WASHINGTON STATE REGISTER

WSR 04-11-116

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed May 19, 2004, 11:28 a.m. ]

аааааOriginal Notice.

аааааPreproposal statement of inquiry was filed as WSR 04-07-189.

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

аааааPurpose: The purpose of revising the boarding home licensing rules is to assure that chapter 388-78A WAC complies with chapter 18.20 RCW as amended by SSB 6225, SSB 6160 and SSB 5733 by the 2004 legislature, and to be responsive to the needs of department clients.

аааааOther Identifying Information: The department is proposing to repeal all rules in chapter 388-78A WAC adopted under WSR 03-16-047 scheduled to take effect September 1, 2004, and replace them with the proposed rules contained in this notice.

аааааStatutory Authority for Adoption: RCW 18.20.090, chapter 142, Laws of 2004.

аааааStatute Being Implemented: Chapter 18.20 RCW, chapter 142, 144, and 140, Laws of 2004.

аааааSummary: The proposed amendments:

Х Repeal all existing sections in chapter 388-78A WAC adopted under WSR 03-16-047, and replace them with new sections.

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

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

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

Х Identify when specialized training for developmental disabilities, mental illness, and dementia is required in boarding homes in accordance with chapter 18.20 RCW and chapter 388-112 WAC.

Х Improve the requirements for boarding home administrators.

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

аааааReasons Supporting Proposal: See Explanation of Rule below.

аааааName 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.

аааааName of Proponent: Department of Social and Health Services, governmental.

аааааAgency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: DSHS intends to adopt proposed rules as permanent by July 30, 2004, and make them effective as of September 1, 2004.

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

аааааExplanation of Rule, its Purpose, and Anticipated Effects: Chapter 388-78A WAC contains the licensing standards for boarding homes. It is being revised in part to comply with directions provided by the 2004 legislature contained in SSB 6225, SSB 6160, and SSB 5733. The department is also revising the chapter to be responsive to the needs of department clients. The anticipated effects of this rule are that residents will receive more appropriate and individualized care and services in a boarding home.

аааааProposal Changes the Following Existing Rules: The entire licensing chapter 388-78A WAC has been revised to make it consistent with recent legislation and to be responsive to the needs of department clients. The proposed changes include:

Х Repealing all sections in chapter 388-78A WAC adopted under WSR 03-16-047, and replacing them with new sections.

Х Specifying when a boarding home license is and is not required.

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

Х Specifying the content and timing of preadmission resident assessments and full reassessments.

Х Specifying who is qualified to complete the preadmission assessment.

Х Specifying the process of developing negotiated service agreements for residents, including the timing and content of these agreements.

Х Specifying the requirements for implementing negotiated service agreements and monitoring residents' well-being.

Х Specifying the required services a boarding home must provide.

Х Identifying the optional domiciliary care services a boarding home may provide, and the minimum level of assistance with activities of daily living a boarding home must provide if it chooses to provide assistance with activities of daily living.

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

Х Specifying the requirements for families providing medication assistance to residents.

Х Specifying the requirements for food services and therapeutic diets.

Х Specifying the requirements associated with providing nursing services.

Х Specifying the requirements concerning resident-arranged services with providers external to the boarding home.

Х Specifying the requirements for coordinating services with providers external to the boarding home.

Х Specifying the requirements for providing adult day care and dementia care, and the requirements for operating a unit with restricted egress.

Х Specifying the requirements associated with documenting resident care, and maintaining records regarding residents' care.

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

Х Specifying the training requirements for staff.

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

Х 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.

Х Specifying resident rights in boarding homes.

Х Specifying requirements for disaster preparedness and disclosing available services.

Х Specifying the requirements for obtaining a boarding home license and the procedures for application.

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

Х Specifying the requirements for the building to be used as a boarding home.

Х Specifying the rights and responsibilities of the boarding home during the inspection process.

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

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

Small Business Economic Impact Statement
аааа SUMMARY OF PROPOSED RULES: Chapter 388-78A WAC, Boarding home licensing rules, contains the requirements that boarding homes must meet in order to be licensed in Washington. The statutory authority for chapter 388-78A WAC is RCW 18.20.090. The purpose of chapter 388-78A WAC is to implement chapter 18.20 RCW, as directed by the statute, to promote the safe and adequate care of individuals in boarding homes, and to promote sanitary, hygienic and safe conditions in boarding homes.

аааа 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 home licensing rules.

аааа The purpose of these amendments is to:

Х Repeal all sections in chapter 388-78A WAC filed under WSR 03-16-047 (effective September 1, 2004) in response to the needs of department clients.

Х Adopt revised sections in chapter 388-78A WAC that are consistent with chapter 18.20 RCW as amended by SSB 5733, 6160 and 6225 passed by the 2004 legislature, which address the following issues:

&lhlsqbul; Revised assessment requirements;

&lhlsqbul; Revised requirements for initial resident service plans, and negotiated service agreements;

&lhlsqbul; Required basic services;

&lhlsqbul; Assuming general responsibility for the safety and well-being of residents;

&lhlsqbul; Optional domiciliary care services including:

&sqbul; Assistance with activities of daily living;

&sqbul; Health support services; and

&sqbul; Intermittent nursing services;

&lhlsqbul; Disclosing available services to residents and their representatives;

&lhlsqbul; Family assistance with medications;

&lhlsqbul; Resident-arranged services with health care practitioners, home health and home care agencies, and hospice agencies; and

&lhlsqbul; When a boarding home license is and is not required.

Х Make editorial changes for additional clarity.

аааа The proposed amendments include:

аааа 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.

аааа Residential care services (RCS), Aging and Disability Services Administration, has analyzed our proposed rule amendments and concludes a comprehensive SBEIS is required.

аааа 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.

аааа 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. The department determined the on-going costs associated with complying with the revised rules should be expressed in terms of dollars per resident day. Further, the department determined that the "average" "small business" is best represented by a boarding home licensed for thirty-two beds, and that the "average" "large business" is best represented by a boarding home licensed for eighty-two beds.

аааа The department arrived at these two representative numbers by analyzing its own data available in the Home and Community Rates section of ADSA. This data suggested that on an average, a boarding home licensed for sixty beds employed approximately fifty employees. Therefore, the department considered boarding homes with sixty or fewer licensed beds as "small businesses." The department then arrayed five hundred twenty-seven licensed boarding homes into two groups by number of licensed beds: Those with sixty or fewer licensed beds (small businesses); and those with more than sixty licensed beds (large businesses). The median number of licensed beds in "small businesses" is thirty-two beds, and the median number of licensed beds in "large businesses" is eighty-two beds. The department's methodology of determining the "average" small business and "average" large business had been previously reviewed with the boarding home industry, which concurred with the department's methodology.

аааа INVOLVEMENT OF SMALL BUSINESSES: ADSA 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 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:

Х Provision of nursing services and health care supports;

Х The process of assessing residents' needs;

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

Х Administrative issues in the boarding home;

Х Provision of care to persons with dementia;

Х Enforcement issues;

Х The building and physical environment; and

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

аааа 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 website 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.

аааа Additionally, the 2003 legislature enacted SSB 5579, which amended chapter 18.20 RCW and also impacted chapter 388-78A WAC.

аааа Based on the department's analysis of these recommendations and SSB 5579, proposed rules were then filed under WSR 03-03-018, further comments were accepted in writing and during testimony in a formal hearing, and final rules were filed and adopted under WSR 03-16-047 with an effective date of September 1, 2004.

аааа Subsequently, the 2004 legislature enacted SSB 5733, 6160 and 6225, which further impacted several sections of the rule. Consequently, the department decided to propose repealing the rules filed under WSR 03-16-047 and adopting a revised chapter that will assure that chapter 388-78A WAC complies with recent changes in statute and is responsive to concerns of various stakeholders.

аааа The department filed a preproposal statement of inquiry in WSR 04-07-189, and notified interested persons that it intended to amend the rules. The department then drafted amendments to chapter 388-78A WAC and provided to representatives of three boarding home trade associations (Northwest Assisted Living Facilities Association, Washington Association of Housing and Services for the Aging, and Washington Center for Assisted Living/Washington Health Care Association), the Long Term Care Ombudsman, and the Residents Councils of Washington, a copy of draft amendments and requested their feedback. The department considered the feedback provided, made appropriate changes to the draft, and is now proposing an amended chapter 388-78A WAC.

аааа Western Health Care Corporation of Boise, Idaho, was hired to review the draft rules and develop an assessment of the costs of implementing the revised rules. (A copy of the report from Western Health Care Corporation is available by contacting Denny McKee at mckeedd@dshs.wa.gov or (360) 725-2590.) The department then distributed Western Health Care Corporation's cost analysis to the three boarding home trade associations, the Long Term Care Ombudsman, the Residents Councils of Washington and select boarding home operators. These stakeholders and select legislative members and staff were invited to a committee meeting to review this analysis and provide additional information in response to it. The committee meeting was held on May 6, 2004, during which the invited stakeholders discussed and responded to the analysis with department representatives, Western Health Care Corporation and invited legislative staff. The industry representatives were then given additional time to May 10, 2004, to submit additional information to the department.

аааа COST OF COMPLIANCE: To fairly consider costs of compliance, RCS 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:

аааа 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.

аааа 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.

аааа COST ANALYSIS: Western Health Care Corporation identified the costs listed in the first column. The boarding home industry representatives responded during the May 6, 2004, meeting and with additional information provided on May 10, 2004, and noted the on-going costs listed in the second column. The department's analysis of this information and conclusions are identified in the third column.

WESTERN HEALTH CARE CORPORATION COST ANALYSIS STAKEHOLDER INPUT FROM COMMITTEE MEETING
(May 6, 2004)
DEPARTMENT COST ANALYSIS

WAC 388-78A-2010 Purpose and 388-78A-2020 Definitions.
Cost Impact: None.
ANALYSIS: This section includes definitions of terms used throughout the draft rules. There are no tasks associated with the definitions, therefore there are no costs associated with this section.
Industry comments include the following regarding WAC 388-78A-2020.
Cost of additional training for volunteers who are not directly supervised by boarding home staff is a result of the definition of "resident care staff person."
The definition "resident care staff person" does not expand the requirements for training of volunteers so there is no cost imposed by this definition. Volunteers who provide hands-on personal care and are not directly supervised are considered "caregivers" as defined in WAC 388-112-0005, effective August 11, 2002.

Volunteers will be required to take the same level of training as boarding home staff: Twenty-eight hours basic training and twenty-two through twenty-four hours for mental health training. By law, since 2002, boarding homes have been required to train volunteers who meet the "caregiver" definition as they would other caregivers in accordance with RCW 18.20.270.

To mitigate any confusion by the definition, the department has replaced the draft definition of "resident care staff person" with the definition of "caregiver" consistent with chapter 388-112 WAC.

Cost increase for independent living due to "nonresident" definition.
The definition of boarding home specifically excludes independent living from the definition and application of these requirements; therefore, there is no cost based on these rules. Further, the definition of "nonresident individual" is based on the statutory definition found in SSB 6225.

There will be increased cost for providing low sodium and diabetic diets. SSB 6225 reduces the scope of diets currently required. Current requirements in WAC 388-78A-170 (3)(a) require the licensee to provide therapeutic diets without limitation when prescribed by a heath care practitioner. Chapter 18.20 RCW as amended by SSB 6225 requires the provision of prescribed general low sodium, diabetic, and mechanical soft foods diets. There is no increased cost associated with this rule.

WAC 388-78A-2080 Qualified assessor.
Cost Impact: $0.08 to $0.16 per resident day, average of $0.12 per resident day.
The industry comments include:
Requires assessment to be done by a higher qualified employee or as a purchased service.
Current WAC 388-78A-265 (1)(b) already requires an RN or physician to assess or supervise an LPN's assessment of each resident requiring limited nursing services.

ANALYSIS: This section is a new requirement under the draft rules. There are many examples of people who will be A private case manager may cost $45 to $90 per hour. A nursing assessment is not required under the proposed rules unless the boarding home chooses to provide services to an individual needing nursing

considered qualified to perform the preadmission assessment, including social workers, nurses, physicians, and people who have three years of experience One provider agreed with the consultants estimate of twelve cents per day to implement the rules. This facility is doing their own assessments. services. Any nursing assessments that are completed must be completed by a nurse acting within his/her scope of practice described in chapter 246-840 WAC, Practical and registered nursing.

assessing boarding home residents prior to September 1, 2004. Although most facilities already have staff who meet this Cost of doing assessments will be reduced if an RN is no longer required and an LPN can do the assessments. Therefore there are no new costs associated with the proposed rule related to nursing assessments.

requirement, some may not.
If a facility needs to hire a person to complete the assessments, additional costs to the facility may be incurred due to this rule. Facilities with fifteen patients can be expected to have
Rural facilities are located two hours from a pool of nurses to complete assessments. This will cost two to three times more per assessment. Cost is $50/hour to drive to their location to do an assessment. In information provided by the industry via e-mail May 10, 2004, they estimated that a resident assessment potentially takes three hours to complete, and that one could expect an average of two new admissions per month for boarding homes licensed for fifteen to forty beds.

between one and two admissions per month. If the assessor is paid $20 per hour, and each preadmission assessment takes two hours, the facility will incur costs of $20 per hour times two to four hours per month. This equals $40-80 per month, divided by 450 patient days per month results in approximate costs of $0.08 to $0.16 per resident day. This cost is a variable cost, and should be the same regardless of facility size. Cost of assessments is not only large vs. small facilities, but also rural vs. urban.
To reduce cost, the consultants suggested the resident or their representative fill out an inquiry form that has most of the information needed and review at preadmission assessment.
Discussion during the May 6, 2004, meeting revealed that many boarding homes already have assessors on staff who meet the requirements of the proposed rule. Other boarding homes, especially small rural boarding homes, may need to hire contracted individuals. The department mitigated these potential costs by "grandfathering” in persons with three years of experience, by expanding the settings in which qualifying experience may be gained, and by including travel time in the time allotted for conducting assessments.

In terms of a small business vs. larger facility, the larger facility has qualified assessors on staff. It takes an average of two hours to complete an assessment. There are additional costs of time to go to the applicant to obtain information and discuss with staff. A qualified assessor at $20 per hour is not enough for a good RN. The cost will be two to three times higher for small business. Information provided by the industry via e-mail May 10, 2004, states contracted assessors may cost from $35 to $90 per hour (no supporting documentation provided). The same e-mail indicates current wages for assessors are $10 per hour. Information obtained from Employment Security data indicates the average hourly wage (50th percentile) for a MSW social worker in King County is $16.99 (SOC Code 21-1022, June, 2002). A department case manager who is qualified to conduct resident assessments

Average cost for a private case manager to complete an assessment for an adult family home is $285. If required to have qualified assessors the costs would be more. currently (2004) may receive a maximum salary of a "Social Worker 3" at an hourly wage of $23.06. Given that some boarding homes will have qualified assessors on staff, while others may need to contract with professionals in the community, the department considers the wages paid to the department's social worker 3's to be a reasonable average wage, especially when the boarding home industry indicated in 2002 that a qualified assessor would cost $20 per hour. This is equivalent to a 15% increase in wages in two years.

Based upon the above information, the department has determined boarding homes (fifteen to forty licensed beds) would experience additional costs of $.08 per resident day related to the increased qualifications of an assessor. (2 assessments x 3 hours per assessment x ($23.06-$10.00) /30 days per month/ average thirty-two residents). Proportional increases in the number of licensed beds would result in proportional numbers of new admissions divided by a proportional increase in the number of resident days, resulting in the same cost of $.08 per resident day for large boarding homes.

WAC 388-78A-2090 Full reassessment topics.
Cost Impact: None.
ANALYSIS: The "Full reassessment topics" section
The industry comments include:
Current rule does not require RN to complete assessments.
Current WAC 388-78A-265 (1)(b) requires an RN or physician to assess or supervise an LPN's assessment of each resident requiring limited nursing services.

lists items that must be included on a full assessment to be completed within fourteen days of a resident's move in. The Strike out registered nurse for potential reduced cost. The proposed rule does not require a registered nurse to do an assessment. A nurse is needed in accordance with

reason we find there to be no cost impact for this draft rule is because the topics are listed in SB 6225 section 8(1), therefore they are now required by law to be completed. Staff qualifications to complete the full and on-going reassessments are currently found in the Nurse Practice Act (chapter 18.79 RCW). chapter 18.79 RCW and the rules promulgated thereunder only if the resident has nursing issues. There is no cost related to this requirement.

WAC 388-78A-2160 Implementation of negotiated service agreement and 388-78A-2120 Monitoring residents well-being.
Cost Impact: None.
ANALYSIS: No substantial change in these sections from the existing rules (WAC 388-78A-260).
Industry comments are as follows:
Will require spending time talking and negotiating services to be provided to the resident. This is a change in requirement that could be a cost. It is a new expectation to spend time with the resident representative regarding care and will add to costs.
This is not a new requirement. RCW 70.129.140 (1) and (2)(e) and (f) requires the boarding home to involve the resident and the resident representative in the assessment and planning process.
Additionally RCW 70.129.030(3) requires the resident participation in care and services including preferences important to the resident such as food and daily routine.

May be required in chapter 388-110 WAC for Medicaid residents.
RCW 70.129.140 (2)(e) says the resident has a right to participate in plan and treatment. Now there is no choice, must participate.
Although the term negotiated service agreement has not been in rule, the requirement to involve the resident and the resident representative has been in statute since 1994. Consequently, there is no cost to implementing this rule.

Not currently a common practice in addition to assessment.

WAC 388-78A-2180 Activities.
Cost Impact: None.
ANALYSIS: This section is substantially already present in current rules (WAC 388-78A-260(3).
Minimal cost associated with supplies and equipment by resident activities on individual basis.
The word "reasonable" might be used here to clarify minimal cost.
Not substantively different from current WAC.
The department recognizes the concern that there could be an expense for an extraordinary activity requested by a resident. To mitigate the potential cost impact to small business the department added language to clarify the expectation that the boarding home must make available for resident activities only "routine" supplies and equipment.

WAC 388-78A-2220 Prescribed medication authorization, 388-78A-2230 Medication refusal, 388-78A-2240 Nonavailability of medications, 388-78A-2250 Alteration of medication, 388-78A-2260 Storing, securing, and accounting for medication, 388-78A-2270 Resident controlled medication, 388-78A-2280 Medication Industry comments to WAC 388-78A-2260 are as follows: Boarding homes will experience significant increases in costs if additional staff and/or training is required to conduct a two-person inventory of Schedule II and III drugs.
In response to cost concerns raised by the boarding home industry, the department mitigated the cost by eliminating from the proposed rule the requirement to have a daily two-person inventory of Schedule II and III drugs. Boarding homes must meet the requirements of medication services outlined in chapter 69.41 RCW per SSB 6225. Therefore there will be no additional costs associated with inventorying drugs due to the proposed rule.

organizers, and 388-78A-2290 Family assistance with medication.
Cost Impact: None.
ANALYSIS: The only section in the above draft rules that changed from existing rule and not incorporated in SB 6225 is WAC 388-78A-2260. In WAC 388-78A-2260, there is an added requirement to have a second
Comments regarding WAC 388-78A-2290: Increased oversight for family assistance with medications and treatments is a new expectation. Current WAC 388-78A-300 (7)(e) requires boarding homes to have documentation of prescribers' orders for medications. The proposed rule allows medication assistance and administration to be provided with an expanded range of recognized authorizations beyond a prescriber's order, such as the label on a prescription bottle. Therefore there are no costs associated with medication authorizations in the proposed rule.

staff person present during a daily inventory of Schedule II and III drugs. This added rule assists in tracking these medications should any medications turn up missing during a daily count. We believe this requirement is an industry standard, especially with regard to narcotics. WAC 388-78A-2270 is already present in WAC 388-78A-300(2). WAC 388-78A-2290 is part of SB 6225, section 6. Requirements associated with family assistance with medications are based upon SSB 6225 and do not result from this proposed rule.
Therefore there are no new costs associated with medication requirements contained in the proposed rule.

WAC 388-78A-2300 Food and nutrition services.
Cost Impact: None.
ANALYSIS: Western Health Care reviewed this section with a registered dietitian who consults
Consultants suggested keeping cost down yet provide residents choice. Yesterday's leftovers, or soup and sandwich are common practice. The department concurs with the consultants' analyses that safely handled and stored food could be used to provide an alternate for lunch and dinner.
Therefore there would be no cost associated with this requirement.

for a variety of skilled and assisted living facilities in several states including Washington. It was her opinion that requiring alternate meal choices of comparable quality and nutritional value would not significantly increase costs if facilities employed proper food handling and storage techniques with prior day's Costs associated with alternate
lunch and dinner.
Commercial dishwasher is a cost for small facilities.
Cost of new dishwasher or booster may vary depending on location of dishwasher and wiring to install. May be $700 to $1000 if rewiring required.
The commercial dishwasher could impact facilities with sixteen or fewer residents when the dishwasher is replaced some time in the future. However, this requirement can be met by installing a water temperature booster system at minimal cost. A facility with seventeen or more residents currently needs a commercial dishwasher.

entrees. However, it should also be noted that the draft rules limit, not expand, the number of different diets required to be One time cost. Cost of doing business. Dishwasher lasts eight to ten years and cost can be depreciated. Therefore there are no additional costs associated with food service requirements because of the proposed rule.

available to residents. Rather than stating that the facility must provide "resident specific, modified or therapeutic" diets, the draft regulations only mention a low sodium, a general diabetic, and a mechanical soft Disproportionate cost for small businesses.
This requirement is for anyone licensed after September 1, 2004, or if the dishwasher needs to be replaced.

food diet. These changes are consistent with section 1, part 6 and 8 in SB 6225. Much of this section is also currently included in WAC 388-78A-170, with the exception that new dishwasher installations after September 1, 2004, must have a final rinse temperature of 180░. Installing a temperature boost system for new or replacement systems after September 1, 2004, will cost an estimated $500 ($200 for the water heater plus $300 for installation). However, it is unknown how many facilities may incur this cost.

WAC 388-78A-2310 Intermittent nursing services, 388-78A-2320 Intermittent nursing services systems, 388-78A-2330 Tube feeding, 388-78A-2340 Resident arranged services, and 388-78A-2350 Coordination of Industry comments includes the following:
Nursing services are optional. This is a higher standard with regard to practice and a cost to those choosing to provide the service.
The department has revised the draft sections related to intermittent nursing services in order to add the intermittent nursing services language from SSB 6225 and to clarify the related requirements.

health care services.
Cost Impact: None.
ANALYSIS: WAC 388-78A-2330 lists a service that boarding homes are not required to
It looks like an RN would have to provide oversight to another RN. Nursing supervision is not part of SB 6225. Additional cost for RN. Intermittent nursing services is an optional boarding home service. The boarding home has the choice whether or not to provide this service.

provide. WAC 388-78A-2310 and 388-78A-2320 are currently in chapter 18.79 RCW, Nurse Practice Act and chapter 246-840 Nurse Practice Act in RCW 18.79.260 says what an RN can do. Any cost to provide intermittent nursing services is one the boarding home imposes on itself with the decision to provide this service.

WAC. WAC 388-78A- 2310 regarding the availability of a nursing supervisor by pager or telephone is already in existing rules, WAC 388-78A-265 (1)(d). WAC 388-78A-2340 is recreated in section 10 of SB 6225, therefore is a state law not subject to modification or interpretation by the draft rules. Finally, WAC 388-78A- 2350 was modified only to the extent that it meet the requirements of several sections of SB 6225, including but not limited to, sections 8 and 10.

WAC 388-78A-2370 Dementia care and 388-78A-2380 Restricted egress.
Cost Impact: None.
ANALYSIS: WAC 388-78A-2370 lists several items to be included as part of an assessment in order to develop a negotiated
Industry comments are as follows concerning WAC 388-78A-2370.
This is a new requirement. Information has to be included as part of their assessment process. Will drive the time needed for assessment.
SSB 6225 includes several assessment requirements that could be specifically related to dementia. Those requirements include assessing significant known behaviors or symptoms of the individual causing concern or requiring special care; the individual's special needs by evaluating available information or

service agreement that better meets the needs of residents who have symptoms of dementia. This information is especially needed to appropriately address and redirect inappropriate behavior and actions. Facilities that care for residents with moderate to advanced dementia are likely already collecting the New and additional assessment for those already serving residents with dementia. Cost is thirty-three cents per resident day and $300 start-up costs. When there is a change in a resident it will take more time. selecting and using an appropriate tool to determine the presence of symptoms consistent with, and implications for care and services for several conditions, including dementia; and the individual's personal identity and lifestyle. It is reasonable to assume that most of the information required by the dementia care assessment would be provided without additional activity required on the part of the boarding home.

information listed in WAC 388-78A-2370. WAC 388-78A-2380 discusses egress requirements that are not significantly different than current rules (WAC 388-78A-335). Change of condition requires a limited assessment. Assessment of person with dementia requires more detail. 40% of residents in boarding homes have some form of dementia. With the assessment requirements of SSB 6225 the department estimates minimal costs associated with the dementia care assessment requirements. The boarding home could provide family members, if any, with a questionnaire to obtain some specific personal identity and lifestyle information. There are a number of personal and social history questionnaires available.

Issue between required or not required. No choice now it is required and there will be cost involved.

Will require facilities to redo their assessment forms and train staff and document.

What takes more time costs more money.

WAC 388-78A-2450 Staff, 388-78A-2470 Criminal history background checks, and 388-78A-2480 TB tests.
Cost Impact: Minimal.
ANALYSIS: The facility will now be required to complete criminal background checks on every staff member every two years. The requirement to have
Industry comments to WAC 388-78A-2470 are as follows:
Because of the administrative time to check with the state regarding background check, three to six months, prefer to pay $10 and check on-line with state patrol.
WAC 388-89A- 2470: The rule requires boarding homes to submit all criminal history background check authorization forms to the department. The department does not charge for these background checks. If a boarding home chooses to obtain a limited background check in addition to the department requirement that is optional and not a cost of implementing this rule.

background checks completed on all newly hired staff is already part of the existing regulations (WAC 388-78A-045). Further, tuberculosis tests will be required every year. The actual cost of completing Pay private firm $15-$20 to provide background checks. More applicants being disqualified. As the pool gets smaller, the costs go up. Prefer to know immediately. The additional requirement of obtaining the background check every two years is a new requirement and will require tracking in order to submit the forms in a timely fashion. This requirement creates a minimal cost that is outweighed by the need to protect vulnerable residents.

background checks is zero, as the state does not charge for these checks. Facility staff will be required to mail in criminal background requests on all staff that have worked at the facility for more than two years. For a facility with fifty residents, we estimate it will take one staff Cost to make a list of staff and fill out the form for every two year background checks. With 50% turnover this is an increased cost.
Comments to WAC 388-78A-2480:
WAC 388-78A-2480:
The department responded to industry concerns regarding the cost of annual TB testing and has mitigated the cost impact by deleting this from the proposed rule. Therefore there are no additional costs associated with TB testing attributed to the proposed rule.

person approximately one half hour per month to review staff Cost for TB tests is more than $10.

records to determine who has been employed at the facility for more than two years and collect staff signatures to initiate the background check process. If Possibly $35 for TB tests.
TB testing every year was free. Now King County charging $10 to $35, not sure.

the staff member is paid $15 per hour, this translates to approximately $7.50 per month divided by 1,500 resident days is approximately $0.005 per resident day. The feds are looking at using the Health Department for TB tests which may reduce cost.

WAC 388-78A-2490 Specialized training for developmental disabilities, 388-78A-2500 Specialized training for mental illness and 388-78A-2510 Specialized training for dementia.
Cost Impact: None.
ANALYSIS: These requirements are substantially included in
Under WAC 388-78A-2510 there is a cost of training volunteers who provide hands-on care to residents now that they are included in the definition of "resident care staff person." The boarding home is already required to ensure that volunteers who provide hands-on personal care and who are not directly supervised have the same training that WAC 388-112-0005 requires "caregivers" to have. Chapter 388-112 WAC, including this definition, was effective August 12, 2002. Therefore there is no new cost associated in implementing this portion of the rule.

WAC 388-112-0110. Additionally, we believe that most facilities with these types of residents already provide training for staff to meet the needs of these special populations.

WAC 388-78A-2520 Administrator qualifications, 388-78A-2530 Qualifying administrator training program, 388-78A-2540 Administrator training requirements, 388-78A-2550 Administrator Industry comments are as follows:
WAC 388-78A-2520:
Cost for increase in significant requirements for administrator. Increase the standards for people who run the buildings.
All persons employed as boarding home administrators on September 1, 2004, are "grandfathered" under the proposed rule and no new costs will be associated with this requirement for existing boarding homes regarding administrator wages/salaries.

training documentation, 388-78A-2560 Administrator responsibilities, and 388-78A-2570 Notification of change in administrator.
Cost Impact: None.
ANALYSIS: The draft rules suggest changes to the existing rules in that they remove the
With high qualifications and a higher standard, when there is turn over in administrator they will drive costs.
WAC 388-78A-2530:
There will be increased costs associated with providing a qualifying administrator training program.
Any costs associated with obtaining the necessary training and experience to become qualified as a boarding home administrator in the future, such as taking the NAB examination or the WCAL course, would be the responsibility of the individual seeking that training unless a boarding home voluntarily chose to pay for that individual's training.

requirement that an alternate administrator with equal credentials to the administrator be available when the administrator is not available. Many parts of the WAC listed immediately above are already included in WAC 388-78A-040. Department training will take administrator's time and will cost.
WAC 388-78A-2560:
Although the alternate administrator is no longer required the facilities still need someone with experience. It is common practice to have a nurse that is qualified to be the alternative administrator.
The boarding home industry presented no basis to conclude that the additional minimal training requirements for new administrators would result in higher salaries for current administrators now or at any time in the immediate future.

There is cost savings because you don't have an additional administration.
Two people are still required, cannot assume the expense is not there.
Boarding homes may choose to provide a qualifying administrator training program, but it is not required by the proposed rules. The qualifying administrator training program is one of several options open to individuals in order to obtain required experience and training to become an administrator.

It is estimated that the average amount of time it will take an administrator to complete the department training on-line is four hours. Employment security data indicates the average administrator hourly wage (50th percentile for SOC Code 11-3011, June 2002) is $23.33 for King County. Allowing for benefits and inflation, assuming an administrator's time is worth $30 per hour and prorating the expense over one year (365 days) in a small business, the theoretical costs to the boarding home would be $.01 per resident day (4 hours x $30/32 residents/365 days). In a large boarding home, the cost would be insignificant (less than 1/2 cent per resident day--4 hours x $30/82 residents/365 days). However, since most administrators are salaried employees, there would be no actual additional costs to the boarding home.

There are no new additional costs associated with having a person qualified by experience to assume duties in the administrator's absence since current WAC 388-78A-040 requires boarding homes to employ an alternate administrator.

WAC 388-78A-2600 Policies and procedures.
Cost Impact: None.
ANALYSIS: The vast majority of the policies and procedures listed under this section are likely already in place in most if
An association has reviewed the old WACs against the draft rules comparing policies and procedures. Took forty hours to critique and develop new policies. Then attorney will review. Discussion at the May 6, 2004, meeting revealed boarding homes could review and develop policies required by the draft rule in forty hours.

not all boarding care homes. The required policies and procedures are currently found in WAC 388-78A-055. There will be a need for all boarding care homes to review their policy and procedure manuals, but most facilities are likely reviewing their policies and procedures at least annually. Associations reported one-time cost to determine current policies, craft new, train on handbooks; and for legal review to be $8,580 start up per facility. The department determined that the cost of reviewing and developing policies required by the proposed rules in a small boarding home is $25 per licensed bed in the first year only (40 hours x $20/32 beds). The department determined that the cost of reviewing and developing policies required by the proposed rules in a large boarding home is $9.76 per licensed bed in the first year only (40 hours x $20/82 beds).

The new requirements are much more detailed and will require training for staff on policies and procedures, to update the resident handbook and give thirty-day notice to residents of changes. In order to mitigate some of the industry's concerns about the costs of reviewing and developing new policies required by the draft rules, in addition to no longer requiring a number of old policies, the department eliminated from the proposed rules some of the required new policies

There will be review at company level and then at the local level. that were contained in the draft rule. The department has identified only six new

Facilities may not be doing annual reviews now. Policies may not change from year to year. Upfront cost for critiquing policies and procedures. policies that will be specifically required under the proposed rules, while it has also eliminated or significantly reduced the specificity of a large number of required policies.

Cost to review policies is forty hours for a thirty-three bed facility is fourteen cents a day for an annual review (Also see section on "mitigating expenses.")

Cost of training must be added, this is a big change.

WAC 388-78A-2620 Pets.
Cost Impact: None.
ANALYSIS: There is no requirement that pets be maintained at the facility. If residents are allowed to have pets in the facility, it should be their responsibility to provide
Cost of transferring responsibility from resident to facility. This is a new requirement with heightened expectations. The cost of the examinations and immunization for pets belonging to residents would be the responsibility of the resident. The resident can then provide the paperwork to the boarding home staff. The department anticipates the cost to the facility to make sure that the resident provides the information would be minimal.

for examinations and immunizations, therefore, we do not find any added costs associated with complying with this part of the draft rules. A pet belonging to the boarding home would be the boarding home's responsibility.

WAC 388-78A-2660 Resident rights, 388-78A-2670 Services by resident for boarding home, Will require policies and procedures. The proposed rules do not specifically require the boarding home to develop policies regarding these issues.

388-78A-2680 Boarding home use of audio and video monitoring, and 388-78A-2690 Resident use of electronic monitoring.
Cost Impact: None.
ANALYSIS: WAC 388-78A-2660 is substantially present in existing law (chapter 70.129 RCW). Use of electronic and video monitoring is not required, but allowed by the draft rules under certain conditions. Finally, if a resident requests video or audio monitoring, the cost of this monitoring may be passed on to the resident.

WAC 388-78A-2700 Safety and disaster preparedness.
Cost Impact: None.
Emergency lighting in "common" areas to reduce cost. Emergency lighting or flashlights in all areas of the boarding home is in current rule, WAC 388-78A-290 (1)(f).

ANALYSIS: The draft rules propose grandfathering all current boarding homes with regard to emergency lighting. Other components of this section are already included in current rule (WAC 388-78A-290). Alternative flashlights no cost. Emergency lighting in all areas of the boarding home applies to new construction after September 1, 2004.

WAC 388-78A-2710 Disclosure of services and 388-78A-2720 Timing of disclosure.
Cost Impact: None.
ANALYSIS: WAC 388-78A-2710
Industry comments as follows:
The requirement to disclose to the residents and resident representatives the scope of care and services that it chooses to provide is in statute, SSB 6225 and not a cost of implementing this rule.

is included in SB 6225 section 2. WAC 388-78A-2720 states that the boarding home must disclose various information regarding the operation of the home on department approved One time costs minimum and ongoing costs if requests are made including costs for reproduction and postage. Also cost for legal review. Will provide analysis for costs.

disclosure forms. We do not believe that time required to collect the information listed on the forms will be substantial. Associations provided analysis of costs for disclosure of services. The new rule will require development, implementation, legal review, etc. Estimate nine cents per resident day and $1,650 start-up costs.

WAC 388-78A-2740 Licensee qualifications through 388-78A-2890 Time frame for approval.
Cost Impact: None.
ANALYSIS: Licensing requirements are already included in some parts of the
Industry comments are as follows:
WAC 388-78A-2780: Cost related to changing a license. Current boarding homeowner must ensure person who wants license submits application. Will send costs.
To mitigate the requirements on the current boarding home owner, the department has revised the language of the draft rule and given the responsibility to submit the application to the prospective licensee.

current rules (WAC 388-78A-020, 388-78A-030, RCW 18.20.220). However, the licensing requirements listed in these sections would be one time costs for changes in operations, therefore any cost associated with meeting the requirements listed under these Cost related to change in standard to bring on and off line. Currently it is immediate. Thirty days will increase cost of liability insurance. One day also assists the residents to be able to change bed status rather than move to another room. Current WAC 388-78A-020 (6)(a) requires boarding home to provide thirty days notice prior to changing the licensed bed capacity, so there is no increased cost associated with the draft rule.

sections of the draft rules would be amortized over several months or years. Thirty day notice, loss of net operating income, or maintain current practice to mitigate added costs of fifty-five cents per resident day. However, to mitigate costs to small facilities, the department is changing the rule from thirty days to one day for the boarding home to submit a request to the department to change their licensed bed capacity.

To make a change in one day increases revenue and offsets against insurance. Otherwise, liability insurance would be higher.

WAC 388-78A-2900 Retention of approved construction documents through 388-78A-3130 Plant restrictions.
Cost Impact: None.
Association comment concerning WAC 388-78A-2930: Two way intercom applies to new construction but if it applies to all it will be a cost. This requirement only applies to new construction and is not a cost of implementing these rules.

ANALYSIS: These sections are largely included in existing rule (WAC 388-78A-070 through 388-78A-160). Existing will be grandfathered; any added requirements apply to new construction only.

WAC 388-78A-3140 Responsibilities during inspections through 388-78A-3230 Fees.
Cost Impact: None.
ANALYSIS: These sections separate the components listed in current rule (WAC 388-78A-030) and clarify what a facility must and what it cannot do during a survey.
Association comment as follows:
WAC 388-78A-3160: This is a different standard than in statute. $100 per resident per day is an increased fine level. Statute says $100 per violation. Anticipate increased costs for attorney fees.
Potential penalties are not a cost of implementing the rule.

Summary: The department recognizes on-going costs to the average boarding home of implementing this proposed rule to be $.08 per resident day for large boarding homes and $.09 per resident day for small boarding homes.

Additionally, the department recognizes one-time costs to the average small boarding home of implementing this proposed rule to be $25.00 per licensed bed and $9.76 per licensed bed in large boarding homes.

аааа 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 to small businesses is $.09 per resident day and is $.08 per resident day in large businesses.

аааа 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 $25.00 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 $9.76 per licensed bed.

аааа 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 develop new policies and procedures at times that were normally scheduled for other activities. While there is no debate about the value of staff time, there in fact may not be a significant additional expenditure required for developing policies.

аааа Mitigating Expenses: RCS has plans for mitigating expenses for small businesses by presenting 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.

аааа Additionally, 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-2600:

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

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

Х Subsection (2)(d) regarding what to do when a resident does not have a personal physician;

Х Subsection (2)(n) regarding the safe operation of boarding home vehicles;

Х Subsection (2)(o) regarding coordinating services and sharing resident information;

Х Subsection (2)(q) regarding receiving and responding to resident grievances.

аааа 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.

аааа Costs that apply only to new construction are considered minimal when amortized per resident over the useful life of the building. Other minimal costs associated with this rule are considered to be outweighed by their benefits as described in a cost-benefit analysis on file with the department.

аааа CONCLUSION: RCS 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, RCS 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. RCS will provide training, and suspend enforcement actions for specific violations for a period of six months following the effective date of the rules.

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

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

аааааHearing Location: Blake Office Park East (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on July 6, 2004, at 10:00 a.m.

аааааAssistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by July 1, 2004, phone (360) 664-6094, TTY (360) 664-6178, e-mail fernaax@dshs.wa.gov.

аааааSubmit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, mail to P.O. Box 45850, Olympia, WA 98504-5850, deliver to 4500 10th Avenue S.E., Lacey, WA, fax (360) 664-6185, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., July 6, 2004.

аааааDate of Intended Adoption: No later than July 30, 2004.

May 19, 2004

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

OTS-7104.4

GENERAL
NEW SECTION
WAC 388-78A-2010 Purpose. This chapter is written to implement chapter 18.20 RCW, to promote the safety and well-being of boarding home residents, to specify standards for boarding home operators, and to further establish requirements for the operation of boarding homes.

[]

NEW SECTION
WAC 388-78A-2020 Definitions. "Abandonment" means action or inaction by a person with a duty of care for a vulnerable adult that leaves the vulnerable person without the means or ability to obtain necessary food, clothing, shelter, or health care.

аааа "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:

аааа (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;

аааа (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;

аааа (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;

аааа (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;

аааа (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.

аааа "Activities of daily living" means the following tasks related to basic personal care: Bathing; toileting; dressing; personal hygiene; mobility; transferring; and eating.

аааа "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 overnight stay.

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

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

аааа (2) "Semiambulatory" 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.

аааа "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.

аааа "Basic services" means housekeeping services, meals, nutritious snacks, laundry, and activities.

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

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

аааа "Boarding home" means any home or other institution, however named, which is advertised, announced, or maintained for the express or implied purpose of providing housing, basic services, and assuming general responsibility for the safety and well-being of the residents, and may also provide domiciliary care, consistent with this chapter to seven or more residents after July 1, 2000. However, a boarding home that is licensed for three to six residents prior to or 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.

аааа "Building code" means the building codes and standards adopted by the Washington state building code council.

аааа "Caregiver" means anyone providing hands-on personal care to another person including, but not limited to: Cuing, reminding or supervision of residents, on behalf of a boarding home, except volunteers who are directly supervised. Direct supervision means oversight by a person who has demonstrated competency in the basic training (and specialty training if required), or who has been exempted from the basic training requirements, and who is quickly and easily available to the caregiver, but not necessarily on-site.

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

аааа "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.

аааа "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.

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

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

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

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

аааа (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

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

аааа "Domiciliary care" means:

аааа (1) Assistance with activities of daily living provided by the boarding home either directly or indirectly; or

аааа (2) Health support services, if provided directly or indirectly by the boarding home; or

аааа (3) Intermittent nursing services, if provided directly or indirectly by the boarding home.

аааа "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.

аааа "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.

аааа "General responsibility for the safety and well-being of the resident" means the provision of the following:

аааа (1) Prescribed general low sodium diets;

аааа (2) Prescribed general diabetic diets;

аааа (3) Prescribed mechanical soft foods;

аааа (4) Emergency assistance;

аааа (5) Monitoring of the resident;

аааа (6) Arranging health care appointments with outside health care providers and reminding residents of such appointments as necessary;

аааа (7) Coordinating health care services with outside health care providers consistent with WAC 388-78A-2350;

аааа (8) Assisting the resident to obtain and maintain glasses, hearing aids, dentures, canes, crutches, walkers, wheelchairs, and assistive communication devices;

аааа (9) Observation of the resident for changes in overall functioning;

аааа (10) Blood pressure checks as scheduled;

аааа (11) Responding appropriately when there are observable or reported changes in the resident's physical, mental, or emotional functioning; or

аааа (12) Medication assistance as permitted under RCW 69.41.085 and as described in RCW 69.41.010 and chapter 246-888 WAC.

аааа "Harm" means a physical or mental or emotional injury or damage to a resident including those resulting from neglect or violations of a resident's rights.

аааа "Health support services" means any of the following optional services:

аааа (1) Blood glucose testing;

аааа (2) Puree diets;

аааа (3) Calorie controlled diabetic diets;

аааа (4) Dementia care;

аааа (5) Mental health care; or

аааа (6) Developmental disabilities care.

аааа "Independent living unit" means:

аааа (1) Independent senior housing;

аааа (2) Independent living unit in a continuing care retirement community or other similar living environments;

аааа (3) Boarding home unit where domiciliary services are not provided; or

аааа (4) Boarding home unit where one or more items listed under "general responsibilities" are not provided.

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

аааа "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.

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

аааа "Licensed resident bed capacity" means the resident occupancy level requested by the licensee and approved by the department. All residents receiving domiciliary care or the items or services listed under general responsibility for the safety and well-being of the resident as defined in this section, and their roommates count towards the licensed resident bed capacity. Adult day care clients do not count towards the licensed resident bed capacity.

аааа "Majority owner" means any person or entity that owns:

аааа (1) More than fifty percent interest; or

аааа (2) If no one person or entity owns more than fifty percent interest, the largest interest portion; or

аааа (3) If more than one person or entity owns equal largest interest portions, then all persons and entities owning those equal largest interest portions.

аааа "Manager" means the person defined in this chapter, providing management services on behalf of the licensee.

аааа "Management agreement" means a written, executed agreement between the licensee and the manager regarding the provision of certain services on behalf of the licensee.

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

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

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

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

аааа (b) Twice the seating capacity of the dining area(s) consistent with WAC 388-78A-2300 (1)(h); or

аааа (c) The number of residents permitted by calculating the ratios of toilets, sinks, and bathing fixtures to residents consistent with WAC 388-78A-3030; or

аааа (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-3050; or

аааа (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-3050.

аааа "Medication administration" means the direct application of a prescribed medication whether by injection, inhalation, ingestion, or other means, to the body of the resident by a person legally authorized to do so.

аааа "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.

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

аааа "Neglect" means:

аааа (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

аааа (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.

аааа "Nonresident individual" means a person who resides in independent senior housing, independent living units in continuing care retirement communities, or in other similar living environments or in a boarding home and may receive one or more of the services listed in WAC 388-78A-2030 (2)(a) through (g), but may not receive domiciliary care as defined in this section, directly or indirectly by the facility, and may not receive the items or services listed under general responsibility for the safety and well-being of the resident as defined in this section.

аааа "Nonpractitioner" means any individual who is not a practitioner as defined in WAC 388-78A-2020 and chapter 69.41 RCW.

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

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

аааа (2) "Registered nurse" (RN).

аааа "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.

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

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

аааа "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.

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

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

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

аааа (1) "Recurring problem" means, for all purposes other than section 4, chapter 144, Laws of 2004, that the department has cited the boarding home for a violation of WAC or RCW and the circumstances of (a) or (b) of this subsection are present:

аааа (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 the preceding thirty-six months; or

аааа (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 on two occasions within the preceding thirty-six months.

аааа (c) If the previous violation in (a) or (b) of this subsection was pursuant to WAC or RCW that has changed at the time of the new violation, citation to the equivalent current WAC or RCW section is sufficient.

аааа (d) When there is a change in licensees between the first and the second or third citations, the new licensee must accept, and the department will consider, the prior licensee's compliance and enforcement record as part of the new licensee's compliance record at that boarding home if any person affiliated with the new licensee was affiliated with the prior licensee at the same boarding home. A person is considered affiliated with the licensee if the person is an applicant for the boarding home license, or is listed on the license application as a partner, officer, director, or majority owner of the applying entity.

аааа (2) "Serious problem" means:

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

аааа (b) Significant harm has actually occurred to a resident; or

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

аааа (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. When a change in licensees occurs, the new licensee is responsible for correcting any remaining violations that may exist, including complying with any plan of correction in effect immediately prior to the change in licensees.

аааа "Reasonable accommodation" and "reasonably accommodate" have the meaning given in federal and state antidiscrimination laws and regulations.

аааа "RCW" means Revised Code of Washington.

аааа "Records" means:

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

аааа (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.

аааа "Resident" means an individual who:

аааа (1) Chooses to reside in a boarding home, including those receiving respite care;

аааа (2) Is not related by blood or marriage to the operator of the boarding home;

аааа (3) Receives basic services;

аааа (4) Receives one or more of the services listed under general responsibility for the safety and well-being of the resident, and may receive domiciliary care or respite care provided directly, or indirectly, by the boarding home; and

аааа (5) Must be permitted to receive hospice care through an outside provider when arranged by the resident or the resident's legal representative.

аааа "Resident applicant" means an individual who is seeking admission to a licensed boarding home and who has completed and signed an application for admission, or such application for admission has been completed and signed in their behalf by their legal representative if any, and if not, then the designated representative if any.

аааа "Resident's representative" means:

аааа (1) The legal representative who is the person or persons identified in RCW 7.70.065 and who may act on behalf of the resident pursuant to the scope of their legal authority. The legal representative shall not be affiliated with the licensee, boarding home, or management company, unless the affiliated person is a family member of the resident; or

аааа (2) If there is no legal representative, a person designated voluntarily by a competent resident in writing, to act in the resident's behalf concerning the care and services provided by the boarding home and to receive information from the boarding home if there is no legal representative. The resident's competence shall be determined using the criteria in RCW 11.88.010 (1)(e). The resident's representative may not be affiliated with the licensee, boarding home, or management company, unless the affiliated person is a family member of the resident.

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

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

аааа (1) Confinement, unless agreed to as provided in WAC 388-78A-2370;

аааа (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

аааа (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.

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

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

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

аааа "Significant change" means a change in the resident's physical, mental, or psychosocial status that causes either life-threatening conditions or clinical complications.

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

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

аааа "State fire marshal" means the chief of the Washington director of fire protection under the direction of the chief of the Washington state patrol.

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

аааа "Volunteer" means an individual who interacts with residents without reimbursement.

аааа "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.

аааа "WAC" means Washington Administrative Code.

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

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NEW SECTION
WAC 388-78A-2030 Applicability. (1) A person must have a boarding home license issued by the department under chapter 18.20 RCW and this chapter, except as otherwise exempted by RCW 18.20.170 and subsection (2) of this section, if the person advertises as, or operates, or maintains a facility that meets the definition of a "boarding home" in this chapter, within Washington state and provides housing, one or more basic services, and one or more of the following:

аааа (a) Assumes general responsibility for the safety and well-being of the residents;

аааа (b) Provides assistance with activities of daily living, either directly or indirectly;

аааа (c) Provides health support services, either directly or indirectly; or

аааа (d) Provides intermittent nursing services, either directly or indirectly.

аааа (2) A boarding home license is not required for one or more of the following services that may be provided to a nonresident individual. These services may not include continual care or supervision of a nonresident individual without a boarding home license:

аааа (a) Emergency assistance provided on an intermittent or nonroutine basis to any nonresident individual; or

аааа (b) Systems employed by independent senior housing, or independent living units in continuing care retirement communities, to respond to the potential need for emergency services for nonresident individuals; or

аааа (c) Infrequent, voluntary, and nonscheduled blood pressure checks for nonresident individuals; or

аааа (d) Nurse referral services provided at the request of a nonresident individual to determine whether referral to an outside health care provider is recommended; or

аааа (e) Making health care appointments at the request of nonresident individuals; or

аааа (f) Preadmission assessment, at the request of the nonresident individual; or

аааа (g) Services customarily provided under landlord tenant agreements governed by the Residential Landlord-Tenant Act, chapter 59.18 RCW.

аааа (3) When housing nonresident individuals who, without ongoing assistance from the boarding home, initiate and arrange for services with a practitioner licensed under Title 18 RCW or a home health, hospice, or home care agency licensed under chapter 70.127 RCW, or other persons as permitted by the boarding home.

аааа (4) This section does not prohibit a boarding home from furnishing written information concerning available community resources to nonresident individuals or the individual's family members or legal representatives. However, the boarding home may not require the use of any particular service provider.

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NEW SECTION
WAC 388-78A-2040 Other requirements. (1) The boarding home must comply with all other applicable federal, state, county and municipal statutes, rules, codes and ordinances, including without limitations those that prohibit discrimination.

аааа (2) The boarding home must have its building approved by the Washington state fire marshal, fire protection bureau in order to be licensed.

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NEW SECTION
WAC 388-78A-2050 Resident characteristics. The boarding home may accept and retain an individual as a resident in a boarding home only if:

аааа (1) The boarding home can safely and appropriately serve the resident with appropriate staff and through the reasonable accommodation required by state or federal law, and provide any specialized training to caregivers that may be required according to WAC 388-78A-2480 through 388-78A-2510;

аааа (2) The person does not require the frequent presence and frequent evaluation of a registered nurse, excluding those persons who are receiving hospice care or persons who have short-term illness that is expected to be resolved within fourteen days as long as the boarding home has the capacity to meet the resident's identified needs;

аааа (3) The individual is ambulatory, unless the boarding home is approved by the Washington state director of fire protection to care for semiambulatory or nonambulatory residents; and

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

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ASSESSMENT AND MONITORING
NEW SECTION
WAC 388-78A-2060 Preadmission assessment. (1) The boarding home must conduct a preadmission assessment for each resident applicant that includes the following information, unless unavailable despite the best efforts of the boarding home:

аааа (a) Medical history;

аааа (b) Necessary and contraindicated medications;

аааа (c) A licensed medical or health professional's diagnosis, unless the individual objects for religious reasons;

аааа (d) Significant known behaviors or symptoms that may cause concern or require special care;

аааа (e) Mental illness diagnosis, except where protected by confidentiality laws;

аааа (f) Level of personal care needs;

аааа (g) Activities and service preferences; and

аааа (h) Preferences regarding other issues important to the applicant, such as food and daily routine.

аааа (2) The boarding home must complete an initial resident service plan upon move in:

аааа (a) To identify the resident's immediate needs; and

аааа (b) To provide direction to staff and caregivers relating to the resident's immediate needs, capabilities, and preferences; and

аааа (c) To include information obtained under subsection (1) of this section.

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NEW SECTION
WAC 388-78A-2070 Timing of preadmission assessment. (1) The boarding home must complete the preadmission assessment of the resident applicant before each resident applicant moves into the boarding home.

аааа (2) Unless there is an emergency, the boarding home must ensure the preadmission assessment is completed within five calendar days of the resident moving into the boarding home when the resident moves in under emergency conditions.

аааа (3) For the purposes of this section, "emergency" includes, but is not limited to: Evening, weekend, or Friday afternoon admissions if the resident applicant would otherwise need to remain in an unsafe setting or be without adequate and safe housing.

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NEW SECTION
WAC 388-78A-2080 Qualified assessor. The boarding home must ensure the person responsible for completing a preadmission assessment of a prospective resident:

аааа (1) 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

аааа (2) 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

аааа (3) Has a valid Washington state license to practice nursing, in accordance with chapters 18.79 RCW and 246-840 WAC; or

аааа (4) Is a physician with a valid state license to practice medicine; or

аааа (5) Has three years of successful experience acquired prior to September 1, 2004, assessing prospective and current boarding home residents 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.

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NEW SECTION
WAC 388-78A-2090 Full assessment topics. The boarding home must obtain sufficient information to be able to assess the capabilities, needs, and preferences for each prospective resident, and must complete a full reassessment addressing the following, within fourteen days of the resident's move-in date, unless extended by the department for good cause:

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

аааа (a) A licensed medical or health professional's diagnosis, unless the resident objects for religious reasons;

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

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

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

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

аааа (b) Any prescribed medications, and over-the-counter medications commonly taken by the individual, that the individual is able to self-administer when he/she has the assistance of a caregiver; and

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

аааа (3) The individual's nursing needs when the individual requires the services of a nurse on the boarding home premises.

аааа (4) Individual's sensory abilities, including:

аааа (a) Vision; and

аааа (b) Hearing.

аааа (5) Individual's communication abilities, including:

аааа (a) Modes of expression;

аааа (b) Ability to make self understood; and

аааа (c) Ability to understand others.

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

аааа (a) History of substance abuse;

аааа (b) History of harming self, others, or property; or

аааа (c) Other conditions that may require behavioral intervention strategies;

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

аааа (e) 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.

аааа (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:

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

аааа (b) Developmental disability;

аааа (c) Dementia, while screening a resident for dementia, the boarding home must base any determination that the resident has short-term memory loss upon objective evidence, and document the evidence in the resident's record; or

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

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

аааа (a) Ability to perform activities of daily living;

аааа (b) Medication management ability, including:

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

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

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

аааа (10) Individual's personal identity and lifestyle, to the extent the individual is willing to share the information, and the manner in which they are expressed, including preferences regarding food, community contacts, hobbies, spiritual preferences, or other sources of pleasure and comfort.

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

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

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

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

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NEW SECTION
WAC 388-78A-2100 On-going assessments. The boarding home must:

аааа (1) Complete a full assessment addressing the elements set forth in WAC 388-78A-2080 for each resident at least annually;

аааа (2) Complete a limited assessment of a resident's change of condition when the resident's negotiated service agreement no longer addresses the resident's current needs:

аааа (a) Consistent with the resident's change of condition as specified in WAC 388-78A-2120; or

аааа (b) When the resident's negotiated service agreement no longer addresses the resident's current needs and preferences.

аааа (3) Ensure the staff person performing the on-going assessments is qualified to perform them.

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NEW SECTION
WAC 388-78A-2110 Resident participation in assessments. The boarding home must directly involve each resident or resident applicant, to the extent possible, along with any appropriate resident representative approved by the resident, in the preadmission assessment and on-going assessment process in the boarding home.

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NEW SECTION
WAC 388-78A-2120 Monitoring residents' well-being. The boarding home must:

аааа (1) Observe each resident consistent with his or her assessed needs and negotiated service agreement;

аааа (2) Identify any changes in the resident's physical, emotional, and mental functioning that are:

аааа (a) Departure from the resident's customary range of functioning; or

аааа (b) Recurring condition in a resident's physical, emotional, or mental functioning that has previously required intervention by others.

аааа (3) Evaluate the change identified in the resident per subsection (2) of this section to determine if there is a need for further action, including, but not limited to, assessment;

аааа (4) Ensure that changes that may require further action by the boarding home are documented in the resident's record, including dates, times, and facts;

аааа (5) Assess a resident consistent with WAC 388-78A-2090 if assessment is identified as needed;

аааа (6) Update the negotiated service as needed; and

аааа (7) Take appropriate action in response to each resident's changing needs.

[]

NEGOTIATED SERVICE AGREEMENT
NEW SECTION
WAC 388-78A-2130 Service agreement planning. The boarding home must:

аааа (1) Develop an initial negotiated service agreement, based upon discussions with the resident and the resident's representative if the resident has one, and the preadmission assessment of a qualified assessor, upon admitting a resident into a boarding home;

аааа (2) Complete the negotiated service agreement for each resident using the resident's preadmission assessment, initial resident service plan, and full assessment information, within thirty days of the resident moving in;

аааа (3) Integrate the assessment information provided by the department's case manager into the initial negotiated service agreement for each resident whose care is partially or wholly funded by the department;

аааа (4) Review and update each resident's negotiated service agreement consistent with WAC 388-78A-2120:

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

аааа (b) Whenever the negotiated service agreement no longer adequately addresses the resident's current assessed needs and preferences.

аааа (5) Review and update each resident's negotiated service agreement as necessary following an annual full assessment;

аааа (6) Involve the following persons in the process of developing a negotiated service agreement:

аааа (a) The resident or resident applicant;

аааа (b) The resident's representative to the extent he or she is willing and capable, if the resident has one;

аааа (c) Other individuals the resident wants included;

аааа (d) The department's case manager, if the resident is a recipient of Medicaid assistance, or any private case manager, if available; and

аааа (e) Staff designated by the boarding home.

аааа (7) Ensure:

аааа (a) Individuals participating in developing the resident's negotiated service agreement:

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

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

аааа (b) Staff persons document in the resident's record the agreed upon plan for services.

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NEW SECTION
WAC 388-78A-2140 Negotiated service agreement contents. The boarding home must develop, and document in the resident's record, the agreed upon plan to address and support each resident's assessed capabilities, needs and preferences, including the following:

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

аааа (a) The plan to monitor the resident and address interventions for risks to the resident's health and safety that were identified in the resident's preadmission assessment or full assessment, and on-going assessments;

аааа (b) The plan to provide assistance with activities of daily living, if provided by the boarding home;

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

аааа (d) The plan to provide necessary health support services, if provided by the boarding home;

аааа (e) The resident's preferences for how services will be provided, supported and accommodated by the boarding home.

аааа (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. Except as specified in WAC 388-78A-2290, if a person other than a caregiver is to be responsible for providing care or services to the resident in the boarding home, the boarding home must specify in the negotiated service agreement 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:

аааа (a) Exclusively for the individual resident; or

аааа (b) Based on standard policies and procedures in the boarding home provided that they are consistent with the reasonable accommodation requirements of state and federal law.

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

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

аааа (5) Appropriate behavioral interventions, if needed;

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

аааа (7) The resident's ability to leave the boarding home premises unsupervised; and

аааа (8) The boarding home must not require or ask the resident or the resident's representative to sign any contract or agreement, including a negotiated service or risk agreement, that purports to waive any rights of the resident or that purports to place responsibility or liability for losses of personal property or injury on the resident.

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NEW SECTION
WAC 388-78A-2150 Signing negotiated service agreement. The boarding home must ensure that the negotiated service agreement is agreed to and signed at least annually by:

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

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

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

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NEW SECTION
WAC 388-78A-2160 Implementation of negotiated service agreement. The boarding home must provide the care and services as agreed upon in the negotiated service agreement to each resident unless a deviation from the negotiated service agreement is mutually agreed upon between the boarding home and the resident or the resident's representative at the time the care or services are scheduled.

[]

BOARDING HOME SERVICES
NEW SECTION
WAC 388-78A-2170 Required boarding home services. (1) The boarding home must provide housing and assume general responsibility for the safety and well-being of each resident, as defined in this chapter, consistent with the resident's assessed needs and negotiated service agreement.

аааа (2) The boarding homes must provide each resident with the following basic services, consistent with the resident's assessed needs and negotiated service agreement:

аааа (a) Activities -- Arranging for activities in accordance with WAC 388-78A-2180;

аааа (b) Housekeeping -- Providing a safe, clean and comfortable environment for each resident, including personal living quarters and all other resident accessible areas of the building;

аааа (c) Laundry -- Keeping the resident's clothing clean and in good repair, and laundering towels, washcloths, bed linens on a weekly basis or more often as necessary to maintain cleanliness;

аааа (d) Meals -- Providing meals in accordance with WAC 388-78A-2300; and

аааа (e) Nutritious snacks -- Providing snack items of nutritive value on a scheduled and nonscheduled basis, and providing nutritious snacks in accordance with WAC 388-78A-2300.

аааа (3) The boarding home must:

аааа (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

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

аааа (4) The boarding home must ensure each resident is able to obtain individually preferred personal care items when:

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

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

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NEW SECTION
WAC 388-78A-2180 Activities. The boarding home must:

аааа (1) Provide space and staff support necessary for:

аааа (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 service agreement; and

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

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

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NEW SECTION
WAC 388-78A-2190 Activities of daily living. Assistance with activities of daily living are an optional service that the boarding home may provide.

аааа (1) If a boarding home chooses not to provide assistance with activities of daily living:

аааа (a) The boarding home must admit or retain only those residents who are independent in activities of daily living; except that

аааа (b) A resident, or the resident's representative, may independently arrange for outside services to assist with activities of daily living.

аааа (2) When a boarding home chooses to provide assistance with activities of daily living, the boarding home must provide that assistance consistent with the reasonable accommodation requirements in state and federal laws.

аааа (3) When a boarding home chooses to provide, either directly or indirectly, assistance with activities of daily living, the boarding home must provide to each resident, consistent with the resident's assessed needs, minimal assistance with the following activities of daily living:

аааа (a) Bathing: Minimal assistance with bathing means the boarding home must provide the resident with occasional:

аааа (i) Reminding or cuing to wash and dry all areas of the body as needed;

аааа (ii) Stand-by assistance getting into and out of the tub or shower; and

аааа (iii) Physical assistance limited to steadying the resident during the activity.

аааа (b) Dressing: Minimal assistance with dressing means the boarding home must provide the resident with occasional:

аааа (i) Reminding or cuing to put on, take off, or lay out clothing, including prostheses when the assistance of a licensed nurse is not required; and

аааа (ii) Stand-by assistance during the activity.

аааа (c) Eating: Minimal assistance with eating means the boarding home must provide the resident with occasional:

аааа (i) Reminding or cuing to eat and drink; and

аааа (ii) Physical assistance limited to cutting food up, preparing food and beverages, and bringing food and fluids to the resident.

аааа (d) Personal hygiene: Minimal assistance with personal hygiene means the boarding home must provide the resident with occasional:

аааа (i) Reminding and cuing to comb hair, perform oral care and brush teeth, shave, apply makeup, and wash and dry face, hands and other areas of the body;

аааа (ii) Stand-by assistance during the activity; and

аааа (iii) Physical assistance limited to steadying the resident during the activity.

аааа (e) Transferring: Minimal assistance in transferring means the boarding home must provide the resident with occasional:

аааа (i) Reminders or cuing to move between surfaces, for example to and from the bed, chair and standing;

аааа (ii) Stand-by assistance during the activity; and

аааа (iii) Physical assistance limited to steadying the resident during self-transfers.

аааа (f) Toileting: Minimal assistance in toileting means the boarding home must provide the resident with occasional:

аааа (i) Reminders and cuing to toilet, including resident self-care of ostomy or catheter, to wipe and cleanse, and to change and adjust clothing, protective garments and pads;

аааа (ii) Stand-by assistance during the activity; and

аааа (iii) Physical assistance limited to steadying the resident during the activity.

аааа (g) Mobility: Minimal assistance in mobility means the boarding home must provide the resident with occasional:

аааа (i) Reminding or cuing to move between locations on the boarding home premises;

аааа (ii) Stand-by assistance during the activity; and

аааа (iii) Physical assistance limited to steadying the resident during the activity.

аааа (4) The boarding home may choose to provide more than minimal assistance with activities of daily living consistent with state and federal law.

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NEW SECTION
WAC 388-78A-2200 Health support services. Health support services are an optional service that the boarding home may provide. The boarding home may choose to provide any of the following health support services; however, boarding home may or may not need to provide additional health support services to comply with the reasonable accommodation requirements in federal and state law.

аааа (1) Blood glucose testing;

аааа (2) Puree diets;

аааа (3) Calorie controlled diabetic diets;

аааа (4) Dementia care;

аааа (5) Mental health care; and

аааа (6) Developmental disabilities care.

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Medications
NEW SECTION
WAC 388-78A-2210 Medication services. (1) A boarding home providing medication service must meet the requirements of chapter 69.41 RCW Legend drugs -- Prescription drugs, and the rules promulgated under the statute.

аааа (2) The boarding home must ensure the following residents receive their medications as prescribed, except as provided for in WAC 388-78A-2250:

аааа (a) Each resident who requires medication assistance and his or her negotiated service agreement indicates the boarding home will provide medication assistance; and

аааа (b) If the boarding home provides medication administration services, each resident who requires medication administration and his or her negotiated service agreement indicates the boarding home will provide medication administration.

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NEW SECTION
WAC 388-78A-2220 Prescribed medication authorizations. (1) Before the boarding home may provide medication assistance or medication administration to a resident for prescribed medications, the boarding home must have one of the following:

аааа (a) A prescription label completed by a licensed pharmacy;

аааа (b) A written order from the prescriber;

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

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

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

аааа (a) The name of the resident;

аааа (b) The name of the medication;

аааа (c) The dosage and dosage frequency of the medication; and

аааа (d) The name of the prescriber.

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NEW SECTION
WAC 388-78A-2230 Medication refusal. (1) When a resident who is receiving medication assistance or medication administration services from the boarding home chooses to not take his or her medications, the boarding home must:

аааа (a) Respect the resident's right to choose not to take medication;

аааа (b) Document the time, date and medication the resident did not take;

аааа (c) Notify the physician of the refusal and follow any instructions provided, unless 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;

аааа (i) Conducts an evaluation; and

аааа (ii) Takes the appropriate action, including notifying the prescriber or primary care practitioner when there is a consistent pattern of the resident choosing to not take his or her medications.

аааа (2) The boarding home must comply with subsection (1) of this section, unless the prescriber or primary care practitioner has provided the boarding home with:

аааа (a) Specific directions for addressing the refusal of the identified medication;

аааа (b) The boarding home documents such directions; and

аааа (c) The boarding home is able to fully comply with such directions.

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NEW SECTION
WAC 388-78A-2240 Nonavailability of medications. When the boarding home has assumed responsibility for obtaining a resident's prescribed medications, the boarding home must obtain them in a correct and timely manner.

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NEW SECTION
WAC 388-78A-2250 Alteration of medications. The boarding home must generally provide medications in the form they are prescribed when administering medications or providing medication assistance to a resident. The boarding home may provide medications in an altered form consistent with the following:

аааа (1) Alteration includes, but is not limited to, crushing tablets, cutting tablets in half, opening capsules, mixing powdered medications with foods or liquids, or mixing tablets or capsules with foods or liquids.

аааа (2) Residents must be aware that the medication is being altered or added to their food.

аааа (3) A pharmacist or other practitioner practicing within their scope of practice must determine that it is safe to alter a medication.

аааа (4) If the medication is altered, documentation of the appropriateness of the alteration must be on the prescription container, or in the resident's record.

аааа (5) Alteration of medications for self-administration with assistance is provided in accordance with chapter 246-888 WAC.

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NEW SECTION
WAC 388-78A-2260 Storing, securing, and accounting for medications. (1) The boarding home must secure medications for residents who are not capable of safely storing their own medications.

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

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

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

аааа (c) Separate from food or toxic chemicals;

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

аааа (e) In environments recommended on the medication label.

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NEW SECTION
WAC 388-78A-2270 Resident controlled medications. (1) The boarding home must ensure all medications are stored in a manner that prevents each resident from gaining access to another resident's medications.

аааа (2) The boarding home must allow residents who are assessed to be capable of self-administration or self-administration with assistance to control and secure the medications they self-administer or are self-administered with assistance.

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NEW SECTION
WAC 388-78A-2280 Medication organizers. (1) The boarding home must ensure no staff person other than a nurse fills medication organizers for residents. A nurse may fill a medication organizer for a resident only when:

аааа (a) The resident understands the use of the medications that have been prescribed for him or her; and

аааа (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

аааа (c) Staff persons have no further responsibility for:

аааа (i) Storing the resident's medication; or

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

аааа (iii) Providing medication administration services to the resident.

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

аааа (i) The name of the resident;

аааа (ii) The name of the medications in the organizer; and

аааа (iii) The frequency of the dosage.

аааа (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:

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

аааа (b) Providing medication assistance to the resident; or

аааа (c) Providing medication administration services to the resident.

аааа (3) A resident may use a medication organizer only when he or she stores and secures the medication organizer and is capable of either:

аааа (a) Independently self-administering his or her own medications contained in the medication organizer; or

аааа (b) Safely directing others to administer his or her medications contained in the medication organizer.

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NEW SECTION
WAC 388-78A-2290 Family assistance with medications and treatments. (1) A boarding home may permit a resident's family member to administer medications or treatments or to provide medication or treatment assistance, including obtaining medications or treatment supplies, to the resident.

аааа (2) The boarding home must disclose to the department, residents, the residents' legal representatives, if any, and if not the residents' representative if any, and to interested consumers upon request, information describing whether the boarding home permits such family administration or assistance and, if so, the extent of any limitations or conditions.

аааа (3) If the boarding home allows family assistance with or administration of medications and treatments, and the resident and a family member(s) agree a family member will provide medication or treatment assistance, or medication or treatment administration to the resident, the boarding home must request that the family member submit to the boarding home a written plan for such assistance or administration that includes at a minimum:

аааа (a) By name, the family member who will provide the medication or treatment assistance or administration;

аааа (b) A description of the medication or treatment assistance or administration that the family member will provide, to be referred to as the primary plan;

аааа (c) An alternate plan if the family member is unable to fulfill his or her duties as specified in the primary plan;

аааа (d) An emergency contact person and telephone number if the boarding home observes changes in the resident's overall functioning or condition that may relate to the medication or treatment plan; and

аааа (e) Other information determined necessary by the boarding home.

аааа (4) The plan for family assistance with medications or treatments must be signed and dated by:

аааа (a) The resident, if able;

аааа (b) The resident's representative, if any;

аааа (c) The resident's family member responsible for implementing the plan; and

аааа (d) A representative of the boarding home authorized by the boarding home to sign on its behalf.

аааа (5) The boarding home may, through policy or procedure, require the resident's family member to immediately notify the boarding home of any changes in the medication or treatment plans for family assistance or administration.

аааа (6) The boarding home must require that whenever a resident's family provides medication assistance or medication administration services, the resident's significant medications remain on the boarding home premises whenever the resident is on the boarding home premises.

аааа (7) The boarding home's duty of care shall be limited to: Observation of the resident for changes in overall functioning consistent with RCW 18.20.280; notification to the person or persons identified in RCW 70.129.030 when there are observed changes in the resident's overall functioning or condition, or when the boarding home is aware that both the primary and alternate plan are not implemented; and appropriately responding to obtain needed assistance when there are observable or reported changes in the resident's physical or mental functioning.

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Food
NEW SECTION
WAC 388-78A-2300 Food and nutrition services. (1) The boarding home must:

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

аааа (i) At regular intervals;

аааа (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.

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

аааа (c) Ensure all menus:

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

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

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

аааа (iv) Are retained at least six months;

аааа (v) Provide a variety of foods; and

аааа (vi) Are not repeated for at least three weeks, except that breakfast menus in boarding homes that provide a variety of daily choices of hot and cold foods are not required to have a minimum three-week cycle.

аааа (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:

аааа (i) Age, gender and activities, unless medically contraindicated; and

аааа (ii) Individual preferences to the extent reasonably possible.

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

аааа (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 on the menus the alternate choices in entrees that are served;

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

аааа (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.

аааа (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 to each resident as ordered:

аааа (a) Prescribe general low sodium, general diabetic, and mechanical soft food diets according to a diet manual. The boarding home must ensure the diet manual is:

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

аааа (ii) Approved by a dietitian; and

аааа (iii) Reviewed and updated as necessary or at least every five years.

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

аааа (3) The boarding home may provide to a resident at his or her request and as agreed upon in the resident's negotiated service agreement, nonprescribed:

аааа (a) Modified or therapeutic diets;

аааа (b) Nutritional concentrates or supplements.

аааа (4) 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 in boarding homes licensed for sixteen or fewer beds, may use domestic or home-type kitchen appliances, provided that:

аааа (a) If a home-type mechanical dishwasher was installed before September 1, 2004, the boarding home must:

аааа (i) Operate it according to manufacturer directions; and

аааа (ii) Ensure the dishwasher is supplied with water heated to 155░F or more.

аааа (b) If a home-type mechanical dishwasher is installed after September 1, 2004, the boarding home must ensure the dishwasher has:

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

аааа (ii) A high temperature final rinse resulting in a minimum of 160░F measured at the surface of the utensil;

аааа (iii) A continuous supply of water heated to 155░F throughout its operating cycle; or

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

аааа (5) The boarding home must ensure employees working as food service workers obtain a food worker card according to chapter 246-217 WAC.

аааа (6) The boarding home must ensure a resident obtains a food worker card according to chapter 246-217 WAC whenever:

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

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

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

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Intermittent Nursing Services and Resident-Arranged Services
NEW SECTION
WAC 388-78A-2310 Intermittent nursing services. (1) The boarding home is not required to provide intermittent nursing services.

аааа (2) The boarding home may choose to provide any of the following intermittent nursing services through appropriately licensed and credentialed staff; however, the facility may or may not need to provide additional intermittent nursing services to comply with the reasonable accommodation requirements in federal or state law:

аааа (a) Medication administration;

аааа (b) Administration of health treatments;

аааа (c) Diabetic management;

аааа (d) Nonroutine ostomy care;

аааа (e) Tube feeding; and

аааа (f) Nurse delegation consistent with chapter 18.79 RCW.

аааа (3) The boarding home must clarify on the disclosure form any limitations, additional services, or conditions that may apply under this section.

аааа (4) In providing intermittent nursing services, the boarding home must observe the resident for changes in overall functioning and respond appropriately when there are observable or reported changes in the resident's physical, mental or emotional functioning.

аааа (5) The boarding home may provide intermittent nursing services to the extent permitted by RCW 18.20.160.

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NEW SECTION
WAC 388-78A-2320 Intermittent nursing services systems. (1) When a boarding home provides nursing services to any resident, either directly or indirectly, the boarding home must develop and implement systems that support and promote the safe practice of nursing in accordance with chapters 18.79 RCW and 246-840 WAC.

аааа (2) The boarding home providing nursing services, either directly or indirectly, must ensure that the nursing services systems include:

аааа (a) Nursing services supervision;

аааа (b) Nurse delegation, if provided;

аааа (c) Initial and on-going assessments of the nursing needs of each resident;

аааа (d) Development and necessary amendments to the nursing component of the negotiated service agreement of each resident;

аааа (e) Implementation of the nursing component of each resident's negotiated service agreement; and

аааа (f) Availability of the supervisor, in person, by pager, or by telephone, to respond to residents' needs on the boarding home premises as necessary.

аааа (3) The boarding home must ensure that all nursing services, including nursing supervision and nurse delegation, are provided in accordance with applicable statutes and rules, including, but not limited to:

аааа (a) Chapter 18.79 RCW, Nursing care;

аааа (b) Chapter 18.88A RCW, Nursing assistants;

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

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

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

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NEW SECTION
WAC 388-78A-2330 Tube feeding. (1) The boarding home must provide nursing services to develop and implement the nursing component of the negotiated service agreement, administer feedings and necessary medications, and provide routine care of the tube insertion site whenever any resident requiring tube feeding is not able to:

аааа (a) Independently and safely manage:

аааа (i) Maintenance of the tube insertion site;

аааа (ii) Necessary medication administration through the tube; and

аааа (iii) Feeding administration through the tube.

аааа (b) Arrange for an outside resource to provide:

аааа (i) Maintenance of the tube insertion site;

аааа (ii) Necessary medication administration through the tube; and

аааа (iii) Feeding administration through the tube.

аааа (2) The boarding home is not required to provide 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.

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NEW SECTION
WAC 388-78A-2340 Resident-arranged services. (1) The boarding home must allow a resident to arrange to receive on-site care and services from:

аааа (a) A practitioner, licensed under Title 18 RCW regulating health care professions; and

аааа (b) A home health, hospice, or home care agency licensed under chapter 70.127 RCW.

аааа (2) The boarding home may permit the resident or the resident's legal representative, if any, to independently arrange for other persons to provide on-site care and services to the resident.

аааа (3) The boarding home is not required to supervise the activities of a person providing care or services to a resident when the resident or resident's representative has independently arranged for or contracted with the person.

аааа (4) The boarding home may establish policies and procedures that describe reasonable limitations, conditions, or requirements that must be met prior to an outside service provider being allowed on-site.

аааа (5) When the resident or the resident's representative, if any, independently arranges for outside services under subsection (1) of this section, the boarding home's duty of care, and any negligence that may be attributed thereto, shall be limited to: The responsibilities described under subsection (3) of this section, excluding supervising the activities of the outside service provider; observation of the resident for changes in overall functioning, consistent with RCW 18.20.280; notification to the person or persons identified in RCW 70.129.030 when there are observed changes in the resident's overall functioning or condition; and appropriately responding to obtain needed assistance when there are observable or reported changes in the resident's physical or mental functioning.

аааа (6) When information sharing is authorized by the resident or the resident's legal representative, the licensee shall request such information and integrate relevant information from the outside services provider into the resident's negotiated service agreement, only to the extent such information is actually shared with the licensee.

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NEW SECTION
WAC 388-78A-2350 Coordination of health care services. (1) The boarding home must coordinate services with external health care providers to meet the residents' needs, consistent with the resident's negotiated service agreement.

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

аааа (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; and

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

аааа (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.

аааа (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:

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

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

аааа (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.

аааа (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:

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

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

аааа (c) Address known associated risks in the resident's negotiated service agreement.

аааа (7) When coordinating care or services, the boarding home must:

аааа (a) Integrate relevant information from the external provider into the resident's preadmission assessment and reassessment, and when appropriate, negotiated service agreement; and

аааа (b) Respond appropriately when there are observable or reported changes in the resident's physical, mental, or emotional functioning.

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Service Delivery and MonitoringAdult Day Care
NEW SECTION
WAC 388-78A-2360 Adult day care. (1) The boarding home may, but is not required to, provide an adult day care program for nonresidents.

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

аааа (a) Ensure each adult day care client receives appropriate supervision and agreed upon care and services during the time spent in the day care program;

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

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

аааа (d) Only accept adult day care clients who are appropriate for boarding home care and services, consistent with WAC 388-78A-2050;

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

аааа (f) Notify appropriate individuals specified in the client's record and consistent with WAC 388-78A-2660 when there is a significant change in the condition of an adult day care client;

аааа (g) Investigate and document incidents and accidents involving adult day care clients consistent with WAC 388-78A-2720;

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

аааа (i) Maintain a resident record for each adult day care client.

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Dementia Care
NEW SECTION
WAC 388-78A-2370 Dementia care. (1) The boarding home must, to the fullest extent reasonably possible, obtain for each resident who has symptoms consistent with dementia as assessed per WAC 388-78A-2090(7):

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

аааа (i) Family members or other significant relationships;

аааа (ii) Education and training;

аааа (iii) Employment and career experiences;

аааа (iv) Religious or spiritual preferences;

аааа (v) Familiar roles or sources of pride and pleasure.

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

аааа (i) Articulate his or her personal needs; and

аааа (ii) Initiate activity.

аааа (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:

аааа (i) Agitation;

аааа (ii) Wandering;

аааа (iii) Resistance to care;

аааа (iv) Social isolation; and

аааа (v) Aggression.

аааа (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 service agreement for the resident.

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NEW SECTION
WAC 388-78A-2380 Restricted egress. A boarding home must ensure all of the following conditions are present before moving residents into units or buildings with exits that may restrict a resident's egress:

аааа (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.

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

аааа (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 service agreement.

аааа (4) Each resident who is assessed as being unsafe to leave the boarding home unescorted is able to leave the boarding home consistent with his or her negotiated service agreement.

аааа (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.

аааа (6) Installation of special egress control devices in all proposed construction issued a project number by construction review services on or after September 1, 2004, must conform to standards adopted by the state building code council.

аааа (7) Installation of special egress control devices in all construction issued a project number by construction review services prior to September 1, 2004, must conform to the following:

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

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

аааа (i) The egress control device itself;

аааа (ii) The smoke detection system; or

аааа (iii) The means of egress illumination.

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

аааа (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.

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

аааа (f) The unlatching must not require more than one operation.

аааа (g) A sign must be provided on the door located above and within twelve inches of the panic bar or other door-latching hardware reading:

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

аааа The sign lettering must be at least one inch in height and must have a stroke of not less than one-eighth inch.

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

аааа (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.

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

аааа (a) Is accessible to residents without staff assistance;

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

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

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

аааа (e) Has suitable outdoor furniture.

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Resident Records
NEW SECTION
WAC 388-78A-2390 Resident records. The boarding home must maintain adequate records concerning residents to enable the boarding home:

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

аааа (2) To respond appropriately in emergency situations.

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NEW SECTION
WAC 388-78A-2400 Protection of resident records. The boarding home must:

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

аааа (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;

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

аааа (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;

аааа (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

аааа (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.

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NEW SECTION
WAC 388-78A-2410 Content of resident records. The boarding home must organize and maintain resident records in a format that the boarding home determines to be useful and functional for the boarding home to effectively provide care and services to each resident. Active resident records must include the following:

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

аааа (a) Name;

аааа (b) Birth date;

аааа (c) Move-in date; and

аааа (d) Sleeping room identification.

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

аааа (a) Resident's primary health care provider;

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

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

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

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

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

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

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

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

аааа (6) The resident's negotiated service agreement consistent with WAC 388-78A-2140.

аааа (7) Any orders for medications, treatments, and modified or therapeutic diets, including any directions for addressing a resident's refusal of medications, treatments, and prescribed diets.

аааа (8) Medical and nursing services provided by the boarding home for a resident, including:

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

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

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

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

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

аааа (b) A record of any nursing treatments, including the signature or initials of the person providing them.

аааа (9) Documentation consistent with WAC 388-78A-2120 Monitoring resident well-being.

аааа (10) Staff interventions or responses to subsection (9) of this section, including any modifications made to the resident's negotiated service agreement.

аааа (11) Notices of and reasons for relocation as specified in RCW 70.129.110.

аааа (12) The individuals who were notified of a significant change in the resident's condition and the time and date of the notification.

аааа (13) When available, a copy of any legal documents in which:

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

аааа (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

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

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NEW SECTION
WAC 388-78A-2420 Record retention. (1) The boarding home must maintain on the boarding home premises in a resident's active record(s) all relevant information and documentation necessary for meeting a resident's current assessed needs.

аааа (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 assessed service and care needs, and maintain it in an inactive record that must remain on the boarding home premises as long as the resident remains in the boarding home.

аааа (3) The boarding home must maintain all documentation filed in a closed resident record, 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.

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

аааа (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.

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NEW SECTION
WAC 388-78A-2430 Resident review of records. (1) The boarding home must assemble all records pertaining to a resident and make them available to a resident within twenty-four hours of the resident's or the resident's representative's request to review the resident's records per RCW 70.129.030.

аааа (2) The boarding home must provide to the resident or the resident's representative, photocopies of the records or any portions of the records pertaining to the resident, within two working days of the resident's or resident's representative's request for the records.

аааа (a) For the purposes of this section, "working days" means Monday through Friday, except for legal holidays.

аааа (b) The boarding home may charge the resident or the resident's representative a fee not to exceed twenty-five cents per page for the cost of photocopying the resident's record.

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NEW SECTION
WAC 388-78A-2440 Resident register. (1) The boarding home must maintain in the boarding home a single current roster of all boarding home residents, their roommates and identification of the rooms in which such persons reside or sleep.

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

аааа (a) Authorized department staff;

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

аааа (c) Representatives of the Washington state fire protection bureau when conducting fire safety inspections.

аааа (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:

аааа (a) Date of moving in;

аааа (b) Full name;

аааа (c) Date of birth;

аааа (d) Date of moving out;

аааа (e) Reason for moving out; and

аааа (f) New address if known.

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ADMINISTRATIONStaff
NEW SECTION
WAC 388-78A-2450 Staff. (1) Each boarding home must provide sufficient, trained staff persons to:

аааа (a) Furnish the services and care needed by each resident consistent with his or her negotiated service agreement;

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

аааа (c) Implement fire and disaster plans.

аааа (2) The boarding home must:

аааа (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;

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

аааа (c) Verify prior to hiring that staff persons have the required licenses, certification, registrations, or other credentials for the position, and that such licenses, certifications, registrations, and credentials are current and in good standing;

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

аааа (e) Ensure all resident care and services are provided only by staff persons who have the training, credentials, experience and other qualifications necessary to provide the care and services;

аааа (f) Ensure at least one caregiver, 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:

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

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

аааа (iii) When staff persons transport a resident.

аааа (g) Ensure caregiver provides on-site supervision of any resident voluntarily providing services for the boarding home;

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

аааа (i) Organization of boarding home;

аааа (ii) Physical boarding home layout;

аааа (iii) Specific duties and responsibilities;

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

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

аааа (vi) Needs and service preferences identified in the negotiated service agreements of residents with whom the staff persons will be working; and

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

аааа (i) Develop and implement a process to ensure caregivers:

аааа (i) Acquire the necessary information from the preadmission assessment, on-going assessment and negotiated service agreement relevant to providing services to each resident with whom the caregiver works;

аааа (ii) Are informed of changes in the negotiated service agreement of each resident with whom the caregiver works; and

аааа (iii) Are given an opportunity to provide information to responsible staff regarding the resident when assessments and negotiated service agreements are updated for each resident with whom the caregiver works.

аааа (j) Ensure all caregivers have access to resident records relevant to effectively providing care and services to the resident.

аааа (3) The boarding home must:

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

аааа (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;

аааа (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;

аааа (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;

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

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

аааа (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;

аааа (B) Cardiopulmonary resuscitation;

аааа (C) First aid; and

аааа (D) HIV/AIDS training.

аааа (ii) Criminal history disclosure and background checks as required in WAC 388-78A-2470; and

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

аааа (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.

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NEW SECTION
WAC 388-78A-2460 Quality assurance committee. (1) To ensure the proper delivery of services and the maintenance and improvement in quality of care through self-review, any boarding home licensed under this chapter may maintain a quality assurance committee that, at a minimum, includes:

аааа (a) A licensed registered nurse under chapter 18.79 RCW;

аааа (b) The administrator; and

аааа (c) Three other members from the staff of the boarding home.

аааа (2) When established, the quality assurance committee shall meet at least quarterly to identify issues that may adversely affect quality of care and services to residents and to develop and implement plans of action to correct identified quality concerns or deficiencies in the quality of care provided to residents.

аааа (3) To promote quality of care through self-review without the fear of reprisal, and to enhance the objectivity of the review process, the department shall not require, and the long-term care ombudsman program shall not request, disclosure of any quality assurance committee records or reports, unless the disclosure is related to the committee's compliance with this section, if:

аааа (a) The records or reports are not maintained pursuant to statutory or regulatory mandate; and

аааа (b) The records or reports are created for and collected and maintained by the committee.

аааа (4) If the boarding home refuses to release records or reports that would otherwise be protected under this section, the department may then request only that information that is necessary to determine whether the boarding home has a quality assurance committee and to determine that it is operating in compliance with this section. However, if the boarding home offers the department documents generated by, or for, the quality assurance committee as evidence of compliance with boarding home requirements, the documents are not protected as quality assurance committee documents when in the possession of the department.

аааа (5) Good faith attempts by the committee to identify and correct quality deficiencies shall not be used as a basis for sanctions.

аааа (6) Any records that are created for and collected and maintained by the quality assurance committee shall not be discoverable or admitted into evidence in a civil action brought against a boarding home.

аааа (7) Notwithstanding any records created for the quality assurance committee, the facility shall fully set forth in the resident's records, available to the resident, the department, and others as permitted by law, the facts concerning any incident of injury or loss to the resident, the steps taken by the facility to address the resident's needs, and the resident outcome.

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NEW SECTION
WAC 388-78A-2470 Criminal history background checks. (1) The boarding home must:

аааа (a) Ensure any nonresident individual having unsupervised access to residents has a criminal history background check.

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

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

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

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

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

аааа (v) Convicted of criminal mistreatment; or

аааа (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.

аааа (c) 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:

аааа (i) Employees;

аааа (ii) Managers;

аааа (iii) Volunteers who are not residents;

аааа (iv) Contractors;

аааа (v) Resident arranged contractors;

аааа (vi) Students; and

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

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

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

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

аааа (ii) Background check central unit every two years for each individual identified in (c) of this subsection. 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.

аааа (f) Except as provided in (i) of this subsection, not hire an individual who may have unsupervised access to residents prior to receiving favorable results of the background check;

аааа (g) 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;

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

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

аааа (ii) Used for employment purposes only;

аааа (iii) Not disclosed to any individual except:

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

аааа (B) Authorized state and federal employees;

аааа (C) The Washington state patrol auditor; and

аааа (D) As otherwise authorized in chapter 43.43 RCW.

аааа (iv) Retained and available for department review:

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

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

аааа (i) 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:

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

аааа (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.

аааа (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.

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NEW SECTION
WAC 388-78A-2480 TB tests. (1) The boarding home must ensure each staff person is screened for tuberculosis, as follows:

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

аааа (i) Given no less than one and no more than three weeks apart;

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

аааа (iii) Read between forty-eight and seventy-two hours following administration, by trained personnel; and

аааа (iv) Recorded in millimeters of induration.

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

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

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

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

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

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

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

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

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

аааа (ii) Report positive chest X rays to the appropriate public health authority; and

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

аааа (2) The boarding home must:

аааа (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:

аааа (i) Tuberculin test results;

аааа (ii) Reports of X-ray findings; and

аааа (iii) Physician or public health official orders.

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

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

аааа (ii) When requested by the staff person.

аааа (3) The boarding home must ensure that caregivers caring for a resident with suspected tuberculosis comply with the WISHA standard for respiratory protection.

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Specialized Training
NEW SECTION
WAC 388-78A-2490 Specialized training for developmental disabilities. The boarding home must provide caregivers with specialized training, consistent with chapter 388-112 WAC, to serve residents with developmental disabilities, whenever at least one of the residents in the boarding home is:

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

аааа (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:

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

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

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

аааа (i) Self-care;

аааа (ii) Understanding and use of language;

аааа (iii) Learning;

аааа (iv) Mobility;

аааа (v) Self-direction; and

аааа (vi) Capacity for independent living.

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NEW SECTION
WAC 388-78A-2500 Specialized training for mental illness. The boarding home must provide caregivers with specialized training, consistent with chapter 388-112 WAC, to serve residents with mental illness, whenever at least one of the residents in the boarding home is a person who has been diagnosed with or treated for an Axis I or Axis II diagnosis, as described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and:

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

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

аааа (a) A licensed physician;

аааа (b) A mental health professional;

аааа (c) A psychiatric advanced registered nurse practitioner; or

аааа (d) A licensed psychologist.

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NEW SECTION
WAC 388-78A-2510 Specialized training for dementia. The boarding home must provide caregivers with specialized training, consistent with chapter 388-112 WAC, to serve residents with dementia, whenever at least one of the residents in the boarding home has symptoms consistent with dementia as assessed per WAC 388-78A-2090(7).

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Administrator
NEW SECTION
WAC 388-78A-2520 Administrator qualifications. (1) The licensee must appoint an administrator who is at least twenty-one years old and who is not a resident, and is qualified to perform the administrator's duties specified in WAC 388-78A-2560.

аааа (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) of this subsection:

аааа (a) The individual was actively employed as a boarding home administrator and met existing qualifications on September 1, 2004;

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

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

аааа (i) Obtained certification of completing a recognized administrator training course consisting of a minimum of twenty-four hours of instruction or equivalent on-line training or certification of passing an administrator examination, from or endorsed by a department-recognized national accreditation health or personal care organization such as:

аааа (A) The American Association of Homes and Services for the Aging; or

аааа (B) The American Health Care Association; or

аааа (C) The Assisted Living Federation of America; or

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

аааа (ii) Three years paid experience:

аааа (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

аааа (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.

аааа (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 (d)(i), (ii) or (iii) of this subsection:

аааа (i) Obtains certification of completing a recognized administrator training course consisting of a minimum of twenty-four hours of instruction or equivalent on-line training, or certification of passing an administrator examination, within six months of beginning duties as the administrator, from or endorsed by a department-recognized national accreditation health or personal care organization such as:

аааа (A) The American Association of Homes and Services for the Aging; or

аааа (B) The American Health Care Association; or

аааа (C) The Assisted Living Federation of America; or

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

аааа (ii) Has two years paid experience:

аааа (iii) Has completed a qualifying administrator training program supervised by a qualified administrator according to WAC 388-78A-2530.

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

аааа (A) The American Association of Homes and Services for the Aging; or

аааа (B) The American Health Care Association; or

аааа (C) The Assisted Living Federation of America; or

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

аааа (ii) Has one year paid experience:

аааа (iii) Has completed a qualifying administrator training program supervised by a qualified administrator according to WAC 388-78A-2530.

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

аааа (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

аааа (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.

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NEW SECTION
WAC 388-78A-2530 Qualifying administrator training program. Before the licensee appoints an individual who must have completed a qualifying administrator training program in order to qualify as a boarding home administrator, the licensee must verify the individual has completed the training and obtain documentation from the individual that the training program met the following requirements:

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

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

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

аааа (4) The supervising administrator met the qualifications to be an administrator specified in WAC 388-78A-2510;

аааа (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;

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

аааа (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;

аааа (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

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

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NEW SECTION
WAC 388-78A-2540 Administrator training requirements. The licensee must ensure the boarding home administrator:

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

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

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

аааа (i) Chapter 18.20 RCW, Boarding homes;

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

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

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

аааа (v) Chapter 388-78A WAC, Boarding home licensing rules; and

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

аааа (b) Individuals hired as boarding home administrators after September 1, 2004, must complete department required training within thirty days of assuming duties as a boarding home administrator.

аааа (c) Individuals employed as boarding home administrators on September 1, 2004, must complete department required training by November 1, 2004.

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NEW SECTION
WAC 388-78A-2550 Administrator training documentation. The boarding home must maintain for department review, documentation of the administrator completing:

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

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

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

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

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NEW SECTION
WAC 388-78A-2560 Administrator responsibilities. The licensee must ensure the administrator:

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

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

аааа (3) Is readily accessible to meet with residents;

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

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

аааа (a) Is available by telephone or electronic pager; or

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

аааа (i) Qualified by experience to assume designated duties; and

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

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NEW SECTION
WAC 388-78A-2570 Notification of change in administrator. The licensee must notify the department in writing within ten calendar days of the effective date of a change in the boarding home administrator. The notice must include the full name of the new administrator and the effective date of the change.

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NEW SECTION
WAC 388-78A-2580 Use of home health/home care. If a boarding home licensee also has a home health or home care license, the licensee may not provide care or services to nonresident individuals living in independent living units on the boarding home premises under the home health or home care license if:

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

аааа (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;

аааа (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

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

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Management Agreements
NEW SECTION
WAC 388-78A-2590 Management agreements. (1) If the licensee uses a manager, the licensee must have a written management agreement approved by the department that is consistent with this section.

аааа (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.

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

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

аааа (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;

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

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

аааа (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.

аааа (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:

аааа (a) Initial application for a license;

аааа (b) Retention of a manager following initial application;

аааа (c) Change of managers; or

аааа (d) Modification of existing management agreement.

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Policies and Procedures
NEW SECTION
WAC 388-78A-2600 Policies and procedures. (1) The boarding home must develop and implement policies and procedures in support of services that are provided and are necessary to:

аааа (a) Maintain or enhance the quality of life for residents including resident decision-making rights;

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

аааа (c) Safely operate the boarding home; and

аааа (d) Operate in comliance with state and federal law, including, but not limited to, chapters 7.70, 11.88, 11.92, 11.94, 69.41, 70.122, 70.129, and 74.34 RCW, and any rules promulgated under these statutes.

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

аааа (a) Related to suspected abuse, neglect, or exploitation of any resident;

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

аааа (c) When a substitute decision maker is no longer appropriate;

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

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

аааа (ii) Related to calling 911;

аааа (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;

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

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

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

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

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

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

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

аааа (f) In response to medical emergencies;

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

аааа (h) In the event of an internal or external disaster, consistent with WAC 388-78A-2700;

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

аааа (j) To appropriately respond to aggressive or assaultive residents, including, but not limited to:

аааа (i) Actions to take if a resident becomes violent;

аааа (ii) Actions to take to protect other residents; and

аааа (iii) When and how to seek outside intervention.

аааа (k) To prevent and limit the spread of infections consistent with WAC 388-78A-2610;

аааа (l) To manage residents' medications, consistent with WAC 388-78A-2210 through 388-78A-2290, including:

аааа (i) Recording and documenting prescriber's orders;

аааа (ii) Providing and documenting medication assistance;

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

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

аааа (v) Safe and secure storage of medications; and

аааа (vi) Disposing of discontinued and/or outdated medications;

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

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

аааа (i) Food service sanitation;

аааа (ii) Procuring and storing food;

аааа (iii) Food preparation; and

аааа (iv) Modified diets and nutritional supplements.

аааа (o) Regarding the safe operation of any boarding home vehicles used to transport residents, and the qualifications of the drivers;

аааа (p) To coordinate services and share resident information with outside resources, consistent with WAC 388-78A-2350;

аааа (q) Regarding the management of pets in the boarding home, if permitted, consistent with WAC 388-78A-2560; and

аааа (r) When receiving and responding to resident grievances consistent with RCW 70.129.060.

аааа (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 must inform residents and residents' representatives of their availability and make available upon request.

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аааааReviser'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.Infection Control
NEW SECTION
WAC 388-78A-2610 Infection control. (1) The boarding home must institute appropriate infection control practices in the boarding home to prevent and limit the spread of infections.

аааа (2) The boarding home must:

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

аааа (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;

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

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

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

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

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NEW SECTION
WAC 388-78A-2620 Pets. If a boarding home allows pets to live on the premises, the boarding home must:

аааа (1) Develop, implement and disclose to potential and current residents, policies regarding:

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

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

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

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

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

аааа (c) Are restricted from central food preparation areas.

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Reporting Requirements
NEW SECTION
WAC 388-78A-2630 Reporting abuse and neglect. (1) The boarding home must ensure that each staff person:

аааа (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

аааа (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.

аааа (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.

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NEW SECTION
WAC 388-78A-2640 Reporting significant change in a resident's condition. (1) The boarding home must consult with the resident's representative, the resident's physician, and other individual(s) designated by the resident as soon as possible whenever:

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

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

аааа (c) The resident dies.

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

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

аааа (b) The resident dies.

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

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

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

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

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NEW SECTION
WAC 388-78A-2650 Reporting fires and incidents. The boarding home must immediately report to the department's aging and disability services administration:

аааа (1) Any accidental or unintended fire, or any deliberately set but improper fire, such as arson, in the boarding home;

аааа (2) Any unusual incident 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

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

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Resident Rights
NEW SECTION
WAC 388-78A-2660 Resident rights. The boarding home must:

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

аааа (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;

аааа (3) Not use restraints on any resident;

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

аааа (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

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

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NEW SECTION
WAC 388-78A-2670 Services by resident for boarding home. If a resident performs services for the boarding home, the boarding home must ensure:

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

аааа (2) The resident performing services does not supervise, or is not placed in charge of, other residents; and

аааа (3) If the resident regularly performs voluntary services for the benefit of the boarding home, the volunteer activity is addressed in the resident's negotiated service agreement.

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NEW SECTION
WAC 388-78A-2680 Boarding home use of audio and video monitoring. (1) Except as provided for in WAC 388-78A-2690, the boarding home must not use:

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

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

аааа (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:

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

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

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

аааа (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;

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

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

аааа (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;

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

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

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

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NEW SECTION
WAC 388-78A-2690 Resident use of electronic monitoring. (1) The boarding home must limit the use of resident-initiated video or audio monitoring to the sleeping room or apartment of the resident who requested the monitoring.

аааа (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:

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

аааа (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;

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

аааа (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 the agreement.

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

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

аааа (a) The resident no longer desires it;

аааа (b) The roommate objects to the use; or

аааа (c) The resident becomes unable to give consent.

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Safety and Disaster Preparedness
NEW SECTION
WAC 388-78A-2700 Safety measures and disaster preparedness. (1) The boarding home must take necessary action to promote the safety of each resident whenever the resident is on the boarding home premises or under the supervision of staff persons, consistent with the resident's negotiated service agreement.

аааа (2) The boarding home must:

аааа (a) Maintain the premises free of hazards;

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

аааа (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:

аааа (i) Determine the circumstances of the event;

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

аааа (iii) Protect other residents during the course of the investigation.

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

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

аааа (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, 2004, the boarding home must provide emergency lighting in all areas of the boarding home;

аааа (g) Make sure first-aid supplies are:

аааа (i) Readily available and not locked;

аааа (ii) Clearly marked;

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

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

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

аааа (i) The size of the boarding home;

аааа (ii) The services provided;

аааа (iii) The residents served; and

аааа (iv) The response time of emergency medical services.

аааа (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:

аааа (i) On-duty staff persons' responsibilities;

аааа (ii) Provisions for summoning emergency assistance;

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

аааа (iv) Alternative resident accommodations;

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

аааа (vi) Emergency communication plan.

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Disclosure
NEW SECTION
WAC 388-78A-2710 Disclosure of services. (1) The boarding home must disclose to residents, the resident's representative, if any, and interested consumers upon request, the scope of care and services it offers, on the department's approved disclosure forms. The disclosure form shall not be construed as an implied or express contract between the boarding home and the resident, but is intended to assist consumers in selecting boarding home services.

аааа (2) The boarding home must provide the services disclosed.

аааа (3) The boarding home must provide a minimum of thirty days written notice to the residents and the residents' representatives, if any, before the effective date of any decrease, due to circumstances beyond the boarding home's control.

аааа (4) The boarding home must provide a minimum of ninety days written notice to the residents and the residents' representative, if any, before the effective date of any voluntary decrease in the scope of care or services provided by the boarding home, and any such decrease in the scope of services provided will result in the discharge of one or more residents.

аааа (5) If the boarding home increases the scope of services that it chooses to provide, the boarding home must promptly provide written notice to the residents and residents' representative, if any, and must indicate the date on which the increase in the scope of care or services is effective.

аааа (6) When the care needs of a resident exceed the disclosed scope of care or services that a boarding home provides, the boarding home may exceed the care or services disclosed consistent with RCW 70.129.030(3) and 70.129.110 (3)(a).

аааа (7) Even though the boarding home may disclose that it can provide certain care or services to residents or resident applicants or residents' representative, if any, the boarding home may deny admission to a resident applicant when the boarding home determines that the needs of the resident applicant cannot be met, as long as the boarding home operates in compliance with state and federal law, including reasonable accommodation requirements and RCW 70.129.030(3).

аааа (8) The boarding home must notify resident applicants of their rights regarding health care decision making consistent with applicable state and federal laws and rules, before or at the time the individual moves into the boarding home.

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NEW SECTION
WAC 388-78A-2720 Timing of disclosure. (1) The boarding home must disclose the information regarding the operation of the boarding home:

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

аааа (b) At the time the boarding home provides an application for residency, an admission agreement or contract, if not previously received by the resident applicant or his or her representative, if any.

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

аааа (a) In advertisements;

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

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

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Licensing
NEW SECTION
WAC 388-78A-2730 Licensee's responsibilities. (1) The boarding home licensee is responsible for:

аааа (a) The operation of the boarding home;

аааа (b) Complying with the requirements of this chapter, chapter 18.20 RCW, and other applicable laws and rules; and

аааа (c) The care and services provided to the boarding home residents.

аааа (2) The licensee must:

аааа (a) Maintain the occupancy level at or below the licensed resident bed capacity of the boarding home;

аааа (b) Maintain and post in a size and format that is easily read, in a conspicuous place on the boarding home premises:

аааа (i) A current boarding home license, including any related conditions on the license;

аааа (ii) The name, address and telephone number of:

аааа (A) The department;

аааа (B) Appropriate resident advocacy groups; and

аааа (C) State and local long-term care ombudsman with a brief description of ombudsman services.

аааа (iii) A copy of the report and plan of correction of the most recent full inspection conducted by the department.

аааа (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.

аааа (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.

аааа (4) The licensee must act in accord with any department-approved management agreement, if the licensee has entered into a management agreement.

аааа (5) The licensee must appoint the boarding home administrator consistent with WAC 388-78A-2520.

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NEW SECTION
WAC 388-78A-2740 Licensee qualifications. The department must consider separately and jointly as applicants each person named in the application for a boarding home license.

аааа (1) If the department finds any person unqualified as specified in WAC 388-78A-3190, the department must deny, terminate, or not renew the license.

аааа (2) If the department finds any person unqualified as specified in WAC 388-78A-3160, the department may deny, terminate, or not renew the license.

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NEW SECTION
WAC 388-78A-2750 Application process. To apply for a boarding home license, a person must:

аааа (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;

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

аааа (3) Submit criminal history background requests as required in WAC 388-78A-2470;

аааа (4) Sign the application;

аааа (5) Submit the license fee as specified in WAC 388-78A-3230;

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

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

аааа (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

аааа (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.

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NEW SECTION
WAC 388-78A-2760 Necessary information. In making a determination whether to issue a boarding home license, in addition to the information for each person named in the application, the department may review 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.

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NEW SECTION
WAC 388-78A-2770 Change in licensee. (1) The licensee of a boarding home must change whenever the following events occur, including, but not limited to:

аааа (a) The licensee's form of legal organization is changed (e.g., a sole proprietor forms a partnership or corporation);

аааа (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;

аааа (c) The licensee dissolves, or consolidates or merges with another legal organization and the licensee's legal organization does not survive;

аааа (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:

аааа (i) A different party (e.g., new or former shareholders); or

аааа (ii) A person that had less than a five percent ownership interest in the boarding home at the time of the first transaction.

аааа (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.

аааа (2) The licensee is not required to change when the following, without more, occur:

аааа (a) The licensee contracts with a party to manage the boarding home enterprise for the licensee pursuant to an agreement as specified in WAC 388-78A-2590; or

аааа (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.

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NEW SECTION
WAC 388-78A-2780 Requirements to change boarding home licensee. (1) In order to change the licensee of a boarding home, the current licensee must notify the department and all residents of the proposed change in licensee at least ninety days prior to the proposed date of change, including the following information:

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

аааа (b) Name and address of the boarding home for which the licensee is being changed;

аааа (c) Date of proposed change; and

аааа (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.

аааа (2) The prospective licensee must, at least ninety days prior to the proposed date of change:

аааа (a) Sign the application;

аааа (b) Submit the annual license fee, if a licensing fee is due;

аааа (c) Submit 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;

аааа (d) Submit a revised application if any information included on the original application is no longer accurate; and

аааа (e) Complete and submit a revised application if requested by the department.

аааа (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.

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NEW SECTION
WAC 388-78A-2790 Annual renewal. To renew a boarding home license, the boarding home must:

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

аааа (2) Sign the application;

аааа (3) Submit the annual renewal license fee as specified in WAC 388-78A-3230; and

аааа (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.

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NEW SECTION
WAC 388-78A-2800 Changes in licensed bed capacity. To change the licensed bed capacity in a boarding home, the boarding home must:

аааа (1) Select the bed from the licensed room list. "Licensed room list" means a department-approved list identifying resident rooms, the dimensions and calculated square footage of each room, the number of approved bed spaces (in each room), and other information relative to the licensed resident bed capacity of a boarding home.

аааа (a) This list is intended to identify the rooms that meet licensing requirements, whether or not the rooms are occupied by independent residents or residents receiving domiciliary care.

аааа (b) Common use or administrative areas such as dining rooms, laundry rooms, and offices do not need to be included on the licensed room list.

аааа (c) All rooms appearing on this list must be in a building, or a part of a building, that had its plans reviewed and approved by the department of health (DOH) construction review services.

аааа (2) Submit a completed request for approval to the department at least one day before the intended change;

аааа (3) Submit the prorated fee required according to WAC 388-78A-3230; and

аааа (4) Post an amended license obtained from the department, indicating the new bed capacity.

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NEW SECTION
WAC 388-78A-2810 Criteria for increasing licensed bed capacity. Before the licensed bed capacity in a boarding home may be increased, the boarding home must:

аааа (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

аааа (2) Ensure the increased licensed bed capacity does not exceed the maximum facility capacity as determined by the department.

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NEW SECTION
WAC 388-78A-2820 Building requirements and exemptions. (1) To get a building approved for licensing, a person must:

аааа (a) Design plans according to the building code, local codes and ordinances, and this chapter;

аааа (b) Submit construction documents, including any change orders and addenda to:

аааа (i) Construction review services per WAC 388-78A-2850 and include:

аааа (A) A minimum of two sets of final construction drawings complying with the requirements of this chapter, stamped by a Washington state licensed architect or engineer; and

аааа (B) A functional program description; and

аааа (ii) Local county or municipal building departments per local codes to obtain necessary building permits.

аааа (c) Conform to the approved construction documents during construction in accordance with chapter 18.20 RCW;

аааа (d) Obtain written approval from construction review services prior to deviating from approved construction documents;

аааа (e) Provide construction review services with a:

аааа (i) Written notice of completion date;

аааа (ii) Copy of reduced floor plan(s); and

аааа (iii) Copy of certificate of occupancy issued by the local building department.

аааа (f) Obtain authorization from the department prior to providing boarding home services in the new construction area.

аааа (2) The department may exempt the boarding home from meeting a specific requirement related to the physical environment if the department determines the exemption will not:

аааа (a) Jeopardize the health or safety of residents;

аааа (b) Adversely affect the residents' quality of life; or

аааа (c) Change the fundamental nature of the boarding home operation into something other than a boarding home.

аааа (3) A boarding home wishing to request an exemption must submit a written request to the department, including:

аааа (a) A description of the requested exemption; and

аааа (b) The specific WAC requirement for which the exemption is sought.

аааа (4) The boarding home may not appeal the department's denial or a request for an exemption.

аааа (5) The boarding home must retain a copy of each approved exemption in the boarding home.

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NEW SECTION
WAC 388-78A-2830 Conversion of licensed nursing homes. (1) If a person intends to convert a licensed nursing home building into a licensed boarding home, the building must meet all boarding home licensing requirements specified in this chapter and chapter 18.20 RCW unless the licensee has a contract with the department to provide enhanced adult residential care services in the boarding home per RCW 18.20.220.

аааа (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:

аааа (a) As required by RCW 18.51.140; and

аааа (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:

аааа (i) Resident to bathing fixture ratio required per WAC 388-78A-3030;

аааа (ii) Resident to toilet ratio required per WAC 388-78A-3030;

аааа (iii) Corridor call system required per WAC 388-78A-2930;

аааа (iv) Resident room door closures; and

аааа (v) Resident room windows required per WAC 388-78A-3010.

аааа (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.

[]

NEW SECTION
WAC 388-78A-2840 Licenses for multiple buildings. (1) The licensee may have multiple buildings operating under a single boarding home license if:

аааа (a) All of the buildings are located on the same property with the same legal description; or

аааа (b) All of the buildings are located on contiguous properties undivided by:

аааа (i) Public streets, not including alleyways used primarily for delivery services or parking; or

аааа (ii) Other land that is not owned and maintained by the owners of the property on which the boarding home is located.

аааа (2) The licensee must have separate boarding homes licenses for buildings that are not located on the same or contiguous properties.

аааа (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.

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NEW SECTION
WAC 388-78A-2850 Required reviews of building plans. (1) A person or boarding home must notify construction review services of all planned construction regarding boarding homes prior to beginning work on any of the following:

аааа (a) A new building or portion thereof to be used as a boarding home;

аааа (b) An addition of, or modification or alteration to an existing boarding home, including, but not limited to, the boarding home's:

аааа (i) Physical structure;

аааа (ii) Electrical fixtures or systems;

аааа (iii) Mechanical equipment or systems;

аааа (iv) Fire alarm fixtures or systems;

аааа (v) Fire sprinkler fixtures or systems;

аааа (vi) Carpeting;

аааа (vii) Wall coverings 1/28 inch thick or thicker; or

аааа (viii) Kitchen or laundry equipment.

аааа (c) A change in the department-approved use of an existing boarding home or portion of a boarding home; and

аааа (d) An existing building or portion thereof to be converted for use as a boarding home.

аааа (2) A person or boarding home does not need to notify construction review services of the following:

аааа (a) Repair or maintenance of equipment, furnishings or fixtures;

аааа (b) Replacement of equipment, furnishings or fixtures with equivalent equipment, furnishings or fixtures;

аааа (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;

аааа (d) Painting; or

аааа (e) Cosmetic changes that do not affect resident activities, services, or care and are performed in accordance with the current edition of the building code.

аааа (3) The boarding home must submit plans to construction review services as directed by construction review services and consistent with WAC 388-78A-2820 for approval 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.

[]

NEW SECTION
WAC 388-78A-2860 Relocation of residents during construction. (1) Prior to moving residents out of the boarding home during construction, the boarding home must:

аааа (a) Notify the department at least thirty days prior to the anticipated move date, of the boarding home's plans for relocating residents, including:

аааа (i) How the residents will be informed of the required move and their options consistent with chapter 70.129 RCW;

аааа (ii) The location to which the residents will be relocated;

аааа (iii) The boarding home's plans for providing care and services during the relocation;

аааа (iv) The boarding home's plans for returning residents to the building; and

аааа (v) The projected time frame for completing the construction.

аааа (b) Obtain the department's approval for the relocation plans prior to relocating residents.

аааа (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.

[]

NEW SECTION
WAC 388-78A-2870 Vacant buildings. Whenever a boarding home moves out all residents and ceases operation for reasons other than construction, as specified in WAC 388-78A-2860, the licensee must relinquish the boarding home license or the department may revoke the boarding home license.

[]

NEW SECTION
WAC 388-78A-2880 Changing use of rooms. Prior to using a room for a purpose other than what was approved by construction review services, the boarding home must:

аааа (1) Notify construction review services:

аааа (a) In writing;

аааа (b) Thirty days or more before the intended change in use;

аааа (c) Describe the current and proposed use of the room; and

аааа (d) Provide all additional documentation as requested by construction review services.

аааа (2) Obtain the written approval of construction review services for the new use of the room.

[]

NEW SECTION
WAC 388-78A-2890 Time frame for approval. (1) A person or the licensee must:

аааа (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.

аааа (b) Obtain approval by construction review services, of landscaping, fire alarm and fire sprinkler plans prior to their installation.

аааа (2) The department will not issue a boarding home license unless construction review services:

аааа (a) Notifies the department that construction has been completed;

аааа (b) Provides the department:

аааа (i) A copy of the certificate of occupancy granted by the local building official;

аааа (ii) A copy of the functional program; and

аааа (iii) A reduced copy of the approved floor plan indicating room numbers or names and the approved use.

[]

Building
NEW SECTION
WAC 388-78A-2900 Retention of approved construction documents. The boarding home must retain on the boarding home premises:

аааа (1) Specification data on materials used in construction, for the life of the product;

аааа (2) Stamped "approved" set of construction documents.

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NEW SECTION
WAC 388-78A-2910 Applicable building codes. (1) Newly licensed boarding homes and construction in existing boarding homes must meet all the current building codes and this chapter.

аааа (2) Existing licensed boarding homes must continue to meet the building codes in force at the time of their initial licensing.

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NEW SECTION
WAC 388-78A-2920 Area for nursing supplies and equipment. (1) If the boarding home provides intermittent nursing services, the boarding home must provide on the boarding home premises for the safe and sanitary:

аааа (a) Storage and handling of clean and sterile nursing equipment and supplies; and

аааа (b) Cleaning and disinfecting of soiled nursing equipment.

аааа (2) For all boarding homes first issued a project number by construction review services on or after September 1, 2004, in which intermittent nursing services are provided, or upon initiating 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:

аааа (a) A "clean" utility room for the purposes of storing and preparing clean and sterile nursing supplies, equipped with:

аааа (i) A work counter or table;

аааа (ii) Handwashing sink, with soap and paper towels or other approved hand-drying device; and

аааа (iii) Locked medication storage, if medications are stored in this area, that is separate from all other stored items consistent with WAC 388-78A-2260.

аааа (b) A "soiled" utility room for the purposes of storing soiled linen, cleaning and disinfecting soiled nursing care equipment, and disposing of refuse and infectious waste, equipped with:

аааа (i) A work counter or table;

аааа (ii) A two-compartment sink for handwashing and equipment cleaning and sanitizing;

аааа (iii) A clinical service sink or equivalent for rinsing and disposing of waste material;

аааа (iv) Soap and paper towels or other approved hand-drying device; and

аааа (v) Locked storage for cleaning supplies, if stored in the area.

[]

NEW SECTION
WAC 388-78A-2930 Communication system. (1) The boarding home must:

аааа (a) Provide residents and staff with the means to summon on-duty staff assistance from:

аааа (i) Resident units;

аааа (ii) Common areas accessible to residents;

аааа (iii) Corridors accessible to residents; and

аааа (iv) All bathrooms and all toilet rooms in boarding homes issued a project number by construction review services on or after September 1, 2004.

аааа (b) Provide residents, families, and other visitors with the means to contact staff inside the building from outside the building after hours.

аааа (2) The boarding home must provide one or more nonpay telephones:

аааа (a) In each building located for ready access by staff; and

аааа (b) On the premises for reasonable access and privacy by residents.

аааа (3) In boarding homes issued a project number by construction review services on or after September 1, 2004, the boarding home must equip each resident room with:

аааа (a) An intercom system with a mechanism that allows a resident to control:

аааа (i) Whether or not announcements are broadcast into the resident's room; and

аааа (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.

аааа (b) Two telephone lines that are compatible with:

аааа (i) Telecommunication devices for the deaf equipment; and

аааа (ii) Telephones that have:

аааа (A) Visual signals for ringing; and

аааа (B) Voice amplification.

аааа (c) Television cable access where available in the community.

[]

NEW SECTION
WAC 388-78A-2940 Two-way intercom systems. The boarding home may use a two-way intercom system between staff persons and residents in other rooms only when:

аааа (1) A resident initiates the contact; or

аааа (2) Staff persons announce to the resident that the intercom has been activated at the time it is activated, and:

аааа (a) The resident and any others in the room agree to continue the contact;

аааа (b) A visible signal is activated in the resident's room at all times the intercom is in operation; and

аааа (c) The boarding home deactivates the intercom when the conversation is complete.

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NEW SECTION
WAC 388-78A-2950 Water supply. The boarding home must:

аааа (1) Provide water meeting the provisions of chapter 246-290 WAC, Group A public water supplies or chapter 246-291 WAC, Group B public water systems;

аааа (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;

аааа (3) Provide hot and cold water under adequate pressure readily available throughout the boarding home;

аааа (4) Provide all sinks and bathing fixtures used by residents with hot water between 105░F and 120░F at all times; and

аааа (5) Label or color code nonpotable water supplies "unsafe for domestic use."

[]

NEW SECTION
WAC 388-78A-2960 Sewage and liquid waste disposal. The boarding home must:

аааа (1) Ensure that all sewage and waste water drain into a municipal sewage disposal system in accordance with chapter 246-271 WAC, if available; or

аааа (2) Provide on-site sewage disposal systems designed, constructed, and maintained as required by chapters 246-272 and 173-240 WAC, and local ordinances; and

аааа (3) Provide a grease interceptor when the boarding home has an on-site commercial kitchen or septic system in accordance with chapter 246-272 WAC.

[]

NEW SECTION
WAC 388-78A-2970 Garbage and refuse disposal. The boarding home must:

аааа (1) Provide an adequate number of garbage containers to store refuse generated by the boarding home:

аааа (a) Located in a storage area convenient for resident and staff use;

аааа (b) Constructed of nonabsorbent material;

аааа (c) Cleaned and maintained to prevent:

аааа (i) Entrance of insects, rodents, birds, or other pests;

аааа (ii) Odors; and

аааа (iii) Other nuisances.

аааа (2) Assure garbage and waste containers are emptied frequently to prevent hazards and nuisances; and

аааа (3) Provide for safe and sanitary collection and disposal of:

аааа (a) Garbage and refuse;

аааа (b) Infectious waste; and

аааа (c) Waste grease from the kitchen.

[]

NEW SECTION
WAC 388-78A-2980 Lighting. (1) The boarding home must maintain electric light fixtures and lighting necessary for the comfort and safety of residents and for the activities of residents and staff.

аааа (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 N/A

Corridors, hallways, and stairways 30 N/A

Janitor's closet and utility rooms 30 N/A

Reading rooms 100 N/A

аааа (3) The boarding home must provide enough lighting in each resident's room to meet the resident's needs, preferences and choices.

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NEW SECTION
WAC 388-78A-2990 Heating-cooling -- Temperature. The boarding home must:

аааа (1) Equip each resident-occupied building with an approved heating system capable of maintaining a minimum temperature of 70░F per the building code. The boarding home must:

аааа (a) Maintain the boarding home at a minimum temperature of 60░F during sleeping hours; and

аааа (b) Maintain the boarding home at a minimum of 68░F during waking hours, except in rooms:

аааа (i) Designated for activities requiring physical exertion; or

аааа (ii) Where residents can individually control the temperature in their own living units, independent from other areas.

аааа (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;

аааа (3) Equip each boarding home issued a project number by construction review services on or after September 1, 2004, with a backup source of heat in enough common areas to keep all residents adequately warm during interruptions of normal heating operations;

аааа (4) Prohibit the use of portable space heaters unless approved in writing by the Washington state director of fire protection; and

аааа (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, 2004, with individual temperature controls located between thirty and forty-eight inches above the floor capable of maintaining room temperature plus or minus 3░F from setting, within a range of minimum 60░F to maximum 85░F.

[]

NEW SECTION
WAC 388-78A-3000 Ventilation. The boarding home must:

аааа (1) Ventilate rooms to:

аааа (a) Prevent excessive odors or moisture; and

аааа (b) Remove smoke.

аааа (2) Designate and ventilate smoking areas, if smoking is permitted in the boarding home, to prevent air contamination throughout the boarding home;

аааа (3) Provide intact sixteen mesh screens on operable windows and openings used for ventilation; and

аааа (4) Prohibit screens that may restrict or hinder escape or rescue through emergency exit openings.

[]

NEW SECTION
WAC 388-78A-3010 Resident room -- Room furnishings-storage. (1) The boarding home must ensure each resident has a sleeping room that has:

аааа (a) Eighty or more square feet of usable floor space in a one-person sleeping room;

аааа (b) Seventy or more square feet of usable floor space per individual in a sleeping room occupied by two or more individuals, except:

аааа (i) When a resident sleeping room is located within a private apartment; and

аааа (ii) The private apartment includes a resident sleeping room, a resident living room, and a private bathroom; and

аааа (iii) The total square footage in the private apartment equals or exceeds two hundred twenty square feet excluding the bathroom; and

аааа (iv) There are no more than two residents living in the apartment; and

аааа (v) Both residents mutually agree to share the resident sleeping room; and

аааа (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.

аааа (c) A maximum sleeping room occupancy of:

аааа (i) Four individuals if the boarding home was licensed before July 1, 1989, and licensed continuously thereafter; and

аааа (ii) Two individuals if the boarding home, after June 30, 1989:

аааа (A) Applied for initial licensure; or

аааа (B) Applied to increase the number of resident sleeping rooms; or

аааа (C) Applied to change the use of rooms into sleeping rooms.

аааа (d) Unrestricted direct access to a hallway, living room, outside, or other common-use area;

аааа (e) One or more outside windows with:

аааа (i) Window sills at or above grade, with grade extending horizontally ten or more feet from the building; and

аааа (ii) Adjustable curtains, shades, blinds, or equivalent for visual privacy.

аааа (f) One or more duplex electrical outlets per bed if the boarding home was initially licensed after July 1, 1983;

аааа (g) A light control switch located by the entrance for a light fixture in the room;

аааа (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;

аааа (i) In all boarding homes issued a project number by construction review services on or after September 1, 2004, and when requested by a resident in a boarding home licensed on or prior to September 1, 2004, provide a lockable drawer, cupboard or other secure space measuring at least one-half cubic foot with a minimum dimension of four inches;

аааа (j) Separate storage facilities for each resident in or immediately adjacent to the resident's sleeping room to adequately store a reasonable quantity of clothing and personal possessions;

аааа (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.

аааа (2) The boarding home must ensure each resident sleeping room contains:

аааа (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:

аааа (i) Standard household bed;

аааа (ii) Studio couch;

аааа (iii) Hide-a-bed;

аааа (iv) Day bed; or

аааа (v) Water bed, if structurally and electrically safe.

аааа (b) A mattress for each bed which:

аааа (i) Fits the bed frame;

аааа (ii) Is in good condition; and

аааа (iii) Is at least four inches thick unless otherwise requested or necessary for resident health or safety.

аааа (c) One or more comfortable pillows for each resident;

аааа (d) Bedding for each bed, in good repair; and

аааа (e) Lighting at the resident's bedside when requested by the resident.

аааа (3) The boarding home must not allow a resident sleeping room to be used as a passageway or corridor.

аааа (4) The boarding home may use or allow use of carpets and other floor coverings only when the carpet is:

аааа (a) Securely fastened to the floor or provided with nonskid backing; and

аааа (b) Kept clean and free of hazards, such as curling edges or tattered sections.

аааа (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.

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NEW SECTION
WAC 388-78A-3020 Calculating floor space. Usable floor space in a resident's sleeping room is calculated by measuring from interior wall surface to interior wall surface:

аааа (1) Including:

аааа (a) Areas under moveable furniture; and

аааа (b) Areas of door swings and entryways into the sleeping room.

аааа (2) Excluding:

аааа (a) Areas under ceilings less than seven feet six inches high;

аааа (b) Closet space and built-in storage;

аааа (c) Areas under counters, sinks, or appliances; and

аааа (d) Bathrooms and toilet rooms.

[]

NEW SECTION
WAC 388-78A-3030 Toilet rooms and bathrooms. (1) The boarding home must provide private or common-use toilet rooms and bathrooms to meet the needs of each resident.

аааа (2) The boarding home must provide each toilet room and bathroom with:

аааа (a) Water resistant, smooth, low gloss, nonslip and easily cleanable materials;

аааа (b) Washable walls to the height of splash or spray;

аааа (c) Grab bars installed and located to minimize accidental falls including one or more grab bars at each:

аааа (i) Bathing fixture; and

аааа (ii) Toilet.

аааа (d) Plumbing fixtures designed for easy use and cleaning and kept in good repair; and

аааа (e) Adequate ventilation to the outside of the boarding home. For boarding homes issued a project number by construction review services (CRS) on or after September 1, 2004, must provide mechanical ventilation to the outside.

аааа (3) The boarding home must provide each toilet room with a:

аааа (a) Toilet with a clean, nonabsorbent seat free of cracks;

аааа (b) Handwashing sink in or adjacent to the toilet room. For boarding homes issued a project number by construction review services on or after September 1, 2004, the handwashing 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

аааа (c) Suitable mirror with adequate lighting for general illumination.

аааа (4) For boarding homes approved for construction or initially licensed after August 1, 1994, the boarding home must provide a toilet and handwashing sink in, or adjoining, each bathroom.

аааа (5) When providing common-use toilet rooms and bathrooms, the boarding home must provide toilets and handwashing sinks for residents in the ratios of one toilet and one handwashing sink for every eight residents or fraction as listed in the following table:

Number of Residents Number of Toilets* Number of Handwashing 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.

аааа (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 or fraction thereof 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

аааа (7) When providing common-use toilet rooms and bathrooms, the boarding home must:

аааа (a) Designate toilet rooms containing more than one toilet for use by men or women;

аааа (b) Designate bathrooms containing more than one bathing fixture for use by men or women;

аааа (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;

аааа (d) Provide a handwashing 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;

аааа (e) Provide reasonable access to bathrooms and toilet rooms for each resident by:

аааа (i) Locating a toilet room on the same floor or level as the sleeping room of the resident served;

аааа (ii) Locating a bathroom on the same floor or level, or adjacent floor or level, as the sleeping room of the resident served; and

аааа (iii) Providing access without passage through any kitchen, pantry, food preparation, food storage, or dishwashing area, or from one bedroom through another bedroom.

аааа (8) In boarding homes issued a project number by construction review services on or after September 1, 2004, the boarding home must ensure fifty percent of all the bathing fixtures in the boarding home are roll-in type showers that have:

аааа (a) One-half inch or less threshold;

аааа (b) A minimum size of thirty-six inches by forty-eight inches; and

аааа (c) Single lever faucets located within thirty-six inches of the seat so the faucets are within reach of persons seated in the shower.

[]

NEW SECTION
WAC 388-78A-3040 Laundry. (1) The boarding home must provide laundry and linen services on the premises, or by commercial laundry.

аааа (2) The boarding home must handle, clean, and store linen according to acceptable methods of infection control. The boarding home must:

аааа (a) Provide separate areas for handling clean laundry and soiled laundry;

аааа (b) Ensure clean laundry is not processed in, and does not pass through, areas where soiled laundry is handled;

аааа (c) Ensure areas where clean laundry is stored are not exposed to contamination from other sources; and

аааа (d) Ensure all staff wears gloves and uses other appropriate infection control practices when handling soiled laundry.

аааа (3) The boarding home must use washing machines that have a continuous supply of hot water with a temperature of 140░F measured at the washing machine intake, or that automatically dispense a chemical sanitizer as specified by the manufacturer, whenever the boarding home washes:

аааа (a) Boarding home laundry;

аааа (b) Boarding home laundry combined with residents' laundry into a single load; or

аааа (c) More than one resident's laundry combined into a single load.

аааа (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.

аааа (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.

аааа (6) The boarding home must locate laundry equipment in rooms other than those used for open food storage, food preparation or food service.

аааа (7) For all boarding homes issued a project number by construction review services on or after September 1, 2004, the boarding home must provide a laundry area where residents' may do their personal laundry that is:

аааа (a) Equipped with:

аааа (i) A utility sink;

аааа (ii) A table or counter for folding clean laundry;

аааа (iii) At least one washing machine and one clothes dryer; and

аааа (iv) Mechanical ventilation to the outside of the boarding home.

аааа (b) Is arranged to reduce the chances of soiled laundry contaminating clean laundry.

аааа (8) The boarding home may combine areas for soiled laundry with other areas when consistent with WAC 388-78A-3110.

аааа (9) The boarding home may combine areas for handling and storing clean laundry with other areas when consistent with WAC 388-78A-3120.

[]

NEW SECTION
WAC 388-78A-3050 Day rooms. (1) The boarding home must provide one or more day room areas in which residents may participate in social and recreational activities. Day room areas include, but are not limited to:

аааа (a) Solariums;

аааа (b) Enclosed sun porches;

аааа (c) Recreation rooms;

аааа (d) Dining rooms; and

аааа (e) Living rooms.

аааа (2) The boarding home must provide a total minimum floor space for day room areas of:

аааа (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

аааа (b) One hundred fifty square feet, or twenty square feet per resident, whichever is larger, in boarding homes licensed after December 31, 1988.

аааа (3) The boarding home must provide day room areas with comfortable furniture and furnishings that meet the residents' needs.

[]

NEW SECTION
WAC 388-78A-3060 Storage space. The boarding home must:

аааа (1) Provide adequate storage space for supplies, equipment and linens;

аааа (2) Provide separate, locked storage for disinfectants and poisonous compounds; and

аааа (3) Maintain storage space to prevent fire or safety hazards.

[]

NEW SECTION
WAC 388-78A-3070 Stairs -- Ramps. The boarding home must maintain nonskid surfaces on all stairways and ramps used by residents.

[]

NEW SECTION
WAC 388-78A-3080 Guardrails -- Handrails. (1) The boarding home must install and maintain sturdy handrails according to building code requirements, located:

аааа (a) In halls and corridors, if necessary for resident safety;

аааа (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

аааа (c) On each side of interior and exterior ramps with slopes greater than one to twenty.

аааа (2) The boarding home must install guardrails if the department determines guardrails are necessary for resident safety.

[]

NEW SECTION
WAC 388-78A-3090 Maintenance and housekeeping. (1) The boarding home must:

аааа (a) Provide a safe, sanitary and well maintained environment for residents;

аааа (b) Keep exterior grounds, boarding home structure, and component parts safe, sanitary and in good repair;

аааа (c) Keep facilities, equipment and furnishings clean and in good repair;

аааа (d) Ensure each resident or staff person maintains the resident's quarters in a safe and sanitary condition; and

аааа (e) Equip a housekeeping supply area on the premises with:

аааа (i) A utility sink or equivalent means of obtaining and disposing of mop water, separate from food preparation and service areas;

аааа (ii) Storage for wet mops, ventilated to the outside of the boarding home; and

аааа (iii) Locked storage for cleaning supplies.

аааа (2) For boarding homes issued a project number by construction review services on or after September 1, 2004, the boarding home must provide housekeeping supply room(s):

аааа (a) Located on each floor of the boarding home;

аааа (b) In proximity to laundry and kitchen areas; and

аааа (c) Equipped with:

аааа (i) A utility sink or equivalent means of obtaining and disposing of mop water, away from food preparation and service areas;

аааа (ii) Storage for wet mops;

аааа (iii) Locked storage for cleaning supplies; and

аааа (iv) Mechanical ventilation to the outside of the boarding home.

[]

NEW SECTION
WAC 388-78A-3100 Safe storage of supplies and equipment. The boarding home must secure potentially hazardous supplies and equipment commensurate with the assessed needs of residents and their functional and cognitive abilities. In determining what supplies and equipment may be accessible to residents, the boarding home must consider at a minimum:

аааа (1) The residents' characteristics and needs;

аааа (2) The degree of hazardousness or toxicity posed by the supplies or equipment;

аааа (3) Whether or not the supplies and equipment are commonly found in a private home, such as hand soap or laundry detergent; and

аааа (4) How residents with special needs are individually protected without unnecessary restrictions on the general population.

[]

NEW SECTION
WAC 388-78A-3110 Areas for cleaning and storing soiled equipment, supplies and laundry. (1) The boarding home may combine areas used for storing, handling and cleaning soiled laundry and linens, areas used for cleaning and disinfecting soiled nursing care equipment, areas for disposing of refuse and infectious waste, and/or areas for storing housekeeping and cleaning supplies, into a single area on the premises only when the boarding home equips the area with:

аааа (a) A two-compartment sink for handwashing and sanitizing;

аааа (b) A clinical service sink or equivalent for rinsing and disposing of waste material;

аааа (c) A work counter or table;

аааа (d) Mechanical ventilation to the outside of the boarding home; and

аааа (e) Locked storage for cleaning supplies, if stored in the area.

аааа (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:

аааа (a) Storing or handling clean or sterile nursing supplies or equipment;

аааа (b) Storing or handling clean laundry;

аааа (c) Providing resident care;

аааа (d) Food storage, preparation, or service; or

аааа (e) Other operations, services of functions in the boarding home sensitive to infection control practices.

[]

NEW SECTION
WAC 388-78A-3120 Areas for handling and storing clean supplies and equipment. The boarding home may combine areas used for handling and storing clean laundry, and areas used for storing, preparing and handling clean and sterile nursing supplies, equipment and medications, into a single area on the premises only when the boarding home:

аааа (1) Equips the area with:

аааа (a) A handwashing sink; and

аааа (b) A work counter or table.

аааа (2) Ensures that any work or function performed in the area is performed without significant risk of contamination from other sources; and

аааа (3) Stores medications separate from all other stored items consistent with WAC 388-78A-2260.

[]

NEW SECTION
WAC 388-78A-3130 Plant restrictions. The boarding home must not use poisonous or toxic plants in areas of the boarding home premises accessible to residents who, based on their diagnosed condition or cognitive disabilities, may ingest or have harmful contact with such plants.

[]

Inspections, Enforcement Remedies, and Appeals
NEW SECTION
WAC 388-78A-3140 Responsibilities during inspections. The boarding home must:

аааа (1) Cooperate with the department during any on-site inspection or complaint investigation;

аааа (2) Provide requested records to the representatives of the department; and

аааа (3) 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.

[]

NEW SECTION
WAC 388-78A-3150 Statements of deficiencies and plans of correction. (1) The department must give the administrator or the administrator's designee a written statement of deficiencies specifying any violations of chapter 18.20 or 70.129 RCW or this chapter that the department found during on-site inspections and complaint investigations.

аааа (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:

аааа (a) A specific plan of what will be or was done to correct the violation;

аааа (b) A description of what will be done to prevent future violations of this type;

аааа (c) Who will be responsible for monitoring the corrections to ensure the violations do not recur; and

аааа (d) The date by which lasting correction will be achieved.

[]

NEW SECTION
WAC 388-78A-3160 Authorized enforcement remedies. (1) Whenever the circumstances in WAC 388-78A-3170(1) are present, the department may impose any enforcement remedy authorized by RCW 18.20.050(4), 18.20.185(7) and 18.20.190 on a boarding home, including, without limitation:

аааа (a) Denying a boarding home license;

аааа (b) Suspending a boarding home license;

аааа (c) Revoking a boarding home license;

аааа (d) Refusing to renew a boarding home license;

аааа (e) Suspending admissions to a boarding home;

аааа (f) Suspending admissions to a boarding home of a specific category or categories of residents as related to cited violations;

аааа (g) Imposing conditions on the boarding home license; and/or

аааа (h) Imposing civil penalties of not more than one hundred dollars per day per violation per resident.

аааа (2) Notwithstanding subsection (1) of this section, the department may impose a civil penalty on a boarding home of up to three thousand dollars per day per violation for interference, coercion, discrimination and/or reprisal by a boarding home as set forth in RCW 18.20.185(7).

[]

NEW SECTION
WAC 388-78A-3170 Statutory circumstances resulting in discretionary enforcement remedies. (1) Enforcement remedies described in WAC 388-78A-3160 may be imposed if any person or entity described in subsection (2) of this section is found by the department to have:

аааа (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:

аааа (i) Citations for violation of regulations imposed by regulating entities;

аааа (ii) Sanctions for violation of regulations imposed by regulating entities;

аааа (iii) Involuntary termination, cancellation, suspension, or nonrenewal 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;

аааа (iv) Being denied a license relating to the care of frail elders, vulnerable adults or children; or

аааа (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.

аааа (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;

аааа (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;

аааа (d) Failed or refused to comply with the requirements of chapter 18.20 RCW, applicable provisions of chapter 70.129 RCW or this chapter;

аааа (e) Retaliated against a staff person, resident or other individual for:

аааа (i) Reporting suspected abuse or other alleged improprieties;

аааа (ii) Providing information to the department during the course of the department conducting an inspection of the boarding home; or

аааа (iii) Providing information to the department during the course of the department conducting a complaint investigation in the boarding home.

аааа (f) Operated a facility for the care of children or adults without a current, valid license or under a defunct or revoked license;

аааа (g) Been convicted of a crime, knowingly 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;

аааа (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;

аааа (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;

аааа (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;

аааа (k) Willfully prevented or interfered with or attempted to impede in any way any inspection or investigation by the department, or the work of any authorized representative of the department or the lawful enforcement of any provision of this chapter;

аааа (l) Refused to allow department representatives or agents to examine any part of the licensed premises including the books, records and files required under this chapter;

аааа (m) Moved all residents out of the boarding home without the department's approval and is no longer operating as a boarding home; or

аааа (n) Demonstrated any other factors that give evidence the applicant lacks the appropriate character, suitability and competence to provide care or services to vulnerable adults.

аааа (2) This section applies to any boarding home:

аааа (a) Applicant;

аааа (b) Partner, officer or director;

аааа (c) Manager or managerial employee; or

аааа (d) Majority owner of the entity applicant or licensee:

аааа (i) Who is involved in the management or operation of the boarding home;

аааа (ii) Who may have direct access to boarding home residents;

аааа (iii) Who controls or supervises the provision of care or services to boarding home residents; or

аааа (iv) Who exercises control over daily operations of the boarding home.

аааа (3) For other circumstances resulting in discretionary enforcement remedies, see WAC 388-78A-3200.

[]

NEW SECTION
WAC 388-78A-3180 Circumstances resulting in required enforcement remedies. The department must impose an appropriate remedy consistent with RCW 18.20.125 and as otherwise authorized by RCW 18.20.185 or 18.20.190 whenever the department finds a boarding home has:

аааа (1) A serious problem, a recurring problem, or an uncorrected problem;

аааа (2) Created a hazard that causes or is likely to cause death or serious harm to one or more residents;

аааа (3) 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

аааа (4) Willfully interfered with the performance of official duties by a long-term care ombudsman.

[]

NEW SECTION
WAC 388-78A-3190 Statutorily required enforcement remedies; denial, suspension, revocation, or nonrenewal of license. (1) The department must deny, suspend, revoke or refuse to renew a boarding home license if any person or entity described in subsection (2) of this section who has unsupervised access to residents, is:

аааа (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

аааа (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

аааа (c) Found in any dependency action under chapter 13.34 RCW to have sexually assaulted, neglected, exploited, or physically abused any minor; or

аааа (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

аааа (e) 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.

аааа (2) This section applies to any boarding home:

аааа (a) Applicant;

аааа (b) Partner, officer or director;

аааа (c) Manager or managerial employee; or

аааа (d) Owner of five percent or more of the entity applicant:

аааа (i) Who is involved in the operation of the boarding home; or

аааа (ii) Who may have direct access to the boarding home residents; or

аааа (iii) Who controls or supervises the provision of care or services to the boarding home residents; or

аааа (iv) Who exercises control over daily operations.

[]

NEW SECTION
WAC 388-78A-3200 Other circumstances resulting in discretionary enforcement remedies. (1) When the department cites a boarding home for an initial violation that does not represent a recurring problem, serious problem or uncorrected problem, and that results in minimal or moderate harm that is limited in scope, the department may:

аааа (a) Require a plan of correction from the boarding home;

аааа (b) Impose conditions on the boarding home license; and/or

аааа (c) Impose a civil penalty.

аааа (2) The department may take any of the actions specified in subsection (1) of this section and/or impose a stop-placement or limited stop-placement on a boarding home when:

аааа (a) There is a reasonable probability, at the time the stop-placement or limited stop-placement is imposed, 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

аааа (b) The threatening problem is more than an isolated event or occurrence.

аааа (3) The department may take any of the actions specified in subsections (1) and (2) of this section and/or summarily suspend a boarding home's license when:

аааа (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

аааа (b) The threatening problem is more than an isolated event or occurrence.

аааа (4) The department may take any of the actions specified in subsections (1), (2) and (3) of this section and/or revoke a boarding home's license when:

аааа (a) The department has cause to summarily suspend the boarding home's license;

аааа (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;

аааа (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;

аааа (d) The boarding home has moved all residents out of the boarding home without the department's approval and is no longer operating as a boarding home; or

аааа (e) There is a serious current problem, which may not warrant a summary suspension, with the boarding home that does not have a history of noncompliance. Examples of the types of serious current problems that may warrant license revocation include, but are not limited to:

аааа (i) The licensee has been found or convicted by a court of competent jurisdiction to have engaged in fraudulent activity; or

аааа (ii) The licensee is experiencing significant financial problems resulting in poor care or jeopardizing the care and services that can be provided to residents, and possible business failure; or

аааа (f) The boarding home fails to cooperate with the department during any inspection or complaint investigation.

[]

NEW SECTION
WAC 388-78A-3210 Informal dispute resolution. The boarding home has a right to an informal dispute resolution meeting according to department procedure and consistent with RCW 18.20.195. The boarding home must make a request for an informal dispute resolution meeting in writing within ten days of the receipt of the written notice of deficiency.

[]

NEW SECTION
WAC 388-78A-3220 Appeal rights. (1) An applicant or boarding home may contest an enforcement remedy imposed by the department pursuant to RCW 18.20.190 according to the provisions of chapter 34.05 RCW and chapters 10-08 and 388-02 WAC.

аааа (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.

[]

NEW SECTION
WAC 388-78A-3230 Fees. The boarding home must:

аааа (1) Submit an annual license fee of seventy-nine dollars per bed of the licensed resident bed capacity as determined by and in accordance with RCW 18.20.050;

аааа (2) Submit an additional one hundred fifty dollars when billed by the department for:

аааа (a) A third on-site visit required by the boarding home's failure to adequately correct violations identified in a statement of deficiencies; and

аааа (b) A full out-of-sequence inspection resulting from information gathered during a complaint investigation.

аааа (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

аааа (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.

[]

REPEALER

The following sections of the Washington Administrative Code are repealed:

WAC 388-78A-0010 Purpose.

WAC 388-78A-0020 Definitions.

WAC 388-78A-0030 Applicability.

WAC 388-78A-0040 Other requirements.

WAC 388-78A-0050 Resident characteristics.

WAC 388-78A-0060 Individuals in buildings prior to licensing.

WAC 388-78A-0070 Initial assessment.

WAC 388-78A-0080 Timing of initial assessment.

WAC 388-78A-0090 Qualified assessor.

WAC 388-78A-0100 Assessment topics.

WAC 388-78A-0110 On-going assessments.

WAC 388-78A-0120 Resident participation in assessments.

WAC 388-78A-0130 Service agreement planning.

WAC 388-78A-0140 Negotiated service agreement contents.

WAC 388-78A-0150 Signing negotiated service agreement.

WAC 388-78A-0160 Basic boarding home services.

WAC 388-78A-0170 Activities.

WAC 388-78A-0180 Medication services.

WAC 388-78A-0190 Prescribed medication authorizations.

WAC 388-78A-0200 Medication refusal.

WAC 388-78A-0210 Nonavailability of medications.

WAC 388-78A-0220 Alteration of medications.

WAC 388-78A-0230 Storing, securing, and accounting for medications.

WAC 388-78A-0240 Resident controlled medications.

WAC 388-78A-0250 Medication organizers.

WAC 388-78A-0260 Family assistance with medication.

WAC 388-78A-0270 Food and nutrition services.

WAC 388-78A-0280 Need to provide nursing services.

WAC 388-78A-0290 Tube feeding.

WAC 388-78A-0300 Supervision of nursing services.

WAC 388-78A-0310 Responsibilities of nursing supervisor.

WAC 388-78A-0320 Resident-arranged services.

WAC 388-78A-0330 Coordination of health care services.

WAC 388-78A-0340 Implementation of negotiated service agreement.

WAC 388-78A-0350 Monitoring residents' well-being.

WAC 388-78A-0360 Adult day care.

WAC 388-78A-0370 Dementia care.

WAC 388-78A-0380 Restricted egress.

WAC 388-78A-0390 Resident records.

WAC 388-78A-0400 Protection of resident records.

WAC 388-78A-0410 Content of resident records.

WAC 388-78A-0420 Format of resident records.

WAC 388-78A-0430 Record retention.

WAC 388-78A-0440 Resident review of records.

WAC 388-78A-0450 Resident register.

WAC 388-78A-0460 Staff.

WAC 388-78A-0470 Criminal history background checks.

WAC 388-78A-0480 TB tests.

WAC 388-78A-0490 Specialized training for developmental disabilities.

WAC 388-78A-0500 Specialized training for mental illness.

WAC 388-78A-0510 Specialized training for dementia.

WAC 388-78A-0520 Administrator qualifications.

WAC 388-78A-0530 Qualifying administrator training program.

WAC 388-78A-0540 Administrator training requirements.

WAC 388-78A-0550 Administrator training documentation.

WAC 388-78A-0560 Administrator responsibilities.

WAC 388-78A-0570 Notification of change in administrator.

WAC 388-78A-0580 Use of home health/home care.

WAC 388-78A-0590 Management agreements.

WAC 388-78A-0600 Policies and procedures.

WAC 388-78A-0605 Pets.

WAC 388-78A-0610 Infection control.

WAC 388-78A-0620 Reporting abuse and neglect.

WAC 388-78A-0630 Reporting significant change in a resident's condition.

WAC 388-78A-0635 Reporting fires and incidents.

WAC 388-78A-0640 Resident rights.

WAC 388-78A-0650 Services by resident for boarding home.

WAC 388-78A-0660 Boarding home use of audio and video monitoring.

WAC 388-78A-0670 Resident use of electronic monitoring.

WAC 388-78A-0680 Safety measures and disaster preparedness.

WAC 388-78A-0690 Disclosure of services.

WAC 388-78A-0700 Timing of disclosure.

WAC 388-78A-0710 Licensee qualifications.

WAC 388-78A-0720 Necessary information.

WAC 388-78A-0730 Application process.

WAC 388-78A-0740 Requirements to change boarding home licensee.

WAC 388-78A-0750 Annual renewal.

WAC 388-78A-0760 Licensee's responsibilities.

WAC 388-78A-0770 Change in licensee.

WAC 388-78A-0780 Changes in licensed bed capacity.

WAC 388-78A-0790 Criteria for increasing licensed bed capacity.

WAC 388-78A-0800 Building requirements and exemptions.

WAC 388-78A-0810 Conversion of licensed nursing homes.

WAC 388-78A-0820 Licenses for multiple buildings.

WAC 388-78A-0830 Required reviews of building plans.

WAC 388-78A-0840 Relocation of residents during construction.

WAC 388-78A-0850 Vacant buildings.

WAC 388-78A-0860 Changing use of rooms.

WAC 388-78A-0870 Time frame for approval.

WAC 388-78A-0880 Retention of approved construction documents.

WAC 388-78A-0890 Applicable building codes.

WAC 388-78A-0900 Area for nursing supplies and equipment.

WAC 388-78A-0910 Communication system.

WAC 388-78A-0920 Two-way intercom systems.

WAC 388-78A-0930 Water supply.

WAC 388-78A-0940 Sewage and liquid waste disposal.

WAC 388-78A-0950 Garbage and refuse disposal.

WAC 388-78A-0960 Lighting.

WAC 388-78A-0970 Heating-cooling -- Temperature.

WAC 388-78A-0980 Ventilation.

WAC 388-78A-0990 Resident room -- Room furnishings-storage.

WAC 388-78A-1000 Calculating floor space.

WAC 388-78A-1010 Toilet rooms and bathrooms.

WAC 388-78A-1020 Laundry.

WAC 388-78A-1030 Day rooms.

WAC 388-78A-1040 Storage space.

WAC 388-78A-1050 Stairs -- Ramps.

WAC 388-78A-1060 Guardrails -- Handrails.

WAC 388-78A-1070 Maintenance and housekeeping.

WAC 388-78A-1080 Safe storage of supplies and equipment.

WAC 388-78A-1090 Areas for cleaning and storing soiled equipment, supplies and laundry.

WAC 388-78A-1100 Areas for handling and storing clean supplies and equipment.

WAC 388-78A-1110 Plant restrictions.

WAC 388-78A-1120 Responsibilities during inspections.

WAC 388-78A-1130 Communication during inspections.

WAC 388-78A-1140 Communication following inspections.

WAC 388-78A-1150 Statements of deficiencies and plans of correction.

WAC 388-78A-1160 Authorized enforcement remedies.

WAC 388-78A-1170 Statutory circumstances resulting in discretionary enforcement remedies.

WAC 388-78A-1180 Circumstances resulting in required enforcement remedies.

WAC 388-78A-1190 Statutorily required enforcement remedies; denial, suspension, revocation, or nonrenewal of license.

WAC 388-78A-1200 Other circumstances resulting in discretionary enforcement remedies.

WAC 388-78A-1210 Informal dispute resolution.

WAC 388-78A-1220 Appeal rights.

WAC 388-78A-1230 Fees.

Legislature

Code Reviser

Register

Х	Repeal all existing sections in chapter 388-78A WAC adopted under WSR 03-16-047, and replace them with new sections.
Х	Clarify and strengthen the assessment and care planning requirements for residents in boarding homes.
Х	Outline the minimum level of support all boarding homes must provide to the residents.
Х	Clarify and strengthen the nursing, medication and other health support services available to residents in boarding homes.
Х	Identify when specialized training for developmental disabilities, mental illness, and dementia is required in boarding homes in accordance with chapter 18.20 RCW and chapter 388-112 WAC.
Х	Improve the requirements for boarding home administrators.
Х	Revise all sections to make the requirements easier to understand.

Х	Repealing all sections in chapter 388-78A WAC adopted under WSR 03-16-047, and replacing them with new sections.
Х	Specifying when a boarding home license is and is not required.
Х	Specifying the characteristics of persons that boarding homes may accept and retain in the boarding home.
Х	Specifying the content and timing of preadmission resident assessments and full reassessments.
Х	Specifying who is qualified to complete the preadmission assessment.
Х	Specifying the process of developing negotiated service agreements for residents, including the timing and content of these agreements.
Х	Specifying the requirements for implementing negotiated service agreements and monitoring residents' well-being.
Х	Specifying the required services a boarding home must provide.
Х	Identifying the optional domiciliary care services a boarding home may provide, and the minimum level of assistance with activities of daily living a boarding home must provide if it chooses to provide assistance with activities of daily living.
Х	Specifying the requirements for medication assistance and medication administration, and storing and accounting for medications.
Х	Specifying the requirements for families providing medication assistance to residents.
Х	Specifying the requirements for food services and therapeutic diets.
Х	Specifying the requirements associated with providing nursing services.
Х	Specifying the requirements concerning resident-arranged services with providers external to the boarding home.
Х	Specifying the requirements for coordinating services with providers external to the boarding home.
Х	Specifying the requirements for providing adult day care and dementia care, and the requirements for operating a unit with restricted egress.
Х	Specifying the requirements associated with documenting resident care, and maintaining records regarding residents' care.
Х	Specifying the requirements for hiring and training sufficient staff for the boarding home, including requirements for criminal history background checks and testing for tuberculosis.
Х	Specifying the training requirements for staff.
Х	Specifying the qualifications and training requirements for boarding home administrators.
Х	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.
Х	Specifying resident rights in boarding homes.
Х	Specifying requirements for disaster preparedness and disclosing available services.
Х	Specifying the requirements for obtaining a boarding home license and the procedures for application.
Х	Specifying the licensee's responsibilities in a boarding home.
Х	Specifying the requirements for the building to be used as a boarding home.
Х	Specifying the rights and responsibilities of the boarding home during the inspection process.
Х	Specifying the enforcement actions the department may take in response to a boarding home's noncompliance with rules, and the boarding home's appeal rights.

Х	Repeal all sections in chapter 388-78A WAC filed under WSR 03-16-047 (effective September 1, 2004) in response to the needs of department clients.
Х	Adopt revised sections in chapter 388-78A WAC that are consistent with chapter 18.20 RCW as amended by SSB 5733, 6160 and 6225 passed by the 2004 legislature, which address the following issues:

&lhlsqbul;	Revised assessment requirements;
&lhlsqbul;	Revised requirements for initial resident service plans, and negotiated service agreements;
&lhlsqbul;	Required basic services;
&lhlsqbul;	Assuming general responsibility for the safety and well-being of residents;
&lhlsqbul;	Optional domiciliary care services including:

&sqbul;	Assistance with activities of daily living;
&sqbul;	Health support services; and
&sqbul;	Intermittent nursing services;

&lhlsqbul;	Disclosing available services to residents and their representatives;
&lhlsqbul;	Family assistance with medications;
&lhlsqbul;	Resident-arranged services with health care practitioners, home health and home care agencies, and hospice agencies; and
&lhlsqbul;	When a boarding home license is and is not required.

Х	Provision of nursing services and health care supports;
Х	The process of assessing residents' needs;
Х	Boarding homes disclosing to the public the services they provide;
Х	Administrative issues in the boarding home;
Х	Provision of care to persons with dementia;
Х	Enforcement issues;
Х	The building and physical environment; and
Х	Miscellaneous issues including the basic services that should be required in a boarding home.

Х	Subsection (2)(a) regarding what to do when a resident is not capable of making necessary decisions;
Х	Subsection (2)(b) regarding what to do when a substitute decision maker is no longer appropriate;
Х	Subsection (2)(d) regarding what to do when a resident does not have a personal physician;
Х	Subsection (2)(n) regarding the safe operation of boarding home vehicles;
Х	Subsection (2)(o) regarding coordinating services and sharing resident information;
Х	Subsection (2)(q) regarding receiving and responding to resident grievances.

AVERAGE MAINTAINED FOOTCANDLES
Area	Ambient Light	Task Light
Toilet, bathing and laundry facilities	30	50
Dining/day rooms	50	N/A
Corridors, hallways, and stairways	30	N/A
Janitor's closet and utility rooms	30	N/A
Reading rooms	100	N/A

Number of Residents	Number of Toilets*	Number of Handwashing 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

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

WAC 388-78A-0010	Purpose.
WAC 388-78A-0020	Definitions.
WAC 388-78A-0030	Applicability.
WAC 388-78A-0040	Other requirements.
WAC 388-78A-0050	Resident characteristics.
WAC 388-78A-0060	Individuals in buildings prior to licensing.
WAC 388-78A-0070	Initial assessment.
WAC 388-78A-0080	Timing of initial assessment.
WAC 388-78A-0090	Qualified assessor.
WAC 388-78A-0100	Assessment topics.
WAC 388-78A-0110	On-going assessments.
WAC 388-78A-0120	Resident participation in assessments.
WAC 388-78A-0130	Service agreement planning.
WAC 388-78A-0140	Negotiated service agreement contents.
WAC 388-78A-0150	Signing negotiated service agreement.
WAC 388-78A-0160	Basic boarding home services.
WAC 388-78A-0170	Activities.
WAC 388-78A-0180	Medication services.
WAC 388-78A-0190	Prescribed medication authorizations.
WAC 388-78A-0200	Medication refusal.
WAC 388-78A-0210	Nonavailability of medications.
WAC 388-78A-0220	Alteration of medications.
WAC 388-78A-0230	Storing, securing, and accounting for medications.
WAC 388-78A-0240	Resident controlled medications.
WAC 388-78A-0250	Medication organizers.
WAC 388-78A-0260	Family assistance with medication.
WAC 388-78A-0270	Food and nutrition services.
WAC 388-78A-0280	Need to provide nursing services.
WAC 388-78A-0290	Tube feeding.
WAC 388-78A-0300	Supervision of nursing services.
WAC 388-78A-0310	Responsibilities of nursing supervisor.
WAC 388-78A-0320	Resident-arranged services.
WAC 388-78A-0330	Coordination of health care services.
WAC 388-78A-0340	Implementation of negotiated service agreement.
WAC 388-78A-0350	Monitoring residents' well-being.
WAC 388-78A-0360	Adult day care.
WAC 388-78A-0370	Dementia care.
WAC 388-78A-0380	Restricted egress.
WAC 388-78A-0390	Resident records.
WAC 388-78A-0400	Protection of resident records.
WAC 388-78A-0410	Content of resident records.
WAC 388-78A-0420	Format of resident records.
WAC 388-78A-0430	Record retention.
WAC 388-78A-0440	Resident review of records.
WAC 388-78A-0450	Resident register.
WAC 388-78A-0460	Staff.
WAC 388-78A-0470	Criminal history background checks.
WAC 388-78A-0480	TB tests.
WAC 388-78A-0490	Specialized training for developmental disabilities.
WAC 388-78A-0500	Specialized training for mental illness.
WAC 388-78A-0510	Specialized training for dementia.
WAC 388-78A-0520	Administrator qualifications.
WAC 388-78A-0530	Qualifying administrator training program.
WAC 388-78A-0540	Administrator training requirements.
WAC 388-78A-0550	Administrator training documentation.
WAC 388-78A-0560	Administrator responsibilities.
WAC 388-78A-0570	Notification of change in administrator.
WAC 388-78A-0580	Use of home health/home care.
WAC 388-78A-0590	Management agreements.
WAC 388-78A-0600	Policies and procedures.
WAC 388-78A-0605	Pets.
WAC 388-78A-0610	Infection control.
WAC 388-78A-0620	Reporting abuse and neglect.
WAC 388-78A-0630	Reporting significant change in a resident's condition.
WAC 388-78A-0635	Reporting fires and incidents.
WAC 388-78A-0640	Resident rights.
WAC 388-78A-0650	Services by resident for boarding home.
WAC 388-78A-0660	Boarding home use of audio and video monitoring.
WAC 388-78A-0670	Resident use of electronic monitoring.
WAC 388-78A-0680	Safety measures and disaster preparedness.
WAC 388-78A-0690	Disclosure of services.
WAC 388-78A-0700	Timing of disclosure.
WAC 388-78A-0710	Licensee qualifications.
WAC 388-78A-0720	Necessary information.
WAC 388-78A-0730	Application process.
WAC 388-78A-0740	Requirements to change boarding home licensee.
WAC 388-78A-0750	Annual renewal.
WAC 388-78A-0760	Licensee's responsibilities.
WAC 388-78A-0770	Change in licensee.
WAC 388-78A-0780	Changes in licensed bed capacity.
WAC 388-78A-0790	Criteria for increasing licensed bed capacity.
WAC 388-78A-0800	Building requirements and exemptions.
WAC 388-78A-0810	Conversion of licensed nursing homes.
WAC 388-78A-0820	Licenses for multiple buildings.
WAC 388-78A-0830	Required reviews of building plans.
WAC 388-78A-0840	Relocation of residents during construction.
WAC 388-78A-0850	Vacant buildings.
WAC 388-78A-0860	Changing use of rooms.
WAC 388-78A-0870	Time frame for approval.
WAC 388-78A-0880	Retention of approved construction documents.
WAC 388-78A-0890	Applicable building codes.
WAC 388-78A-0900	Area for nursing supplies and equipment.
WAC 388-78A-0910	Communication system.
WAC 388-78A-0920	Two-way intercom systems.
WAC 388-78A-0930	Water supply.
WAC 388-78A-0940	Sewage and liquid waste disposal.
WAC 388-78A-0950	Garbage and refuse disposal.
WAC 388-78A-0960	Lighting.
WAC 388-78A-0970	Heating-cooling -- Temperature.
WAC 388-78A-0980	Ventilation.
WAC 388-78A-0990	Resident room -- Room furnishings-storage.
WAC 388-78A-1000	Calculating floor space.
WAC 388-78A-1010	Toilet rooms and bathrooms.
WAC 388-78A-1020	Laundry.
WAC 388-78A-1030	Day rooms.
WAC 388-78A-1040	Storage space.
WAC 388-78A-1050	Stairs -- Ramps.
WAC 388-78A-1060	Guardrails -- Handrails.
WAC 388-78A-1070	Maintenance and housekeeping.
WAC 388-78A-1080	Safe storage of supplies and equipment.
WAC 388-78A-1090	Areas for cleaning and storing soiled equipment, supplies and laundry.
WAC 388-78A-1100	Areas for handling and storing clean supplies and equipment.
WAC 388-78A-1110	Plant restrictions.
WAC 388-78A-1120	Responsibilities during inspections.
WAC 388-78A-1130	Communication during inspections.
WAC 388-78A-1140	Communication following inspections.
WAC 388-78A-1150	Statements of deficiencies and plans of correction.
WAC 388-78A-1160	Authorized enforcement remedies.
WAC 388-78A-1170	Statutory circumstances resulting in discretionary enforcement remedies.
WAC 388-78A-1180	Circumstances resulting in required enforcement remedies.
WAC 388-78A-1190	Statutorily required enforcement remedies; denial, suspension, revocation, or nonrenewal of license.
WAC 388-78A-1200	Other circumstances resulting in discretionary enforcement remedies.
WAC 388-78A-1210	Informal dispute resolution.
WAC 388-78A-1220	Appeal rights.
WAC 388-78A-1230	Fees.

й Washington State Code Reviser's Office