-78A-0320 Resident-arranged services.
	•	Subsection (1), edited to clarify the boarding home must allow resident-arranged services from health care practitioners.
	•	Subsection (1)(b), edited to emphasize residents have a right to arrange their own health care, by adding a reference to chapter 70.129 RCW.
	•	Subsection (3), clarified a registered nurse does not need to coordinate a resident's health care with boarding home services, and consistent with SSB 5579, the boarding home is not required to supervise resident-arranged services.
WAC 388-78A-0330 Coordination of health care services.
	•	Subsection (1), clarified consistent with SSB 5579 that the boarding home must coordinate a resident's external health care according to the resident's negotiated service agreement.
	•	Subsection (2)(c), deleted because it is not different from subsection (2) in substance.
	•	Subsection (6)(c), changed term to "negotiated service agreement."
	•	Subsection (7), changed to specify required actions.
WAC 388-78A-0340 Implementation of negotiated service agreement.
	•	Changed term to "negotiated service agreement."
WAC 388-78A-0350 Monitoring residents' well-being.
	•	Changed term to "negotiated service agreement."
	•	Edited to remove the term "noteworthy changes," and more clearly describe when changes require an assessment beyond an initial evaluation and when changes need to be documented.
WAC 388-78A-0360 Adult day care.
	•	Subsection (2)(a), deleted required specific day care services since day care is an optional service.
	•	Subsection (2)(b) and (c), edited for consistency in format.
	•	Subsection (2)(e), deleted references to the types of furniture that were required.
	•	Subsection (2)(i), deleted in response to comments received specific record-keeping requirements.
WAC 388-78A-0370 Dementia care.
	•	Changed term to "negotiated service agreement."
WAC 388-78A-0380 Restricted egress.
	•	Changed term to "negotiated service agreement."
	•	Subsections (2) and (4), edited for clarity and consistency in format.
	•	Subsections (6) and (7), changed the effective date to 2004.
WAC 388-78A-0410 Content of resident records.
	•	Changed term to "negotiated service agreement."
	•	Subsection (7), clarified that "orders" included directions for what to do when a resident refused prescribed treatments, medications and diets.
	•	Subsection (8), clarified in response to comments received that the boarding home does not need to document nursing services provided by outside resources.
	•	Subsection (9)(d), deleted use of term "noteworthy changes."
WAC 388-78A-0430 Record retention.
	•	Subsection (2), clarified a resident's inactive record must remain on the boarding home premises as long as the resident remains in the boarding home.
	•	Subsections (3) and (4), clarified a distinction between "closed records" and "inactive records," and how closed records must be handled .
WAC 388-78A-0440 Resident review of records.
	•	Subsection (2), added in response to comments to specify requirements regarding photocopying residents' records.
WAC 388-78A-0460 Staff.
	•	Changed term to "negotiated service agreement."
	•	Subsection (2)(c) and (e), clarified in response to comments received, issued related to appropriate qualifications and credentials.
	•	Subsection (2)(i), clarified that references are for "resident-care staff persons."
	•	Subsection (3)(b), deleted in response to comments received, "...to the satisfaction of the department."
WAC 388-78A-0480 TB tests.
	•	Subsection (1)(a), clarified in response to comments received that the TB test must be initiated within three days of hiring.
WAC 388-78A-0510 Specialized training for dementia.
	•	Subsection (2), edited for clarity.
WAC 388-78A-0520 Administrator qualifications.
	•	Changed the effective date to 2004.
	•	Changed American Association of Housing and Services for the Aging to American Association of Homes and Services for the Aging.
	•	Clarified that department-recognized national accreditation health or personal care organizations may endorse administrator training programs, as well as directly provide them.
WAC 388-78A-0560 Administrator responsibilities.
	•	Subsection (5)(a), edited for clarity.
WAC 388-78A-0580 Use of home health/home care.
	•	Edited for clarity.
WAC 388-78A-0605 Pets.
	•	Subsection (1), added requirement for boarding homes to disclose their policies regarding pets to potential and current residents.
	•	Subsection (2)(c)(ii), deleted because residents must be advised of the boarding home's policies on pets.
WAC 388-78A-0635 Reporting fires and incidents.
	•	Subsection (1), edited for clarity in response to comments received about certain types of fires in boarding homes.
	•	Subsection (2), edited for clarity in response to comments received.
WAC 388-78A-0650 Services by resident for boarding home.
	•	Changed term to "negotiated service agreement."
WAC 388-78A-0670 Resident use of electronic monitoring.
	•	Subsection (2)(d), edited for clarity.
WAC 388-78A-0680 Safety measures and disaster preparedness.
	•	Changed term to "negotiated service agreement."
	•	Changed the effective date to 2004.
	•	Subsection (1), changed to be consistent with chapter 18.20 RCW as amended by SSB 5579.
	•	Subsection (2)(c)(iii), added to protect residents during the course of an investigation.
WAC 388-78A-0690 Disclosure of services.
	•	Subsection (3), edited to clarify that all boarding homes must notify all residents of their rights under applicable state and federal laws regarding all health care decision-making.
WAC 388-78A-0700 Timing of disclosure.
	•	Subsection (2)(c), edited for clarity in response to comments received.
WAC 388-78A-0760 Licensee's responsibilities.
	•	Subsection (2)(b)(i), edited to clarify that posting a boarding home license should include posting any conditions on the license.
	•	Subsection (2)(b)(ii)(B), deleted in response to comments received, the requirement to notify residents of the local legal services program.
WAC 388-78A-0770 Change in licensee.
	•	Subsection (2)(a), edited for clarity.
WAC 388-78A-0800 Building requirements.
	•	Retitled section.
	•	New subsections added in response to comments received to allow for certain exemptions to the licensing rules.
WAC 388-78A-0830 Required reviews of building plans.
	•	Subsection (1)(a) and (b), edited in response to comments received, for clarification and accuracy.
	•	Subsection (2)(e), edited so rule remains accurate if building code changes.
WAC 388-78A-0860 Changing use of rooms.
	•	Subsection (1)(c), added in response to comments received to require boarding homes to provide additional documentation requested by construction review services.
WAC 388-78A-0900 Area for nursing supplies and equipment.
	•	Deleted "intermittent" from nursing services.
	•	Changed the effective date to 2004.
WAC 388-78A-0910 Communication system.
	•	Changed the effective date to 2004.
WAC 388-78A-0940 Sewage and liquid waste disposal.
	•	Subsections (2) and (3), edited to add clarifying references to relevant WAC.
WAC 388-78A-0960 Lighting.
	•	Subsection (1), edited for clarity.
	•	Subsection (2), added in response to comments received specifications for reading room lighting.
WAC 388-78A-0970 Heating-cooling -- Temperature.
	•	Changed the effective date to 2004.
	•	Subsection (1), changed in response to comments received regarding current standard of 70 degrees.
WAC 388-78A-0990 Resident room—Room furnishings-storage.
	•	Changed the effective date to 2004.
	•	Subsection (1)(j), edited in response to comments received to clarify each resident should have his/her own storage area.
WAC 388-78A-1010 Toilet rooms and bathrooms.
	•	Changed the effective date to 2004.
	•	Subsections (5) and (6), added "...or fraction thereof" in response to comments received.
	•	Subsection (8)(c), edited for clarity.
WAC 388-78A-1020 Laundry.
	•	Changed the effective date to 2004.
	•	Subsection (3), edited in response to comments received, to clarify washing machines must have a continuous supply of hot water.
WAC 388-78A-1070 Maintenance and housekeeping.
	•	Changed the effective date to 2004.
	•	Subsection (1)(e)(i), edited for clarity.
WAC 388-78A-1120 Responsibilities during inspections.
	•	Subsection (1)(a), edited for clarity by deleting reference to financial records and adding reference to statutory provisions.
	•	Subsection (1)(b)(iv), edited to clarify that schedules only need to be retained for six months.
WAC 388-78A-1130 Communication during inspections.
	•	Subsection (2)(b) and (c), edited for clarity in response to comments received regarding when staff persons may be present during interviews and investigations.
WAC 388-78A-1160 Authorized enforcement remedies.
	•	Reorganized and edited for clarity, including statutory authority for civil fines up to $3000 ((2)).
	•	Subsection (1)(f), added enforcement remedy of imposing a limited stop placement per SSB 5579.
WAC 388-78A-1170 Statutory circumstances resulting in discretionary enforcement remedies.
	•	Retitled section.
	•	Subsection (1)(a)(iv), deleted the word "application."
	•	Subsection (1)(g), clarified in response to comments received, a person would have to knowingly permit illegal acts before enforcement remedies would be imposed for this reason.
	•	Subsection (3), added reference to WAC 388-78A-1200 for other circumstances resulting in discretionary enforcement remedies.
WAC 388-78A-1180 Circumstances resulting in required enforcement remedies.
	•	Retitled section and edited for clarity.
	•	Added statutory references to RCW 18.20.185 and [18.20].190.
	•	Subsection (2), added another circumstance for which the statute requires an enforcement remedy.
WAC 388-78A-1190 Statutorily required enforcement remedies: Denial, suspension, revocation, or nonrenewal of license.
	•	Retitled section.
	•	Subsection (1)(e) and (f), deleted from rule in response to comments received, but provisions remain in RCW 18.20.200 and [18.20].210 for licensing actions for failure to repay student loans and for failure to pay child support or violating visitation orders. Additionally, the relationship between the person involved, and the licensed entity, is not clear in statute.
WAC 388-78A-1200 Other circumstances resulting in discretionary enforcement remedies.
	•	Retitled section and edited for clarity.
	•	Subsection (1)(c), included civil penalties per RCW 18.20.190 (2)(c).
	•	Subsection (2), imposition of limited stop-placement was added per SSB 5579.
	•	Subsections (2), (3), and (4), clarified less serious enforcement remedies could also be imposed for more serious problems.
	•	Subsection (4)(f), added another circumstance for which license revocation could be imposed .
WAC 388-78A-1210 Informal dispute resolution.
	•	Subsections (1) and (2), deleted to be consistent with chapter 18.20 RCW as amended by SSB 5579.
WAC 388-78A-1220 Appeal rights.
	•	Subsection (1), edited for clarity.
WAC 388-78A-1230 Fees.
	•	Subsection (2)(a) and (b), edited for clarity.

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

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

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

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 125, Amended 0, Repealed 39.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 125, Amended 0, Repealed 39.
     Effective Date of Rule: September 1, 2004.

July 29, 2003

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

     Reviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 03-18 issue of the Register.

© Washington State Code Reviser's Office