Date of Adoption: October 3, 2003.

     Purpose: The purpose of this emergency filing to amend sections of chapter 388-148 WAC, Licensing requirements for child foster homes, group care programs/facilities, and agencies, which impact the receipt of federal funding for eligible children in care with Children's Administration. See Citation of Existing Rules below for new and amended rules affected. This notice and the full text of these emergency rules are available from the DSHS rule-making website at http://www1.dshs.wa.gov/msa/rpau/docket.html, or by contacting Jean Croisant, DSHS Children's Administration, phone (360) 725-2486, or by e-mail at biggire@dshs.wa.gov.

     Citation of Existing Rules Affected by this Order: Chapter 388-148 WAC, Licensing requirements for child foster homes, staffed residential homes, group care programs/facilities, and agencies; amending WAC 388-148-0035 What personal characteristics do I need to provide care to children?, 388-148-0040 What first aid and cardiopulmonary resuscitation (CPA) training is required?, 388-148-0045 What HIV/AIDS training is required?, 388-148-0050 How do I apply for a license?, 388-148-0060 When am I not allowed to received a license from a child-placing agency?, 388-148-0065 When may I be certified to provide care to children?, 388-148-0095 When are licenses denied, suspended or revoked?, 388-148-0120 What incidents involving children must I report?, 388-148-0125 What are your requirements for keeping client records?, 388-148-0140 What personnel policies must I have?, 388-148-0170 What steps must I take to ensure children's safety around bodies of water?, 388-148-0220 What fire safety requirements must I follow to qualify for a license?, 388-148-0260 What are the general requirements for bedrooms?, 388-148-0270 What are the requirements for beds?, 388-148-0335 When must I get medical exams for the children under my care?, 388-148-0345 What must I do to prevent the spread of infections and communicable diseases?, 388-148-0350 How do I manage medications for children under my care?, 388-148-0395 What requirements must I meet for feeding babies?, 388-148-0460 What requirements do you have for supervising children?, 388-148-0520 What are the training requirements for foster parents and prospective foster parents?, 388-148-0560 Do I need a treatment plan for children under my care?, 388-148-0585 What social service staff do I need?, 388-148-0630 What fire prevention measures must I take?, 388-148-0700 What are the qualifications for an executive director for a group care program or child-placing agency?, 388-148-0720 What qualifications must the child care staff for a group care program and a child-placing agency have?, 388-148-0725 What is the ratio of child care staff to children in group care facilities?, 388-148-0785 What is the proper ratio of staff to children in home or group care facilities offering maternity services?, 388-148-0800 What levels of secure CRCs exist?, 388-148-0915 What steps must be taken after a youth is admitted into a CRC?, 388-148-0995 What are the ratio requirements of youth care staff to youth in crisis residential centers?, 388-148-1060 What services may a child-placing agency provide?, 388-148-1070 What health histories need to be provided to adoptive parents?, 388-148-1115 Do you have requirements for adoptive services? and 388-148-1120 What is the process for adoptions?; and new sections WAC 388-148-0058 May I have a license for both child day care and child foster care?, 388-148-0427 Are there specific requirements regarding Native American children?, 388-148-0462 Who may provide care to a foster child in the foster home when the foster parent is away from the home?, 388-148-0542 May a foster child be supervised by someone under eighteen in the foster home?, 388-148-0722 What are the qualifications for health care staff for a group care program or a child-placing agency?, 388-148-0892 What are the requirements for a level three secure CRC?, 388-148-1076 What are the qualifications for an executive director of a child-placing agency?, 388-148-1077 What are the qualifications for a case aide for a child-placing agency program?, 388-148-1078 What are the qualifications for health care staff hired or contracted by a child-placing agency to provide services to children in care?, and 388-148-1079 What are the qualifications for consultants for child-placing agency programs?

     Statutory Authority for Adoption: Chapter 74.15 RCW.

     Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest; and that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.

     Reasons for this Finding: Children's Administration has found that some of the sections of chapter 388-148 WAC require waivers in order for provider compliance. The approval of waivers then jeopardizes federal funds received by Children's Administration to support services to children and their families.

     These rules replace emergency rules adopted as WSR 03-14-012 on June 18, 2003. Children's Administration has filed a preproposal statement of inquiry (WSR 02-06-083) and is engaged in working with stakeholders for the permanent adoption of rule changes. Stakeholders recently reviewed the draft rules, and the department is preparing economic analyses related to the possible impact of the rules. Providers of group programs are reviewing the fire safety rules included in the chapter. The tentative date for the filing of the proposed rules for public comment is January 2004.

     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 10, Amended 36, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 10, Amended 36, Repealed 0.
     Effective Date of Rule: Immediately.

October 3, 2003

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

     (1) You must demonstrate that you have the understanding, ability, physical health, emotional stability and personality suited to meet the physical, mental, emotional, and social needs of the children under your care.

     (2) You must not have been disqualified by our background check (chapter 388-06 WAC) prior to having unsupervised access to children.

     (3) You have not had a license denied or revoked from an agency that regulates the care of children or vulnerable adults, unless the department determines that you do not post a risk to a child's safety, well being, and long-term stability.

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

     (5) You must have the ability to furnish the child with a nurturing, respectful, supportive, and responsive environment.

     (((4))) (6) The department may require you to give additional information. We may request this information at any time and it may include, but is not limited to:

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

     (b) Psychiatric evaluations;

     (c) Psycho-sexual evaluations; and

     (d) Medical evaluations and/or medical records.

     (((5))) (7) Any evaluation requested under WAC 388-148-0035 (((4)))(6)(a)-(d) will be at the applicant/licensees expense.

     (((6))) (8) The licensor must be given permission to speak with the evaluator/provider prior to and after the evaluation.

     (9) Misrepresentation by a prospective employee, intern, or volunteer may be grounds for termination or denial of employment or volunteer service to that individual.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0035, filed 8/28/01, effective 9/28/01.]

     (1) If you have a home or facility that provides care, the care givers must have current training in:

     (a) Basic standard first aid; and

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

     (2) Approved first aid and CPR training must be in accordance with a nationally recognized standard such as the American Red Cross or American Heart Association.

     (3) For any facilities other than foster homes, the person with first aid and CPR training must be on the premises at all times when children are present.

     (4) The ((requirement for)) CPR training ((may be waived)) is not required for persons with a statement from their physician that the training is not advised for medical reasons.

     (5) You must keep records in your home or facility showing who has completed current first aid and CPR training.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0040, filed 8/28/01, effective 9/28/01.]

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

     (((3) The staff of group care programs are required to complete blood borne pathogen training.))

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0045, filed 8/28/01, effective 9/28/01.]

     (1) You must send the application form to your licensor at DLR or a child-placing agency.

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

     (a) ((Written verification for each applicant of:

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

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

     (((iii))) (c) HIV/AIDS training including infection control standards.

     (((b))) (3) A completed background check form for anyone age sixteen years or older on the premises of the home or facility including, but not limited to:

     (a) Each applicant((,));

     (b) Family member((,));

     (c) Staff person((,));

     (d) Board member((,));

     (e) Intern or volunteer who:

     (i) Is at least sixteen years old;

     (ii) Is not a foster child; and

     (iii) Has unsupervised access to children (see chapter 388-06 WAC).

     (((c))) (4) If you ((have)) or anyone age sixteen years or older in your home or facility has lived in Washington state less than three years, you must provide us with a completed FBI fingerprint form for that person.

     (((d) We may require additional information from you including, but not limited to:

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

     (ii) Psychiatric evaluations;

     (iii) Psycho-sexual evaluations; and

     (iv) Medical evaluations and/or medical records.

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

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0050, filed 8/28/01, effective 9/28/01.]

     (1) It must be clear that one type of care does not interfere with the health and safety of any child while providing the other type of care.

     (2) The total number of children in both categories must not exceed the number permitted by the most stringent capacity standards for the licensed care of children.

     (3) Any exceptions to the limitation on capacity require the written approval of the director of the division of licensed resources or their designee and the appropriate division of child care and early learning approval.

     (4) Approval to have both a child foster care license and a child day care license must:

     (a) Be in writing; and

     (b) Signed by a licensor from the division of licensed resources (for a foster care license) and from the division of child care and early learning (for a child day care license).

[]

     (2) You or your relative may apply to a different child-placing agency for a license.

     (3) Licensed foster parents who become employed by ((the department)) children's administration or a child-placing agency must be relicensed through an agency other than their employer within six months of employment.

     Note: Relative as defined under RCW 74.15.020 (4)(i) through (iv).

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0060, filed 8/28/01, effective 9/28/01.]

     (1) You are exempt from needing a license (per chapter 74.15 RCW);

     (2) You meet the licensing requirements; ((and))

     (3) You wish to serve department-funded children; and

     (4) You are licensed by authority of an Indian tribe within the state under RCW 74.15.190.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0065, filed 8/28/01, effective 9/28/01.]

     (2) The department must, also, disqualify you for any of the reasons that follow.

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

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

     (c) You or anyone living on the premises had a license denied or revoked from an agency that ((provided)) regulates care to children or vulnerable adults, unless the department determines that you do not pose a risk to children or vulnerable adults.

     (d) You try to get a license by deceitful means, such as making false statements or leaving out important information on the application.

     (e) You commit, permit or assist in an illegal act on the premises of a home or facility providing care to children.

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

     (g) You knowingly allowed employees or volunteers who made false statements on their applications to work at your agency.

     (h) You knowingly allowed employees or volunteers who use illegal drugs, alcohol, or prescription drugs that affect their ability to perform their job duties to work at your agency or be on the premises when children are present.

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

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

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

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

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0095, filed 8/28/01, effective 9/28/01.]

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

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

     (c) Death of a child;

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

     (e) Any use of physical restraint that is alleged improper or excessive;

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

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

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

     (i) ((Unexpected health problems that require off-site medical treatment;

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

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

     (l) Any emergent medical care)).

     (2) ((You or your staff must report immediately)) The following are examples of significant incidents that must be reported as soon as possible or in no instance later than forty-eight hours, ((any of the following incidents)) to the child's social worker, if the child is in the department's custody or to the case manager if placed with a child-placing agency program:

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

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

     (c) Any incident of medication incorrectly administered;

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

     (e) Runaways; ((and))

     (f) Any emergent medical care; and

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

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0120, filed 8/28/01, effective 9/28/01.]

     (2) You must keep records about children and their families in a secure place. If the child is in the department's custody, at the end of the child's placement, reports written by others about the child or the child's family must be returned to the child's social worker.

     (3) During a placement in your foster home, your records must be kept at your home and contain, if available, at a minimum, the following information:

     (a) The child's name, birth date, and legal status;

     (b) Name and telephone number of the social worker for each child in care;

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

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

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

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

     (g) Other pertinent information related to the child's health, including dental records;

     (h) Record of immunizations. Receiving and interim care homes and facilities do not need to keep records of immunizations for children in their care less than thirty days. Crisis residential centers and children placed in a foster home by a child-placing agency licensed to provide emergency respite services do not need to keep records of immunizations for children in their care;

     (i) Child's school records, report cards, school pictures, and individual education plans (IEP);

     (j) Special instructions including supervision requirements and suggestions for managing problem behavior;

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

     (l) The child's visitation plan.

     (4) During a child's placement in a staffed residential home ((or a)), group care program, or a child-placing agency program your records must be kept at your site and contain, at a minimum, the following information in addition to the information in subsection (3)(a) through (l) of this section:

     (a) Written consent from the child placing agency, if any, for providing medical care and emergency surgery (unless that care is authorized by a court order);

     (b) Names, addresses, and telephone numbers of persons authorized to take the child under care out of the facility;

     (c) A copy of the court order or voluntary placement agreement that gives approval to place the child;

     (d) Case plans, such as children's administration's "individual service and safety plan";((" and))

     (e) Daily logs of therapy treatment received by children with the signature of the person making the entry in the log; and

     (f) Facility or program logs documenting the following:

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

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

     (iii) Any health or safety issues;

     (iv) Signature of staff reviewing the log during each shift;

     (v) Staff to resident ratio on each shift;

     (vi) On-call and relief staff on premises during emergencies; and

     (vii) After-hours telephone number of the supervisor.

     (5) If you operate a group care program, staffed residential home, or child-placing agency and have client files with information not returned to the department, you must keep them for six years following the termination or expiration of any contract you have with the department.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0125, filed 8/28/01, effective 9/28/01.]

     (1) Each employee, intern, contractor, or volunteer who has unsupervised access to children must have completed an application for employment and signed a form enabling us to do a background check (chapter 388-06 WAC). You must keep a log of all the background check results.

     (2) Misrepresentation by the prospective employee, interns, or volunteer will be grounds for termination or denial of employment or volunteer service.

     (3) If you have five or more staff, volunteers, or interns you must have written policies covering qualifications, training, and duties for employees, interns, and volunteers.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0140, filed 8/28/01, effective 9/28/01.]

     (2) You must daily empty and clean any portable wading pool that children use.

     (3) Children under twelve must be in continuous visual or auditory range at all times when they are swimming((,)) or wading((, or boating)) by an adult with current age appropriate first aid and CPR.

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

     (5) All safety devices and rescue equipment, such as personal flotation devices must meet state and federal water safety regulations.

     (6) You must lock or secure hot tub and spa areas when they are not in use.

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

     (8) Foster homes with pools must have a written safety and supervision plan for each child.

     (9) Individuals providing supervision in foster homes and staffed residential homes serving five or fewer children must know how and be able to use rescue equipment or have a current life-saving certification, when children are using a pool on the premises.

     (10) All group care facilities and staffed residential homes serving six children must have a person with current life-saving certification on-duty when children are using a pool at the facility.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0170, filed 8/28/01, effective 9/28/01.]

     (2) Foster homes and staffed residential homes ((need)) must have inspections by fire marshal or local fire department if either:

     (a) Licensors request the inspections; or

     (b) Local ordinances or State Fire Marshal regulations require these inspections.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0220, filed 8/28/01, effective 9/28/01.]

     (1) An adult must be on the same floor or within easy hearing distance and accessibility to where children under six years of age are sleeping. In foster homes only, children age one through five years may sleep on separate floors provided that they are supervised with an electronic "baby" monitor to ensure health and safety. Infants under age one year must be on the same floor as an adult.

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

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

     (4) For facilities licensed after December 31, 1986, bedrooms must have both:

     (a) Adequate ceiling height for the safety and comfort of the occupants. Normally, this would be seven and a half feet; and

     (b) A window of not less than one-tenth of the required floor space that can open into the outside, allowing natural light into the bedroom and permitting emergency access or exit.

     (5) For any foster children six years of age and over, you must furnish separate sleeping quarters for each gender.

     (6) Children in care must not share the same bed.

     (7) In group care facilities, single occupancy bedrooms must provide at least fifty square feet of floor space.

     (8) In foster homes, single occupancy bedrooms must provide adequate floor space for the safety and comfort of the child. Normally, this would be at least fifty square feet of floor space, not including closets.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0260, filed 8/28/01, effective 9/28/01.]

     (2) For each child in care, you must provide a bed at least thirty inches wide with a clean and comfortable mattress in good condition, pillow, sheets, blankets, and pillowcases. Each child's pillow must be covered with waterproof material or be washable.

     (3) Bedding must be clean.

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

     (5) You must provide an infant with a crib that ensures the safety of the infant and complies with chapter 70.111 RCW, Infant Crib Safety Act.

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

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

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

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

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

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

     (10) You may use toddler beds with a standard crib mattress that is sufficient in length and width for the comfort of children under six years of age.

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

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0270, filed 8/28/01, effective 9/28/01.]

     (a) Been under regular medical supervision; or

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

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

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

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0335, filed 8/28/01, effective 9/28/01.]

     General communicable diseases and infections

     (1) In each home or facility, other than a foster home, staff with a reportable communicable disease, as defined by the department of health, in an infectious stage must not be on duty until they have a physician's approval for returning to work.

     (2) Each home or facility, other than a foster home, that cares for severely and multiple-handicapped children must have an infection control program supervised by a registered nurse.

     (3) Foster homes with medically fragile children may use other alternatives, such as in-home nursing services, to consult on infection control procedures.

     Tuberculosis

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

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

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

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

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

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

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

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

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

     (8) The facility must keep the results of the applicant and employees TB test results in the personnel file on the premises of the facility.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0345, filed 8/28/01, effective 9/28/01.]

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

     (3) Only you or another authorized care provider (example: respite provider) may ((give or)):

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

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

     (((5))) (c) Except for foster homes, keep a record of all medications you give a child;

     (((6))) (d) Foster homes must keep a record of all prescription medication given to foster children; and

     (((7) Properly dispose))

     (4) You or another authorized care provider must follow the department of health protocol in the proper disposal of medications that are no longer being taken or have expired.

     Prescription medications

     (((8))) (5) You or another authorized care provider must:

     (a) Give prescription medications:

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

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

     (b) Check with the physician or pharmacist about possible side effects for any prescription medications, herbal supplements and remedies, and interactions with nonprescription drugs the child is taking.

     Psychotropic medications

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

     (a) The child's parent;

     (b) Dependency guardians;

     (c) A court order; or

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

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

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

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

     Nonprescription medications

     (((11))) (8) Children taking psychotropic medications must have the prescribing physician's authorization before any nonprescription drugs and herbal supplements are given.

     (((12))) (9) You or another authorized care provider must follow these requirements for nonprescription medications. You must:

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

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

     (ii) Nonnarcotic cough suppressants;

     (iii) Decongestants;

     (iv) Antacids and anti-diarrhea medication;

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

     (vi) Shampoo for the removal of lice;

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

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

     (ix) Antibacterial ointments for first aid use.

     (b) Give any other nonprescription medications only when approved in writing by a physician. These nonprescription medications may be given with a physician's standing order. Physician's standing orders must be patient specific.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0350, filed 8/28/01, effective 9/28/01.]

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

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

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

     (4) If breast milk is provided by anyone other than a baby's biological mother, approval must be obtained from the child's social worker.

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

     (6) You must not prop bottles while feeding infants.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0395, filed 8/28/01, effective 9/28/01.]

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     (2) You must supervise children who help with food preparation in the kitchen, based on their age and skills.

     (3) Preschool children and children with severe developmental disabilities must not be left unattended in a bathtub or shower.

     (4) Foster parents and facility staff must provide the children in their care with appropriate adult supervision, emotional support, personal attention, and structured daily routines and living experiences.

     (5) In group care children must be supervised during sleeping hours by at least one awake staff when:

     (a) There are more than six children in care; and

     (b) The major focus of the program is behavioral rather than the development of independent living skills such as a teen parent program or responsible living skills program; or

     (c) The youth's behavior poses a risk to self or others.

     (6) In foster homes and staffed residential homes, children must be supervised during sleeping hours by at least one awake staff when it is part of the written supervision plan with the child's social worker.

     (7) Adequate supervision should be arranged and maintained during times of crisis when one or more family members or staff members may be unavailable to provide the necessary supervision or coverage for other children in care.

     (8) When special supervision is required and agreed upon between the department and the agency or foster parent, the agency or foster parent provides the necessary supervision. This supervision may require auditory or visual supervision at all times.

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

     (10) When a child exhibits behavior that poses a safety risk to other children in care, ((the child must not share a)) sleeping arrangements and/or bedroom ((with)) assignments must be made, in consultation with the child's social worker, to ensure the safety of other children.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0460, filed 8/28/01, effective 9/28/01.]

     (a) Be familiar and comfortable with the individual who will be caring for the foster child;

     (b) Meet with the substitute caregiver and review the expectations regarding supervision and discipline of the foster child;

     (c) Be responsible for providing the caregiver any special care instructions;

     (d) Provide information on how to be contacted by the substitute caregiver; and

     (e) Ensure the child has a safety plan.

     (2) On an occasional basis and for less than twenty-four hours, the foster parent may use a friend or a relative as a substitute caregiver, without verifying criminal and founded child abuse/neglect history when the foster parent has no reason to suspect the substitute caregiver:

     (a) Has a history that would disqualify them from caring for a department child; or

     (b) Would be at risk in the their care.

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     (2) You need)) have:

     (a) Proof of completion of current first-aid/CPR training that is geared for the ages of the foster children ((you)) they want in your home((.

     (3) You need)); and

     (b) Proof of completion of HIV/AIDS prevention training.

     (((4) The primary care givers must))

     (2) The CPR training is not required for person with a statement from their physician that the training is not advised for medical reasons.

     (3) At least one foster parent must:

     (a) Attend required orientation and pre-service training programs that the department sponsors or that your licensed child-placing agency offers; and

     (b) Complete all required DLR-approved training after licensing.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0520, filed 8/28/01, effective 9/28/01.]

     (a) The foster parent knows the youth babysitter to be reliable and mature enough to provide appropriate care to the foster child.

     (b) The youth babysitter has completed a background check within the past year. Exception: For occasional care of less than twenty-four hours, the verification of the background check is not required, provided the foster parent has no reason to suspect:

     (i) The babysitter has a disqualifying criminal history or founded complaint of child abuse/neglect; and

     (ii) The child would be at risk in the care of the babysitter.

     (c) The youth babysitter must not be responsible for more than three foster children.

     (2) If the care by the youth babysitter is a regular arrangement, the foster parents must have the written approval of the social worker for the foster child.

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     (2) The treatment plan must:

     (a) Identify the service needs of the child, parent or guardian;

     (b) Describe the treatment goals and strategies for achieving those goals;

     (c) Include a running account of the treatment received by the child and others involved in the treatment plan, such as any group treatment or individual counseling; and

     (d) Be updated at least quarterly to show the progress toward meeting goals and list barriers to the permanent plan.

     (3) A social service staff person must review and sign approving the child's treatment plan.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0560, filed 8/28/01, effective 9/28/01.]

     (((1))) (2) One person who provides social services must have a master's degree in social work or a closely related field from an accredited school.

     (((2))) (3) Social service staff without a master's degree in social work or closely related field must have a bachelor's degree in social work or a closely related field. A person with a master's degree must consult at least eight hours per month with any social service staff who have only a bachelor's degree.

     (((3))) (4) When social services are provided by another agency, you must have a written agreement with the agency describing the scope of service they provide. Written agreements must meet the requirements of this rule.

     (((4))) (5) A social service staff person must review and sign approving the child's treatment plan.

     (((5))) (6) A social service staff person must review and sign approving licensing application packets before they are submitted to DLR.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0585, filed 8/28/01, effective 9/28/01.]

     (1) You must request the local fire department to visit your home or facility to((:

     (a) Assist care givers in meeting all necessary fire safety requirements; and

     (b))) become familiar with your home or facility.

     (2) You must assure that furnace rooms are:

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

     (b) Suitably isolated, enclosed, or protected.

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

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

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

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

     (7) Candles must not be used.

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

     (9) House and facility numbers must be clearly visible from the street or road in front of the property. Where the home or facility is not clearly visible from the road, the address must be posted at the head of the driveway.

     Note: This is to allow emergency vehicles and fire trucks to easily find addresses.

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

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0630, filed 8/28/01, effective 9/28/01.]

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

     (b) Work with representatives of other agencies.

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

     (a) Have a bachelor's degree in social science or closely related field from an accredited school; or

     (b) Have a minimum of two years of successful, full-time relevant experience, such as working in a group care facility; or

     (c) Have a minimum of two years as a foster parent with a letter of recommendation from the licensing agency and supervising agency.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0700, filed 8/28/01, effective 9/28/01.]

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

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

     (3) Have a high school diploma or GED;

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

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

     (6) Have effective communication and problem solving skills.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0720, filed 8/28/01, effective 9/28/01.]

     (2) The health care staff must maintain their certification or licensure as required by the department of licensing.

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     (1) The ratio for group homes is at least one child care staff member on site for every eight children during waking and sleeping hours.

     Note: Crisis residential centers, staffed residential homes, maternity programs, and programs for children with severe developmental disabilities have different requirements.

     (2) At least two adults, including at least one child care staff person, must be on site whenever more than eight children are on the premises.

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

     (4) During sleeping hours of youth, at least one staff person must be awake in all group home programs when:

     (a) There are more than six youth in care; and

     (b) The major focus of the program is behavioral change rather than the development of independent living skills, such as teen parent and independent living skills programs; or

     (c) The youth's behavior poses a safety risk to self or others.

     (5) When only one child care staff is on site, a second staff must be on call.

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

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

     (8) For certified juvenile detention facilities, at least one child care staff member must be on duty for every ten children in care during the sleeping and waking hours.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0725, filed 8/28/01, effective 9/28/01.]

     (1) These programs must employ sufficient numbers of residential staff to meet the physical, safety, health and emotional needs of the residents. Residential staff are in charge of supervising the day-to-day living situation for youth.

     Note: Child care staff may carry out any maintenance tasks that do not detract from their primary function.

     (2) When youth are on the premises, the ratio of staff to residents must be as follows:

     (a) At least one residential staff member must be on duty for every eight ((mothers)) persons.

     (b) When more than eight persons (((including mothers and children))) are on the premises, at least two adults, including at least one child care staff must be on duty.

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

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0785, filed 8/28/01, effective 9/28/01.]

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0880, filed 8/28/01, effective 9/28/01.]

     (1) Be a free-standing facility, separate unit or separate building within a campus with exterior doors that have special egress-control devices;

     (2) Meet or exceed the current state building code for facilities with special egress-control devices; and

     (3) Maintain a recreation area, within the secured facility or secured on the property of the facility, that can support youth's vigorous physical activity. (Any fences used to secure the recreation area must meet or exceed the specifications of the level-two secure CRC referenced in WAC 388-148-0890(3)).

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     All CRCs

     (1) The director or designee of ((a)) any crisis residential center (CRC) must immediately notify the parents of the youth who has been admitted.

     (2) If the director or designee of any CRC is unable to contact the youth's parents within, forty-eight hours, he or she must:

     (a) Contact the department and request that the case be reviewed for dependency filing under chapter 13.34 RCW or "child in need of services" filing under chapter 13.32A RCW; and

     (b) Document the contact with the department in the youth's case record.

     (3) After a youth is admitted to any CRC, the director or designee must ensure that a youth is assessed for any health needs requiring immediate attention.

     (4) By the first school day after admission, the staff of any crisis residential center must:

     (a) Notify the youth's school district about the youth's placement; and

     (b) Assess the youth for any educational needs as a part of the assessment process for inclusion in the discharge summary.

     Secure CRCs

     (((3))) (5) Within the first twenty-four hours after admitting a youth to a secure crisis residential center, and each twenty-four hours after, the director or designee must assess the youth's risk of running.

     (((4))) (6) The secure CRC director or designee must determine what type of CRC, regular or secure, would be best for the youth.

     (((5))) (7) The secure CRC director or designee must use the following criteria in making the decision, considering the safety, health and welfare of the youth and others:

     (a) The youth's age and maturity;

     (b) The youth's physical, mental, and emotional condition upon arrival at the center;

     (c) The circumstances that led to the youth's placement at the facility;

     (d) The youth's behavior;

     (e) The youth's history of running away;

     (f) The youth's willingness to cooperate in conducting the assessment;

     (g) The youth's need for continued assessment, protection, and intervention services in a CRC; and

     (h) The likelihood the youth will remain at a CRC.

     (((6))) (8) The secure CRC director or designee must put the decision about the youth's status in writing in the youth's file.

     (((7) After a youth is admitted, the CRC director or designee must ensure that a youth is assessed for any health needs requiring immediate attention.

     (8) By the first school day after admission, the crisis residential center staff must:

     (a) Notify the youth's school district about the youth's placement; and

     (b) Assess the youth for any educational needs as a part of the assessment process for inclusion in the discharge summary.))

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0915, filed 8/28/01, effective 9/28/01.]

     Regular CRCs

     (2) At all times, regular crisis residential centers must have at least one youth care staff on duty for every four youth in care.

     (3) Regular crisis residential centers must have at least two awake youth care staff on duty during waking hours of the youth.

     (4) Regular crisis residential centers must have at least one awake youth care staff on duty during sleeping hours of the youth. One or more additional (back-up) staff must be on the premises during sleeping hours to maintain staffing ratios.

     Under extraordinary circumstances, the DLR director may approve an alternative back-up plan.

     Secure CRCs

     (5) At all times, secure crisis residential centers must have at least two staff on duty ((at all times)) when youth are present.

     (6) At all times, secure crisis residential centers not co-located with a detention center must have at least one youth care staff on duty for every three youth in care.

     (7) At all times, secure crisis residential centers that are located in the same facility as a detention ((facilities)) center must have ((the)) at least one awake youth care staff on duty for every four youth in care.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-0995, filed 8/28/01, effective 9/28/01.]

     (1) Certification of eligible foster homes meeting full licensing requirements;

     (2) Maternity services to expectant mothers;

     (3) Specialized (treatment) foster care;

     (4) Emergency respite services;

     (5) Residential care programs, such as group homes, crisis residential centers, and independent living skills programs; and

     (((5))) (6) Adoption services.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-1060, filed 8/28/01, effective 9/28/01.]

     (3) When the child is being placed for adoption, your report must not contain information that might identify the birth parents)) that meets the federal and state statutes.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-1070, filed 8/28/01, effective 9/28/01.]

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     (2) You must)) follow federal and state adoption laws.

     (a) Recruit potential adoptive families that reflect the diversity of children in your community((.

     (3) You must)); and

     (b) Provide adoptive applicants with the following services, at a minimum:

     (((a))) (i) Information about the adoption process;

     (((b))) (ii) Your agency's policies, practices and legal procedures;

     (((c))) (iii) Types of children available for adoption and implications for parenting different types of children; and

     (((d))) (iv) Information on adoption support programs.

     (((4))) (2) You must document that you provided this information to the adoptive applicant in the applicant's file.

     (3) You must visit the adoptive home of all adoptive placements at least once in the first thirty days of placement and an additional face-to-face visit to observe the parent and child each sixty days after that until the adoption is finalized.

     (4) You must be available for consultation regarding the adjustment of the adopted child and the family after finalization of the adoption.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-1115, filed 8/28/01, effective 9/28/01.]

     (1) The applicants must submit an application (including a completed background inquiry form) to the child-placing agency.

     (2) Once you have received an application, but before you have sign a contract for services, you must give the applicants a written statement about:

     (a) The adoption agency's fixed fees and fixed charges to be paid by the applicant;

     (b) An estimate of additional itemized expenses to be paid by applicant; and

     (c) Specific services covered by fees that you offer for child placement or adoption.

     (3) Your staff must complete an adoptive home study as required in RCW 26.33.190 with the participation of the applicant(s). For the study, your staff and the applicants ((need to)) must decide ((about)) the following:

     (a) The suitability of the applicant(s) to be adoptive parent(s); and

     (b) The type of child(ren) for which the applicant or applicants are best suited.

     (4) Your staff must accept or deny the application and give an explanation for your decision.

     (5) You must file preplacement (home study) reports with the court (as required by RCW 26.33.180 through 26.33.190).

     (6) Your staff must prepare the potential adoptive parent(s) for placement of a specific child by:

     (a) Locating and providing information about the child and the birth family to the prospective adoptive family ((as described in chapter 388-25 WAC)) provided under federal and state statute;

     (b) Discussing the likely implications of the child's background for adjusting in the adoptive family.

     (7) Your staff must reevaluate the applicant(s) suitability for adopting a child each time an adoptive placement is considered.

[Statutory Authority: RCW 74.15.030. 01-18-037, § 388-148-1120, filed 8/28/01, effective 9/28/01.]

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