Purpose: 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, 6160 and 5733 adopted by the 2004 legislature, and to be responsive to the needs of department clients.

     Citation of Existing Rules Affected by this Order: Repealing WAC 388-78A-0010 Purpose, 388-78A-0020 Definitions, 388-78A-0030 Applicability, 388-78A-0040 Other requirements, 388-78A-0050 Resident characteristics, 388-78A-0060 Individuals in buildings prior to licensing, 388-78A-0070 Initial assessment, 388-78A-0080 Timing of initial assessment, 388-78A-0090 Qualified assessor, 388-78A-0100 Assessment topics, 388-78A-0110 On-going assessments, 388-78A-0120 Resident participation in assessments, 388-78A-0130 Service agreement planning, 388-78A-0140 Negotiated service agreement contents, 388-78A-0150 Signing negotiated service agreement, 388-78A-0160 Basic boarding home services, 388-78A-0170 Activities, 388-78A-0180 Medication services, 388-78A-0190 Prescribed medication authorizations, 388-78A-0200 Medication refusal, 388-78A-0210 Nonavailability of medications, 388-78A-0220 Alteration of medications, 388-78A-0230 Storing, securing, and accounting for medications, 388-78A-0240 Resident controlled medications, 388-78A-0250 Medication organizers, 388-78A-0260 Family assistance with medication, 388-78A-0270 Food and nutrition services, 388-78A-0280 Need to provide nursing services, 388-78A-0290 Tube feeding, 388-78A-0300 Supervision of nursing services, 388-78A-0310 Responsibilities of nursing supervisor, 388-78A-0320 Resident-arranged services, 388-78A-0330 Coordination of health care services, 388-78A-0340 Implementation of negotiated service agreement, 388-78A-0350 Monitoring residents' well-being, 388-78A-0360 Adult day care, 388-78A-0370 Dementia care, 388-78A-0380 Restricted egress, 388-78A-0390 Resident records, 388-78A-0400 Protection of resident records, 388-78A-0410 Content of resident records, 388-78A-0420 Format of resident records, 388-78A-0430 Record retention, 388-78A-0440 Resident review of records, 388-78A-0450 Resident register, 388-78A-0460 Staff, 388-78A-0470 Criminal history background checks, 388-78A-0480 TB tests, 388-78A-0490 Specialized training for developmental disabilities, 388-78A-0500 Specialized training for mental illness, 388-78A-0510 Specialized training for dementia, 388-78A-0520 Administrator qualifications, 388-78A-0530 Qualifying administrator training program, 388-78A-0540 Administrator training requirements, 388-78A-0550 Administrator training documentation, 388-78A-0560 Administrator responsibilities, 388-78A-0570 Notification of change in administrator, 388-78A-0580 Use of home health/home care, 388-78A-0590 Management agreements, 388-78A-0600 Policies and procedures, 388-78A-0605 Pets, 388-78A-0610 Infection control, 388-78A-0620 Reporting abuse and neglect, 388-78A-0630 Reporting significant change in a resident's condition, 388-78A-0635 Reporting fires and incidents, 388-78A-0640 Resident rights, 388-78A-0650 Services by resident for boarding home, 388-78A-0660 Boarding home use of audio and video monitoring, 388-78A-0670 Resident use of electronic monitoring, 388-78A-0680 Safety measures and disaster preparedness, 388-78A-0690 Disclosure of services, 388-78A-0700 Timing of disclosure, 388-78A-0710 Licensee qualifications, 388-78A-0720 Necessary information, 388-78A-0730 Application process, 388-78A-0740 Requirements to change boarding home licensee, 388-78A-0750 Annual renewal, 388-78A-0760 Licensee's responsibilities, 388-78A-0770 Change in licensee, 388-78A-0780 Changes in licensed bed capacity, 388-78A-0790 Criteria for increasing licensed bed capacity, 388-78A-0800 Building requirements and exemptions, 388-78A-0810 Conversion of licensed nursing homes, 388-78A-0820 Licenses for multiple buildings, 388-78A-0830 Required reviews of building plans, 388-78A-0840 Relocation of residents during construction, 388-78A-0850 Vacant buildings, 388-78A-0860 Changing use of rooms, 388-78A-0870 Time frame for approval, 388-78A-0880 Retention of approved construction documents, 388-78A-0890 Applicable building codes, 388-78A-0900 Area for nursing supplies and equipment, 388-78A-0910 Communication system, 388-78A-0920 Two-way intercom systems, 388-78A-0930 Water supply, 388-78A-0940 Sewage and liquid waste disposal, 388-78A-0950 Garbage and refuse disposal, 388-78A-0960 Lighting, 388-78A-0970 Heating-cooling -- Temperature, 388-78A-0980 Ventilation, 388-78A-0990 Resident room -- Room furnishings-storage, 388-78A-1000 Calculating floor space, 388-78A-1010 Toilet rooms and bathrooms, 388-78A-1020 Laundry, 388-78A-1030 Day rooms, 388-78A-1040 Storage space, 388-78A-1050 Stairs -- Ramps, 388-78A-1060 Guardrails -- Handrails, 388-78A-1070 Maintenance and housekeeping, 388-78A-1080 Safe storage of supplies and equipment, 388-78A-1090 Areas for cleaning and storing soiled equipment, supplies and laundry, 388-78A-1100 Areas for handling and storing clean supplies and equipment, 388-78A-1110 Plant restrictions, 388-78A-1120 Responsibilities during inspections, 388-78A-1130 Communication during inspections, 388-78A-1140 Communication following inspections, 388-78A-1150 Statements of deficiencies and plans of correction, 388-78A-1160 Authorized enforcement remedies, 388-78A-1170 Statutory circumstances resulting in discretionary enforcement remedies, 388-78A-1180 Circumstances resulting in required enforcement remedies, 388-78A-1190 Statutorily required enforcement remedies; denial, suspension, revocation, or nonrenewal of license, 388-78A-1200 Other circumstances resulting in discretionary enforcement remedies, 388-78A-1210 Informal dispute resolution, 388-78A-1220 Appeal rights, and 388-78A-1230 Fees.

     Statutory Authority for Adoption: RCW 18.20.090 (section 19, chapter 142, Laws of 2004).

     Other Authority: Chapter 18.20 RCW.

      Adopted under notice filed as WSR 04-11-116 on May 19, 2004.

     Changes Other than Editing from Proposed to Adopted Version: The following changes have been made to the proposed rule based upon suggestions and comments received, as well as technical and editing changes noted during the process.

WAC 388-78A-2020 Definitions.

•	The definition of "Medication service" has been added for clarity.
•	The definition of "resident applicant" has been replaced by "prospective resident" for clarity.

     The following definitions have been revised or clarified in response to suggestions or comments:

     Boarding home - added to the end of the definition for clarity, "'Boarding home' may also include persons associated with the boarding home to carry out its duties under this chapter.";

     Caregiver - revised to correctly reflect the definition in chapter 388-112 WAC;

     Document - technical edit replacing "impact" with "affect";

     Enforcement remedy - technical amendment;

     Licensed resident bed capacity - revised to reflect that roommates would not be included in licensed resident bed capacity;

     Majority owner - revised to delete reference to "entity" since "entity" is included in the revised definition of "person";

     Medication administration - replaced "person" with "individual";

     Medication service - new definition to clarify what medication service is - "Medication service" means any service provided either directly or indirectly by a boarding home related to medication administration, medication administration provided through nurse delegation, medication assistance, or resident self-administration of medication;

     Nonresident individual - replaced "person" with "individual";

     Over-the-counter (OTC) medications - definition revised to include examples of aspirin and antacids;

     Person - definition clarified to include "any other legal or commercial entity.";

     Recurring problem - clarified the codified statutory reference, technical change from "applying entity" to "applicant.";

     Prospective resident - changed definition from "resident applicant" to "prospective resident" to eliminate possible confusion between resident applicant and applicant;

     Reasonable accommodation/reasonably accommodate - definition revised for clarity;

     Resident - technical change, and deleted a sentence related to a service requirement that is specified in WAC 388-78A-2340;

     Resident applicant - deleted, see definition of prospective resident above;

     Resident's representative - revised to clarify limits on authority;

     Chemical restraint - technical change;

     Physical restraint - technical change;

     Staff person - reworded to clarify volunteers are employed or retained;

     State fire marshal - deleted unnecessary wording; and

     Vulnerable adult - reworded for clarity.

WAC 388-78A-2030 Applicability.

•	Renumbered subsection (3) as subsection (2)(h); and subsection (4) as subsection (3).

WAC 388-78A-2040 Other requirements.

•	Subsection (2) edited for clarity - deleted unnecessary wording.

WAC 388-78A-2050 Resident characteristics.

•	Lead in sentence added - "admit" for clarity;
•	Subsection (1) clarified "available" staff and added subsections (a) and (b) for clarity - including the scope and services criteria from the disclosure information requirement and separating out the reasonable accommodation language;
•	Subsection (2) edited for clarity - word "person" deleted and replaced with "individual"; and
•	Subsection (4) deleted as it was incorporated into subsection (1)(a).

WAC 388-78A-2060 Preadmission assessment.

•	Subsection (1) edited for clarity regarding defined term - made a lead in sentence;
•	Subsections (1)(a)-(h) renumbered accordingly to subsections (1) through (8); and
•	Subsection (2) deleted as unrelated to the section topic and otherwise addressed in WAC 388-78A-2130.

WAC 388-78A-2070 Timing of preadmission assessment.

•	Subsections (1)-(3) edited/reworded for clarity.

WAC 388-78A-2090 Full assessment topics.

•	Subsection (1) edited for clarity - word "prospective" deleted; and
•	Subsections (7), (c)(i) and (ii) edited and renumbered for clarity and to require screening resident for special needs if available information does not indicate special needs are present.

WAC 388-78A-2100 On-going assessments.

•	Subsection (1) edited to correct WAC number reference; and
•	Subsection (2) edited/reworded for clarity.

WAC 388-78A-2110 Resident participation in assessments.

•	Edited for clarity and to include the concept of resident representative's willingness and capability to be involved.

WAC 388-78A-2120 Monitoring residents' well-being.

•	Subsection (2) technical edit;
•	Subsection (5) edited to correct WAC number reference; and
•	Subsection (6) edited to use correct term.

WAC 388-78A-2130 Service agreement planning.

•	Subsection (1) edited to use correct term and incorporate provisions deleted from WAC 388-78A-2060;
•	Deleted subsection (3) and incorporated into subsection (1) as new subsection (a) for clarity;
•	Subsections (1)(b) and (c) added for clarity/understanding of the requirement - resident needs and staff direction;
•	Subsections (2)-(7) renumbered accordingly; and
•	Subsection (5) added "updating" for clarity.

WAC 388-78A-2140 Negotiated service agreement contents.

•	Subsection (1)(a) added "current" to clarify "risks";
•	Subsection (1) split assessment types into subsections (i)-(iii) for clarity;
•	Subsection (2) edited to add reference to WAC for clarity; and
•	Subsection (8) removed "contract or agreement, including" because this section only deals with the contents of the negotiated service agreement.

WAC 388-78A-2170 Required boarding home services.

•	Subsection (2)(e) reworded for clarity.

WAC 388-78A-2190 Activities of daily living.

•	Lead sentence - technical change for clarity.
•	Subsection (2) edited to clarify that the concept of "directly or indirectly" applies; and
•	New subsection (3)(b)(iii) added physical assistance for steadying the resident for clarity and consistency.

WAC 388-78A-2200 Health support services.

•	Lead sentence edited for clarity.

WAC 388-78A-2210 Medication services.

•	Subsection (1) added the concept of "directly or indirectly" for clarity;
•	Subsection (1)(a) edited and new subsection (b) added to clarify the pharmacy statute that applies and the medication service responsibility of the boarding home; and
•	Subsection (2) edited to correct WAC number reference.

WAC 388-78A-2230 Medication refusal.

•	Subsection (1)(c) technical edit.

WAC 388-78A-2260 Storing, securing, and accounting for medications.

•	Subsection (2)(d) edited for clarity - deleted reference to resident.

WAC 388-78A-2270 Resident controlled medications.

•	Subsection (2) technical edit.

WAC 388-78A-2280 Medication organizers.

•	Subsection (1) edited for clarity - added licensed pharmacist;
•	New subsection (2) added to separate for clarity;
•	Former subsection (2) edited for clarity, removed unnecessary wording and renumbered as subsection (3); and
•	Former subsection (3) deleted as unnecessary.

WAC 388-78A-2300 Food and nutrition services.

•	Subsection (1)(a)(ii) edited for clarity - "between" removed and "before" and "after" added; and
•	Subsections (2)(a) and (4) technical edits for clarity.

WAC 388-78A-2310 Intermittent nursing services.

•	Subsection (1) edited for clarity to add "optional" language.

WAC 388-78A-2320 Intermittent nursing services systems.

•	Subsection (1) edited and added subsections (a) and (b) to split out the concepts for clarity;
•	Subsection (2)(d) technical edit for clarity; and
•	Subsection (3) "assessments" added to include the concept for clarity.

WAC 388-78A-2330 Tube feeding.

•	New subsection (1) added "optional" language for clarity; and
•	Subsections (2), (3) edited for clarity and renumbered.

WAC 388-78A-2340 Resident-arranged services.

•	Subsection (5) edited for clarity to delete unnecessary and possibly confusing language; and
•	Subsection (6) deleted duplication with WAC 388-78A-2350.

WAC 388-78A-2360 Adult day care.

•	Subsections (2)(f) and (g) edited to correct WAC number references.

WAC 388-78A-2380 Restricted egress.

•	Subsection (3) technical edit.

WAC 388-78A-2410 Content of resident records.

•	Lead sentence reworded for clarity;
•	Subsection (3)(a) deleted "and relevant updates" as not applicable to this subsection; and
•	Subsection (3)(b) edited for clarity.

WAC 388-78A-2450 Staff.

•	Subsection (2)(f)(iii) deleted for clarity - concept of person providing caregiving assistance required to have training as required remains.

WAC 388-78A-2470 Criminal history background checks.

•	Revised to make consistent with statute including:
	- Deleting former subsection (1)(b);
	- Adding new subsections (1)(b) and (c), and renumbering former subsection (1)(c) to (1)(d);
	- Deleting former subsections (1)(c)(v) and (vii);
	- Renumbering former subsections (d) and (e);
	- Deleting subsection (f);
	- Renumbering subsections (1)(i)(i) and (ii) to subsections (2)(a) and (b), and adding new subsection (c); and
•	Section edited to clarify the intent to have those individuals associated with the boarding home subject to criminal background checks.

WAC 388-78A-2480 TB tests.

•	Subsection (1) edited for clarity to exclude volunteers and contractors from these requirements - boarding homes continue to have the right to test whomever they choose.

WAC 388-78A-2530 Qualifying administrator training program.

•	Subsection (4) edited to correct WAC number reference.

WAC 388-78A-2540 Administrator training requirements.

•	Subsection (2) technical edit for clarity.

WAC 388-78A-2580 Use of home health/home care.

•	Subsection (4) technical edit for clarity.

WAC 388-78A-2600 Policies and procedures.

•	Although the specificity in several sections was deleted, the boarding home continues to be responsible to develop policies and procedures for all services in their home in order to enable their staff to provide safe and adequate care to residents;
•	Deleting subsections (1)(d)(i) through (ix); subsections (l)(i) through (vi); and subsections (n)(i) through (iv) for clarity; and in subsection (q) corrected WAC citation; and
•	Subsection (3) technical edit for clarity.

WAC 388-78A-2630 Reporting abuse and neglect.

•	Subsection (1)(a) added a reference to the administration's hotline for clarity.

WAC 388-78A-2650 Reporting fires and incidents.

•	Subsection (2) deleted reference to "could or did" for clarity.

WAC 388-78A-2660 Resident rights.

•	Subsection (2) deleted unnecessary language focusing on outcome to require that staff provide care in accordance with chapter 70.129 RCW.

WAC 388-78A-2710 Disclosure of services.

•	Subsections (3)(a) and (b) edited for clarity of notice requirements; and
•	Subsections (7) and (8) technical edits for clarity.

WAC 388-78A-2720 Timing of disclosure.

•	Subsection (1) clarified that the disclosure form is to be provided; and
•	Subsections (1)(a) and (b) technical edits for clarity.

WAC 388-78A-2730 Licensee's responsibilities.

•	Subsection (2)(b)(ii)(C) technical edit for clarity;
•	Subsection (2)(b)(iii) added the "cover letter" to the requirement to reflect that consultations are now included in the cover letter; and
•	Subsection (2)(c) technical edit for clarity.

WAC 388-78A-2740 Licensee qualifications.

•	Subsection (2) edited to correct WAC reference number.

WAC 388-78A-2750 Application process.

•	Subsection (8) edited for clarity to delete "entities" since "entity" is included in the revised definition of "person."

WAC 388-78A-2760 Necessary information.

•	Deleted "entity" for clarity.

WAC 388-78A-2770 Change in licensee.

•	Subsection (1)(d)(i) edited for clarity - deleted "party," added "person" and "or partners"; and
•	Subsection (1)(e) the reference to the term "control" was revised for clarity.

WAC 388-78A-2780 Requirements to change boarding home licensee.

•	Subsection (2)(b) technical edit for clarity.

WAC 388-78A-2790 Renewal.

•	Subsection (3) term "renewal" deleted for clarity.

WAC 388-78A-2800 Changes in licensed bed capacity.

•	Subsection (1) deleted as unnecessary/redundant; and
•	Subsections (2)-(4) renumbered accordingly.

WAC 388-78A-2820 Building requirements and exemptions.

•	Subsection (1)(e)(iii) technical edit for clarity; and
•	Subsection (4) technical edit for clarity.

WAC 388-78A-2860 Relocation of residents during construction.

•	Subsection (1)(a) added to reflect when residents need to be notified and subsection (b) split out for clarity;
•	Subsection (1)(b)(i) edited out as clarified in subsection (1)(a); and
•	Subsections (1)(b)(ii)-(v) renumbered correspondingly.

WAC 388-78A-2890 Time frame for approval.

•	Subsection (2) revised to clarify the State Fire Marshal must also approve the boarding home before licensing.

WAC 388-78A-2910 Applicable building codes.

•	Subsection (1) technical edit for clarity.

WAC 388-78A-2920 Area for nursing supplies and equipment.

•	Subsection (2) technical edit for clarity; and
•	Subsection (2)(a)(ii) technical edit for clarity.

WAC 388-78A-2930 Communication system.

•	Subsection (1)(b) technical edit for clarity; and
•	Subsection (3)(b) revised to delete unnecessary language in subsections (b)(i)-(ii) for clarity.

WAC 388-78A-2950 Water supply.

•	Subsection (4) revised to clarify temperatures apply in resident rooms, and toilet rooms and bathrooms.

WAC 388-78A-2990 Heat-cooling -- Temperature.

•	Subsection (2) technical edit for clarity.

WAC 388-78A-3030 Toilet rooms and bathrooms.

•	Subsection (2)(e) technical edit for clarity.

WAC 388-78A-3090 Maintenance and housekeeping.

•	Subsection (1)(a) technical edit for clarity.

WAC 388-78A-3150 Statements of deficiencies and plans of correction.

•	Subsections (2)(a)-(c) replaced the word "violation" with the word "problem" for clarity.

WAC 388-78A-3160 Authorized enforcement remedies.

•	Subsection (1) technical edit and deletion of "without limitation" as unnecessary;
•	Subsection (1)(f) replaced "violation" with "problem" for clarity; and
•	Subsection (1)(h) deleted "per resident" to conform to statutory language.

WAC 388-78A-3170 Statutory circumstances resulting in discretionary enforcement remedies.

•	WAC title revised for clarity;
•	Subsections (1), (a), (a)(i)-(ii) and (iv)-(v), (c), (g), (i), (m) technical changes for clarity; and
•	Subsection (2)(d) term "entity" deleted for clarity.

WAC 388-78A-3180 Circumstances resulting in required enforcement remedies.

•	WAC title revised for clarity.

WAC 388-78A-3190 Statutorily required enforcement remedies; denial, suspension, revocation, or nonrenewal of license.

•	WAC title revised for clarity; and
•	Subsections (1), (2)(d) term "entity" deleted for clarity, since "entity" is included in the revised definition of "person."

WAC 388-78A-3200 Other circumstances resulting in discretionary enforcement remedies.

•	WAC title revised for clarity; and
•	Subsection (1) term "violation" deleted and replaced with "problems" for clarity.

WAC 388-78A-3230 Fees.

•	Subsection (2)(a) term "violation" deleted and replaced with "problems" for clarity.

     A final cost-benefit analysis is available by contacting Denny McKee, ADAS, DSHS, P.O. Box 45600, Olympia, WA 98504-5600, phone (360) 725-2590, fax (360) 438-7903, e-mail mckeedd@dshs.wa.gov.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 23, Amended 0, Repealed 24.

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

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

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 100, Amended 0, Repealed 101.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 123, Amended 0, Repealed 125.

     Date Adopted: July 27, 2004.

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

OTS-7104.7

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.

[]

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

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

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

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

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

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

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

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

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

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

     (2) "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.

     "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.

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

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

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

     "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. "Boarding home" may also include persons associated with the boarding home to carry out its duties under this chapter.

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

     "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, is on the premises, and is quickly and easily available to the caregiver.

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

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

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

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

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

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

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

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

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

     "Domiciliary care" means:

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

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

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

     "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, as authorized by RCW 18.20.190.

     "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.

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

     (1) Prescribed general low sodium diets;

     (2) Prescribed general diabetic diets;

     (3) Prescribed mechanical soft foods;

     (4) Emergency assistance;

     (5) Monitoring of the resident;

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

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

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

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

     (10) Blood pressure checks as scheduled;

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

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

     "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.

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

     (1) Blood glucose testing;

     (2) Puree diets;

     (3) Calorie controlled diabetic diets;

     (4) Dementia care;

     (5) Mental health care; or

     (6) Developmental disabilities care.

     "Independent living unit" means:

     (1) Independent senior housing;

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

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

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

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

     "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.

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

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

     "Majority owner" means any person that owns:

     (1) More than fifty percent interest; or

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

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

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

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

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

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

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

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

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

     (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

     (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

     (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.

     "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 an individual legally authorized to do so.

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

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

     "Medication service" means any service provided either directly or indirectly by a boarding home related to medication administration, medication administration provided through nurse delegation, medication assistance, or resident self-administration of medication.

     "Neglect" means:

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

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

     "Nonresident individual" means an individual 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.

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

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

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

     (2) "Registered nurse" (RN).

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

     "Person" means any individual, firm, partnership, corporation, company, association, joint stock association or any other legal or commercial entity.

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

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

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

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

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

     (1) "Recurring problem" means, for all purposes other than those described in RCW 18.20.400, 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:

     (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

     (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.

     (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.

     (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 applicant.

     (2) "Serious problem" means:

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

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

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

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

     "Prospective resident" 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.

     "Reasonable accommodation" and "reasonably accommodate" have the meaning given in federal and state antidiscrimination laws and regulations which include, but are not limited to, the following:

     (1) Reasonable accommodation means that the boarding home must:

     (a) Not impose admission criteria that excludes individuals unless the criteria is necessary for the provision of boarding home services;

     (b) Make reasonable modification to its policies, practices or procedures if the modifications are necessary to accommodate the needs of the resident;

     (c) Provide additional aids and services to the resident.

     (2) Reasonable accommodations are not required if:

     (a) The resident or individual applying for admission presents a significant risk to the health or safety of others that cannot be eliminated by the reasonable accommodation;

     (b) The reasonable accommodations would fundamentally alter the nature of the services provided by the boarding home; or

     (c) The reasonable accommodations would cause an undue burden, meaning a significant financial or administrative burden.

     "RCW" means Revised Code of Washington.

     "Records" means:

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

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

     "Resident" means an individual who:

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

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

     (3) Receives basic services; and

     (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.

     "Resident's representative" means:

     (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

     (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 representative may not be affiliated with the licensee, boarding home, or management company, unless the affiliated person is a family member of the resident. The resident's representative under this subsection shall not have authority to act on behalf of the resident once the resident is no longer competent. The resident's competence shall be determined using the criteria in RCW 11.88.010 (1)(e).

     "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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

     "WAC" means Washington Administrative Code.

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

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

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

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

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

     (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:

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

     (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

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

     (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

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

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

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

     (h) 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.

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

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     (1) The boarding home can safely and appropriately serve the individual with appropriate available staff providing:

     (a) The scope of care and services described in the boarding home's disclosure information; and

     (b) The reasonable accommodations required by state or federal law, including providing any specialized training to caregivers that may be required according to WAC 388-78A-2490 through 388-78A-2510;

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

     (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.

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     (1) Medical history;

     (2) Necessary and contraindicated medications;

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

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

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

     (6) Level of personal care needs;

     (7) Activities and service preferences; and

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

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     (2) 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.

     (3) For the purposes of this section, "emergency" means any circumstances when the prospective resident would otherwise need to remain in an unsafe setting or be without adequate and safe housing.

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     (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

     (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

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

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

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

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

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

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

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

     (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;

     (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

     (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.

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

     (4) Individual's sensory abilities, including:

     (a) Vision; and

     (b) Hearing.

     (5) Individual's communication abilities, including:

     (a) Modes of expression;

     (b) Ability to make self understood; and

     (c) Ability to understand others.

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

     (a) History of substance abuse;

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

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

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

     (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.

     (7) Individual's special needs, by evaluating available information, or if available information does not indicate the presence of special needs, selecting and using an appropriate tool, to determine the presence of symptoms consistent with, and implications for care and services of:

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

     (b) Developmental disability;

     (c) Dementia. While screening a resident for dementia, the boarding home must:

     (i) Base any determination that the resident has short-term memory loss upon objective evidence; and

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

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

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

     (a) Ability to perform activities of daily living;

     (b) Medication management ability, including:

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

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

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

     (10) Individual's 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.

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

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

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

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

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     (1) Complete a full assessment addressing the elements set forth in WAC 388-78A-2090 for each resident at least annually;

     (2) Complete an assessment specifically focused on a resident's identified problems and related issues:

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

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

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

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

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

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

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

     (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;

     (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;

     (5) Assess a resident consistent with WAC 388-78A-2100 if assessment is identified as needed;

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

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

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     (1) Develop an initial resident service plan, 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. The boarding home must ensure the initial resident service plan:

     (a) Integrates the assessment information provided by the department's case manager for each resident whose care is partially or wholly funded by the department;

     (b) Identifies the resident's immediate needs; and

     (c) Provides direction to staff and caregivers relating to the resident's immediate needs, capabilities, and preferences.

     (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;

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

     (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

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

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

     (5) Involve the following persons in the process of developing and updating a negotiated service agreement:

     (a) The resident;

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

     (c) Other individuals the resident wants included;

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

     (e) Staff designated by the boarding home.

     (6) Ensure:

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

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

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

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

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

     (a) The plan to monitor the resident and address interventions for current risks to the resident's health and safety that were identified in one or more of the following:

     (i) The resident's preadmission assessment;

     (ii) The resident's full assessments;

     (iii) On-going assessments of the resident;

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

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

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

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

     (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 and 388-78A-2340(5), 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:

     (a) Exclusively for the individual resident; or

     (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.

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

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

     (5) Appropriate behavioral interventions, if needed;

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

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

     (8) The boarding home must not require or ask the resident or the resident's representative to sign any 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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     (1) The resident, or the resident's representative if the resident has one and is unable to sign or chooses not to sign;

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

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

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

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

     (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;

     (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;

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

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

     (3) The boarding home must:

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

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

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

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

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

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     (1) Provide space and staff support necessary for:

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

     (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.

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

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

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

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

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

     (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:

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

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

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

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

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

     (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;

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

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

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

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

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

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

     (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;

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

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

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

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

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

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

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

     (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;

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

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

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

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

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

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

     (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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     (1) Blood glucose testing;

     (2) Puree diets;

     (3) Calorie controlled diabetic diets;

     (4) Dementia care;

     (5) Mental health care; and

     (6) Developmental disabilities care.

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     (a) Meet the requirements of chapter 69.41 RCW Legend drugs -- Prescription drugs, and other applicable statutes and administrative rules; and

     (b) Develop and implement systems that support and promote safe medication service for each resident.

     (2) The boarding home must ensure the following residents receive their medications as prescribed, except as provided for in WAC 388-78A-2230 and 388-78A-2250:

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

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

     (b) A written order from the prescriber;

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

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

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

     (a) The name of the resident;

     (b) The name of the medication;

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

     (d) The name of the prescriber.

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

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

     (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, and such staff person;

     (i) Conducts an evaluation; and

     (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.

     (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:

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

     (b) The boarding home documents such directions; and

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

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     (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.

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

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

     (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.

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

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

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

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

     (c) Separate from food or toxic chemicals;

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

     (e) In environments recommended on the medication label.

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     (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 self-administer with assistance.

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     (2) A nurse may fill a medication organizer for a resident only when:

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

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

     (c) Staff persons have no further responsibility for:

     (i) Storing the resident's medication; or

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

     (iii) Providing medication administration services to the resident.

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

     (i) The name of the resident;

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

     (iii) The frequency of the dosage.

     (3) The boarding home must ensure a licensed pharmacy has filled the medication organizer any time the boarding home is:

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

     (b) Providing medication assistance to the resident; or

     (c) Providing medication administration services to the resident.

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     (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.

     (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:

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

     (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;

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

     (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

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

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

     (a) The resident, if able;

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

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

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

     (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.

     (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.

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

     (i) At regular intervals;

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

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

     (c) Ensure all menus:

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

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

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

     (iv) Are retained at least six months;

     (v) Provide a variety of foods; and

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

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

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

     (ii) Individual preferences to the extent reasonably possible.

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

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

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

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

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

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

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

     (ii) Approved by a dietitian; and

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

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

     (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:

     (a) Modified or therapeutic diets;

     (b) Nutritional concentrates or supplements.

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

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

     (i) Operate it according to manufacturer directions; and

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

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

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

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

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

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

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

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

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

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

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

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     (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:

     (a) Medication administration;

     (b) Administration of health treatments;

     (c) Diabetic management;

     (d) Nonroutine ostomy care;

     (e) Tube feeding; and

     (f) Nurse delegation consistent with chapter 18.79 RCW.

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

     (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.

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

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     (a) Develop and implement systems that support and promote the safe practice of nursing for each resident; and

     (b) Ensure the requirements of chapters 18.79 RCW and 246-840 WAC are met.

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

     (a) Nursing services supervision;

     (b) Nurse delegation, if provided;

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

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

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

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

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

     (a) Chapter 18.79 RCW, Nursing care;

     (b) Chapter 18.88A RCW, Nursing assistants;

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

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

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

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     (2) The boarding home must provide intermittent 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:

     (a) Independently and safely manage:

     (i) Maintenance of the tube insertion site;

     (ii) Necessary medication administration through the tube; and

     (iii) Feeding administration through the tube.

     (b) Arrange for an outside resource to provide:

     (i) Maintenance of the tube insertion site;

     (ii) Necessary medication administration through the tube; and

     (iii) Feeding administration through the tube.

     (3) 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 (2)(a) and (b) of this section.

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

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

     (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.

     (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.

     (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.

     (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; 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.

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     (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:

     (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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

     (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;

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

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

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

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

     (f) Notify appropriate individuals specified in the client's record and consistent with WAC 388-78A-2640 when there is a significant change in the condition of an adult day care client;

     (g) Investigate and document incidents and accidents involving adult day care clients consistent with WAC 388-78A-2700;

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

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

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

     (i) Family members or other significant relationships;

     (ii) Education and training;

     (iii) Employment and career experiences;

     (iv) Religious or spiritual preferences;

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

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

     (i) Articulate his or her personal needs; and

     (ii) Initiate activity.

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

     (i) Agitation;

     (ii) Wandering;

     (iii) Resistance to care;

     (iv) Social isolation; and

     (v) Aggression.

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

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

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

     (3) Each resident, assessed as being cognitively able to safely leave the boarding home and who 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.

     (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.

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

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

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

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

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

     (i) The egress control device itself;

     (ii) The smoke detection system; or

     (iii) The means of egress illumination.

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

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

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

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

     (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:

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

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

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

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

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

     (a) Is accessible to residents without staff assistance;

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

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

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

     (e) Has suitable outdoor furniture.

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

     (2) To respond appropriately in emergency situations.

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

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

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

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

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

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

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

     (a) Name;

     (b) Birth date;

     (c) Move-in date; and

     (d) Sleeping room identification.

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

     (a) Resident's primary health care provider;

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

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

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

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

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

     (b) Information required by long-term care resident rights per RCW 70.129.030.

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

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

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

     (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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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     (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.

     (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.

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

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

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     (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.

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

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

     (a) Authorized department staff;

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

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

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

     (a) Date of moving in;

     (b) Full name;

     (c) Date of birth;

     (d) Date of moving out;

     (e) Reason for moving out; and

     (f) New address if known.

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

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

     (c) Implement fire and disaster plans.

     (2) The boarding home must:

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

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

     (c) Verify 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;

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

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

     (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:

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

     (ii) During boarding home activities off of the boarding home premises.

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

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

     (i) Organization of boarding home;

     (ii) Physical boarding home layout;

     (iii) Specific duties and responsibilities;

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

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

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

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

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

     (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;

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

     (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.

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

     (3) The boarding home must:

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

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

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

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

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

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

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

     (B) Cardiopulmonary resuscitation;

     (C) First aid; and

     (D) HIV/AIDS training.

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

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

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

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

     (b) The administrator; and

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

     (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.

     (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:

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

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

     (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.

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

     (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.

     (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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     (a) Ensure any individual associated with the licensee or boarding home who may have unsupervised access to residents has a background check and that individual has not been:

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

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

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

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

     (v) Convicted of criminal mistreatment; or

     (vi) Found by the department to have abused, neglected, or exploited a minor or vulnerable person, provided the individual was offered an administrative hearing to contest the finding, and the finding was upheld, or the individual failed to timely appeal the finding.

     (b) Not hire or retain, directly or by contract, or accept as a volunteer, any individual prohibited from having unsupervised access to residents, under (a) of this subsection except as provided in RCW 43.43.842.

     (c) Not hire, directly or by contract, or accept as a volunteer, any individual who may have unsupervised access to residents, prior to receiving favorable results of the background check except as specified in subsection (2) of this section.

     (d) Inform every individual who is associated with the boarding home and who will have unsupervised access to residents in the boarding home, that a background check is required. This requirement includes, but is not limited to, the following:

     (i) Employees;

     (ii) Managers;

     (iii) Volunteers who are not residents;

     (iv) Contractors; and

     (v) Students.

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

     (f) Submit all background check authorization forms to the department's:

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

     (ii) Background check central unit every two years for each individual identified in (d) of this subsection. A background check result is only valid for two years from the date it is conducted.

     (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;

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

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

     (ii) Used for employment purposes only;

     (iii) Not disclosed to any individual except:

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

     (B) Authorized state and federal employees;

     (C) The Washington state patrol auditor; and

     (D) As otherwise authorized in chapter 43.43 RCW.

     (iv) Retained and available for department review:

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

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

     (2) The boarding home may conditionally hire, directly or by contract, an individual having unsupervised access to residents pending a background inquiry, provided the boarding home:

     (a) Obtains a criminal history background check authorization form from the individual prior to the individual beginning work;

     (b) Submits the criminal history background check authorization form to the department no later than one business day after the individual started working; and

     (c) Has received three positive references for the individual.

     (3) 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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     (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:

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

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

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

     (iv) Recorded in millimeters of induration.

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

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

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

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

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

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

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

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

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

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

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

     (2) The boarding home must:

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

     (i) Tuberculin test results;

     (ii) Reports of X-ray findings; and

     (iii) Physician or public health official orders.

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

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

     (ii) When requested by the staff person.

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

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

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

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

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

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

     (i) Self-care;

     (ii) Understanding and use of language;

     (iii) Learning;

     (iv) Mobility;

     (v) Self-direction; and

     (vi) Capacity for independent living.

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

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

     (a) A licensed physician;

     (b) A mental health professional;

     (c) A psychiatric advanced registered nurse practitioner; or

     (d) A licensed psychologist.

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     (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:

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

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

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

     (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:

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

     (B) The American Health Care Association; or

     (C) The Assisted Living Federation of America; or

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

     (ii) Three years paid experience:

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

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

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

     (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:

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

     (B) The American Health Care Association; or

     (C) The Assisted Living Federation of America; or

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

     (ii) Has two years paid experience:

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

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

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

     (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:

     (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:

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

     (B) The American Health Care Association; or

     (C) The Assisted Living Federation of America; or

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

     (ii) Has one year paid experience:

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

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

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

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

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

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

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

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

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

     (4) The supervising administrator met the qualifications to be an administrator specified in WAC 388-78A-2520;

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

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

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

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

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

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

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

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

     (i) Chapter 18.20 RCW, Boarding homes;

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

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

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

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

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

     (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.

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

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

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

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

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

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

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

     (3) Is readily accessible to meet with residents;

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

     (a) Initial application for a license;

     (b) Retention of a manager following initial application;

     (c) Change of managers; or

     (d) Modification of existing management agreement.

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

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

     (c) Safely operate the boarding home; and

     (d) Operate in compliance 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.

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

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

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

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

     (d) When a resident stops breathing or a resident's heart appears to stop beating, including, but not limited to, any action staff persons must take related to advance directives and emergency care;

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

     (f) In response to medical emergencies;

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

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

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

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

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

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

     (iii) When and how to seek outside intervention.

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

     (l) To manage residents' medications, consistent with WAC 388-78A-2210 through 388-78A-2290; sending medications with a resident when the resident leaves the premises;

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

     (n) Related to food services consistent with chapter 246-215 WAC and WAC 388-78A-2300;

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

     (p) To coordinate services and share resident information with outside resources, consistent with WAC 388-78A-2350;

     (q) Regarding the management of pets in the boarding home, if permitted, consistent with WAC 388-78A-2620; and

     (r) When receiving and responding to resident grievances consistent with RCW 70.129.060.

     (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 them available upon request.

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     (2) The boarding home must:

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

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

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

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

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

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

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     (1) Develop, implement and disclose to potential and current residents, policies regarding:

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

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

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

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

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

     (c) Are restricted from central food preparation areas.

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     (a) Makes a report to the department's Aging and Disability Services Administration Complaint Resolution Unit hotline consistent with chapter 74.34 RCW in all cases where the staff person has reasonable cause to believe that abandonment, abuse, financial exploitation, or neglect of a vulnerable adult has occurred; and

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

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

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

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

     (c) The resident dies.

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

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

     (b) The resident dies.

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

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

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

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

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     (1) Any accidental or unintended fire, or any deliberately set but improper fire, such as arson, in the boarding home;

     (2) Any unusual incident that required implementation of the boarding home's disaster plan, including any evacuation of all or part of the residents to another area of the boarding home or to another address; and

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

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

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

     (3) Not use restraints on any resident;

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

     (a) The resident no longer desires it;

     (b) The roommate objects to the use; or

     (c) The resident becomes unable to give consent.

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     (2) The boarding home must:

     (a) Maintain the premises free of hazards;

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

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

     (i) Determine the circumstances of the event;

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

     (iii) Protect other residents during the course of the investigation.

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

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

     (f) Provide emergency lighting or flashlights in all areas of the boarding home. For all boarding homes first issued a project number by construction review services on or after September 1, 2004, the boarding home must provide emergency lighting in all areas of the boarding home;

     (g) Make sure first-aid supplies are:

     (i) Readily available and not locked;

     (ii) Clearly marked;

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

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

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

     (i) The size of the boarding home;

     (ii) The services provided;

     (iii) The residents served; and

     (iv) The response time of emergency medical services.

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

     (i) On-duty staff persons' responsibilities;

     (ii) Provisions for summoning emergency assistance;

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

     (iv) Alternative resident accommodations;

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

     (vi) Emergency communication plan.

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     (2) The boarding home must provide the services disclosed.

     (3) The boarding home must provide a minimum of thirty days written notice to the residents and the residents' representatives, if any:

     (a) Before the effective date of any decrease in the scope of care or services provided by the boarding home, due to circumstances beyond the boarding home's control; and

     (b) 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 not result in the discharge of one or more residents.

     (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.

     (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.

     (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).

     (7) Even though the boarding home may disclose that it can provide certain care or services to residents or prospective residents or residents' representative, if any, the boarding home may deny admission to a prospective resident when the boarding home determines that the needs of the prospective resident 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).

     (8) The boarding home must notify prospective residents 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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     (a) In response to a request by a prospective resident or his or her representative, if any, for written information about the boarding home's services and capabilities; or

     (b) At the time the boarding home provides an application for residency, an admission agreement or contract, if not previously received by the prospective resident or his or her representative, if any.

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

     (a) In advertisements;

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

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

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     (a) The operation of the boarding home;

     (b) Complying with the requirements of this chapter, chapter 18.20 RCW, and other applicable laws and rules; and

     (c) The care and services provided to the boarding home residents.

     (2) The licensee must:

     (a) Maintain the occupancy level at or below the licensed resident bed capacity of the boarding home;

     (b) Maintain and post in a size and format that is easily read, in a conspicuous place on the boarding home premises:

     (i) A current boarding home license, including any related conditions on the license;

     (ii) The name, address and telephone number of:

     (A) The department;

     (B) Appropriate resident advocacy groups; and

     (C) The state and local long-term care ombudsman with a brief description of ombudsman services.

     (iii) A copy of the report, including the cover letter, and plan of correction of the most recent full inspection conducted by the department.

     (c) Ensure any party responsible for holding or managing residents' personal funds is bonded or obtains insurance in sufficient amounts to specifically cover losses of resident funds; and provides proof of bond or insurance to the department.

     (3) The licensee must not delegate to any person responsibilities that are so extensive that the licensee is relieved of responsibility for the daily operations and provisions of services in the boarding home.

     (4) The licensee must act in accord with any department-approved management agreement, if the licensee has entered into a management agreement.

     (5) The licensee must appoint the boarding home administrator consistent with WAC 388-78A-2520.

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     (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.

     (2) If the department finds any person unqualified as specified in WAC 388-78A-3170, the department may deny, terminate, or not renew the license.

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

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

     (3) Submit criminal history background requests as required in WAC 388-78A-2470;

     (4) Sign the application;

     (5) Submit the license fee as specified in WAC 388-78A-3230;

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

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

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

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

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     (a) The licensee's form of legal organization is changed (e.g., a sole proprietor forms a partnership or corporation);

     (b) The licensee transfers ownership of the boarding home business enterprise to another party regardless of whether ownership of some or all of the real property and/or personal property assets of the boarding home is also transferred;

     (c) The licensee dissolves, or consolidates or merges with another legal organization and the licensee's legal organization does not survive;

     (d) If, during any continuous twenty-four-month period, fifty percent or more of the "licensed entity" is transferred, whether by a single transaction or multiple transactions, to:

     (i) A different person (e.g., new or former shareholders or partners); or

     (ii) A person that had less than a five percent ownership interest in the boarding home at the time of the first transaction.

     (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. As used in this section, "control" means the possession, directly or indirectly, of the power to direct the management, operation and/or policies of the licensee or boarding home, whether through ownership, voting control, by agreement, by contract or otherwise.

     (2) The licensee is not required to change when the following, without more, occur:

     (a) The licensee contracts with a party to manage the boarding home enterprise for the licensee pursuant to an agreement as specified in WAC 388-78A-2590; or

     (b) The real property or personal property assets of the boarding home are sold or leased, or a lease of the real property or personal property assets is terminated, as long as there is not a substitution or substitution of control of the licensee or boarding home.

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

     (b) Name and address of the boarding home for which the licensee is being changed;

     (c) Date of proposed change; and

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

     (2) The prospective licensee must, at least ninety days prior to the proposed date of change:

     (a) Sign the application;

     (b) Submit the annual license fee, if a license fee is due;

     (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;

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

     (e) Complete and submit a revised application if requested by the department.

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

     (2) Sign the application;

     (3) Submit the annual license fee as specified in WAC 388-78A-3230; and

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

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     (1) Submit a completed request for approval to the department at least one day before the intended change;

     (2) Submit the prorated fee required according to WAC 388-78A-3230; and

     (3) Post an amended license obtained from the department, indicating the new bed capacity.

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     (1) Obtain construction review services' review and approval of the additional rooms or beds, and related auxiliary spaces, if not previously reviewed and approved; and

     (2) Ensure the increased licensed bed capacity does not exceed the maximum facility capacity as determined by the department.

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     (a) Design plans according to the building code, local codes and ordinances, and this chapter;

     (b) Submit construction documents, including any change orders and addenda to:

     (i) Construction review services per WAC 388-78A-2850 and include:

     (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

     (B) A functional program description; and

     (ii) Local county or municipal building departments per local codes to obtain necessary building permits.

     (c) Conform to the approved construction documents during construction in accordance with chapter 18.20 RCW;

     (d) Obtain written approval from construction review services prior to deviating from approved construction documents;

     (e) Provide construction review services with a:

     (i) Written notice of completion date;

     (ii) Copy of reduced floor plan(s); and

     (iii) Copy of certificate of occupancy issued by the local building department; and

     (f) Obtain authorization from the department prior to providing boarding home services in the new construction area.

     (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:

     (a) Jeopardize the health or safety of residents;

     (b) Adversely affect the residents' quality of life; or

     (c) Change the fundamental nature of the boarding home operation into something other than a boarding home.

     (3) A boarding home wishing to request an exemption must submit a written request to the department, including:

     (a) A description of the requested exemption; and

     (b) The specific WAC requirement for which the exemption is sought.

     (4) The boarding home may not appeal the department's denial of a request for an exemption.

     (5) The boarding home must retain a copy of each approved exemption in the boarding home.

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     (2) If the licensee provides contracted enhanced adult residential care services in the building converted from a licensed nursing home into a licensed boarding home, the boarding home licensing requirements for the physical structure are considered to be met if the most recent nursing home inspection report for the nursing home building demonstrates compliance, and compliance is maintained, with safety standards and fire regulations:

     (a) As required by RCW 18.51.140; and

     (b) Specified in the applicable building code, as required by RCW 18.51.145, including any waivers that may have been granted, except that the licensee must ensure the building meets the licensed boarding home standards, or their functional equivalency, for:

     (i) Resident to bathing fixture ratio required per WAC 388-78A-3030;

     (ii) Resident to toilet ratio required per WAC 388-78A-3030;

     (iii) Corridor call system required per WAC 388-78A-2930;

     (iv) Resident room door closures; and

     (v) Resident room windows required per WAC 388-78A-3010.

     (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.

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     (a) All of the buildings are located on the same property with the same legal description; or

     (b) All of the buildings are located on contiguous properties undivided by:

     (i) Public streets, not including alleyways used primarily for delivery services or parking; or

     (ii) Other land that is not owned and maintained by the owners of the property on which the boarding home is located.

     (2) The licensee must have separate boarding homes licenses for buildings that are not located on the same or contiguous properties.

     (3) Buildings that construction review services reviewed only as an addition to, or a remodel of, an existing boarding home must not have separate boarding home licenses.

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     (a) A new building or portion thereof to be used as a boarding home;

     (b) An addition of, or modification or alteration to an existing boarding home, including, but not limited to, the boarding home's:

     (i) Physical structure;

     (ii) Electrical fixtures or systems;

     (iii) Mechanical equipment or systems;

     (iv) Fire alarm fixtures or systems;

     (v) Fire sprinkler fixtures or systems;

     (vi) Carpeting;

     (vii) Wall coverings 1/28 inch thick or thicker; or

     (viii) Kitchen or laundry equipment.

     (c) A change in the department-approved use of an existing boarding home or portion of a boarding home; and

     (d) An existing building or portion thereof to be converted for use as a boarding home.

     (2) A person or boarding home does not need to notify construction review services of the following:

     (a) Repair or maintenance of equipment, furnishings or fixtures;

     (b) Replacement of equipment, furnishings or fixtures with equivalent equipment, furnishings or fixtures;

     (c) Repair or replacement of damaged construction if the repair or replacement is performed according to construction documents approved by construction review services within eight years preceding the current repair or replacement;

     (d) Painting; or

     (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.

     (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.

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     (a) Notify the residents and the residents' representatives at least thirty days prior to the anticipated move date, of the required move and their options consistent with chapter 70.129 RCW;

     (b) Notify the department at least thirty days prior to the anticipated move date, of the boarding home's plans for relocating residents, including:

     (i) The location to which the residents will be relocated;

     (ii) The boarding home's plans for providing care and services during the relocation;

     (iii) The boarding home's plans for returning residents to the building; and

     (iv) The projected time frame for completing the construction.

     (b) Obtain the department's approval for the relocation plans prior to relocating residents.

     (2) If the boarding home moves out all of the residents from the boarding home without first obtaining the department's approval of the relocation plans, the boarding home is closed for business and the department may revoke the licensee's boarding home license.

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     Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-78A-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.

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     (1) Notify construction review services:

     (a) In writing;

     (b) Thirty days or more before the intended change in use;

     (c) Describe the current and proposed use of the room; and

     (d) Provide all additional documentation as requested by construction review services.

     (2) Obtain the written approval of construction review services for the new use of the room.

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     (a) Obtain approval by construction review services, of final construction documents prior to starting any construction, except for fire alarm plans, fire sprinkler plans, and landscaping plans.

     (b) Obtain approval by construction review services, of landscaping, fire alarm and fire sprinkler plans prior to their installation.

     (2) The department will not issue a boarding home license unless:

     (a) Construction review services:

     (i) Notifies the department that construction has been completed; and

     (ii) Provides the department:

     (A) A copy of the certificate of occupancy granted by the local building official;

     (B) A copy of the functional program; and

     (C) A reduced copy of the approved floor plan indicating room numbers or names and the approved use; and

     (b) The state fire marshal has inspected and approved the boarding home for fire protection.

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     (1) Specification data on materials used in construction, for the life of the product;

     (2) Stamped "approved" set of construction documents.

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     (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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     (a) Storage and handling of clean and sterile nursing equipment and supplies; and

     (b) Cleaning and disinfecting of soiled nursing equipment.

     (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 intermittent nursing services within an existing boarding home, the boarding home must provide the following two separate rooms in each boarding home building, accessible only by staff persons:

     (a) A "clean" utility room for the purposes of storing and preparing clean and sterile nursing supplies, equipped with:

     (i) A work counter or table;

     (ii) A handwashing sink, with soap and paper towels or other approved hand-drying device; and

     (iii) Locked medication storage, if medications are stored in this area, that is separate from all other stored items consistent with WAC 388-78A-2260.

     (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:

     (i) A work counter or table;

     (ii) A two-compartment sink for handwashing and equipment cleaning and sanitizing;

     (iii) A clinical service sink or equivalent for rinsing and disposing of waste material;

     (iv) Soap and paper towels or other approved hand-drying device; and

     (v) Locked storage for cleaning supplies, if stored in the area.

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     (a) Provide residents and staff with the means to summon on-duty staff assistance from:

     (i) Resident units;

     (ii) Common areas accessible to residents;

     (iii) Corridors accessible to residents; and

     (iv) All bathrooms and all toilet rooms in boarding homes issued a project number by construction review services on or after September 1, 2004.

     (b) Provide residents, families, and other visitors with a means to contact staff inside the building from outside the building after hours.

     (2) The boarding home must provide one or more nonpay telephones:

     (a) In each building located for ready access by staff; and

     (b) On the premises for reasonable access and privacy by residents.

     (3) In boarding homes issued a project number by construction review services on or after September 1, 2004, the boarding home must equip each resident room with:

     (a) An intercom system with a mechanism that allows a resident to control:

     (i) Whether or not announcements are broadcast into the resident's room; and

     (ii) Whether or not voices or conversations within the resident's room can be monitored or listened to by persons outside the resident's room.

     (b) Two telephone lines.

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     (1) A resident initiates the contact; or

     (2) Staff persons announce to the resident that the intercom has been activated at the time it is activated, and:

     (a) The resident and any others in the room agree to continue the contact;

     (b) A visible signal is activated in the resident's room at all times the intercom is in operation; and

     (c) The boarding home deactivates the intercom when the conversation is complete.

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     (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;

     (2) Maintain the boarding home water systems free of cross-connections as specified in Cross-Connection Control Manual, 6th Edition, published by the Pacific Northwest Section of the American Water Works Association;

     (3) Provide hot and cold water under adequate pressure readily available throughout the boarding home;

     (4) Provide all sinks in resident rooms, toilet rooms and bathrooms, and bathing fixtures used by residents with hot water between 105°F and 120°F at all times; and

     (5) Label or color code nonpotable water supplies "unsafe for domestic use."

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     (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

     (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

     (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.

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     (1) Provide an adequate number of garbage containers to store refuse generated by the boarding home:

     (a) Located in a storage area convenient for resident and staff use;

     (b) Constructed of nonabsorbent material;

     (c) Cleaned and maintained to prevent:

     (i) Entrance of insects, rodents, birds, or other pests;

     (ii) Odors; and

     (iii) Other nuisances.

     (2) Assure garbage and waste containers are emptied frequently to prevent hazards and nuisances; and

     (3) Provide for safe and sanitary collection and disposal of:

     (a) Garbage and refuse;

     (b) Infectious waste; and

     (c) Waste grease from the kitchen.

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     (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

     (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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     (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:

     (a) Maintain the boarding home at a minimum temperature of 60°F during sleeping hours; and

     (b) Maintain the boarding home at a minimum of 68°F during waking hours, except in rooms:

     (i) Designated for activities requiring physical exertion; or

     (ii) Where residents can individually control the temperature in their own living units, independent from other areas.

     (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 the Puget Sound chapter of the American Society of Heating, Refrigeration, and Air-Conditioning Engineers;

     (3) Equip each boarding home issued a project number by construction review services on or after September 1, 2004, with a backup source of heat in enough common areas to keep all residents adequately warm during interruptions of normal heating operations;

     (4) Prohibit the use of portable space heaters unless approved in writing by the Washington state director of fire protection; and

     (5) Equip each resident sleeping room and resident living room in boarding homes issued a project number by construction review services on or after September 1, 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.

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     (1) Ventilate rooms to:

     (a) Prevent excessive odors or moisture; and

     (b) Remove smoke.

     (2) Designate and ventilate smoking areas, if smoking is permitted in the boarding home, to prevent air contamination throughout the boarding home;

     (3) Provide intact sixteen mesh screens on operable windows and openings used for ventilation; and

     (4) Prohibit screens that may restrict or hinder escape or rescue through emergency exit openings.

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     (a) Eighty or more square feet of usable floor space in a one-person sleeping room;

     (b) Seventy or more square feet of usable floor space per individual in a sleeping room occupied by two or more individuals, except:

     (i) When a resident sleeping room is located within a private apartment; and

     (ii) The private apartment includes a resident sleeping room, a resident living room, and a private bathroom; and

     (iii) The total square footage in the private apartment equals or exceeds two hundred twenty square feet excluding the bathroom; and

     (iv) There are no more than two residents living in the apartment; and

     (v) Both residents mutually agree to share the resident sleeping room; and

     (vi) All other requirements of this section are met, then the two residents may share a sleeping room with less than one hundred forty square feet.

     (c) A maximum sleeping room occupancy of:

     (i) Four individuals if the boarding home was licensed before July 1, 1989, and licensed continuously thereafter; and

     (ii) Two individuals if the boarding home, after June 30, 1989:

     (A) Applied for initial licensure; or

     (B) Applied to increase the number of resident sleeping rooms; or

     (C) Applied to change the use of rooms into sleeping rooms.

     (d) Unrestricted direct access to a hallway, living room, outside, or other common-use area;

     (e) One or more outside windows with:

     (i) Window sills at or above grade, with grade extending horizontally ten or more feet from the building; and

     (ii) Adjustable curtains, shades, blinds, or equivalent for visual privacy.

     (f) One or more duplex electrical outlets per bed if the boarding home was initially licensed after July 1, 1983;

     (g) A light control switch located by the entrance for a light fixture in the room;

     (h) An individual towel and washcloth rack or equivalent, except when there is a private bathroom attached to the resident sleeping or living room, the individual towel and washcloth rack may be located in the attached private bathroom;

     (i) In all boarding homes issued a project number by construction review services on or after September 1, 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;

     (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;

     (k) A configuration to permit all beds in the resident sleeping room to be spaced at least three feet from other beds unless otherwise requested by all affected residents.

     (2) The boarding home must ensure each resident sleeping room contains:

     (a) A comfortable bed for each resident, except when two residents mutually agree to share a bed. The bed must be thirty-six or more inches wide for a single resident and fifty-four or more inches wide for two residents, appropriate for size, age and physical condition of the resident and room dimensions, including, but not limited to:

     (i) Standard household bed;

     (ii) Studio couch;

     (iii) Hide-a-bed;

     (iv) Day bed; or

     (v) Water bed, if structurally and electrically safe.

     (b) A mattress for each bed which:

     (i) Fits the bed frame;

     (ii) Is in good condition; and

     (iii) Is at least four inches thick unless otherwise requested or necessary for resident health or safety.

     (c) One or more comfortable pillows for each resident;

     (d) Bedding for each bed, in good repair; and

     (e) Lighting at the resident's bedside when requested by the resident.

     (3) The boarding home must not allow a resident sleeping room to be used as a passageway or corridor.

     (4) The boarding home may use or allow use of carpets and other floor coverings only when the carpet is:

     (a) Securely fastened to the floor or provided with nonskid backing; and

     (b) Kept clean and free of hazards, such as curling edges or tattered sections.

     (5) The boarding home must ensure each resident has either a sleeping room or resident living room that contains a sturdy, comfortable chair appropriate for the age and physical condition of the resident. This requirement does not mean a boarding home is responsible for supplying specially designed orthotic or therapeutic chairs, including those with mechanical lifts or adjustments.

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     (1) Including:

     (a) Areas under moveable furniture; and

     (b) Areas of door swings and entryways into the sleeping room.

     (2) Excluding:

     (a) Areas under ceilings less than seven feet six inches high;

     (b) Closet space and built-in storage;

     (c) Areas under counters, sinks, or appliances; and

     (d) Bathrooms and toilet rooms.

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     (2) The boarding home must provide each toilet room and bathroom with:

     (a) Water resistant, smooth, low gloss, nonslip and easily cleanable materials;

     (b) Washable walls to the height of splash or spray;

     (c) Grab bars installed and located to minimize accidental falls including one or more grab bars at each:

     (i) Bathing fixture; and

     (ii) Toilet.

     (d) Plumbing fixtures designed for easy use and cleaning and kept in good repair; and

     (e) Adequate ventilation to the outside of the boarding home. For boarding homes issued a project number by construction review services on or after September 1, 2004, must provide mechanical ventilation to the outside.

     (3) The boarding home must provide each toilet room with a:

     (a) Toilet with a clean, nonabsorbent seat free of cracks;

     (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

     (c) Suitable mirror with adequate lighting for general illumination.

     (4) For boarding homes approved for construction or initially licensed after August 1, 1994, the boarding home must provide a toilet and handwashing sink in, or adjoining, each bathroom.

     (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.

     (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

     (7) When providing common-use toilet rooms and bathrooms, the boarding home must:

     (a) Designate toilet rooms containing more than one toilet for use by men or women;

     (b) Designate bathrooms containing more than one bathing fixture for use by men or women;

     (c) Equip each toilet room and bathroom designed for use by, or used by, more than one person at a time, in a manner to ensure visual privacy for each person using the room. The boarding home is not required to provide additional privacy features in private bathrooms with a single toilet and a single bathing fixture located within a private apartment;

     (d) Provide a 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;

     (e) Provide reasonable access to bathrooms and toilet rooms for each resident by:

     (i) Locating a toilet room on the same floor or level as the sleeping room of the resident served;

     (ii) Locating a bathroom on the same floor or level, or adjacent floor or level, as the sleeping room of the resident served; and

     (iii) Providing access without passage through any kitchen, pantry, food preparation, food storage, or dishwashing area, or from one bedroom through another bedroom.

     (8) In boarding homes issued a project number by construction review services on or after September 1, 2004, the boarding home must ensure fifty percent of all the bathing fixtures in the boarding home are roll-in type showers that have:

     (a) One-half inch or less threshold;

     (b) A minimum size of thirty-six inches by forty-eight inches; and

     (c) Single lever faucets located within thirty-six inches of the seat so the faucets are within reach of persons seated in the shower.

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     (2) The boarding home must handle, clean, and store linen according to acceptable methods of infection control. The boarding home must:

     (a) Provide separate areas for handling clean laundry and soiled laundry;

     (b) Ensure clean laundry is not processed in, and does not pass through, areas where soiled laundry is handled;

     (c) Ensure areas where clean laundry is stored are not exposed to contamination from other sources; and

     (d) Ensure all staff wears gloves and uses other appropriate infection control practices when handling soiled laundry.

     (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:

     (a) Boarding home laundry;

     (b) Boarding home laundry combined with residents' laundry into a single load; or

     (c) More than one resident's laundry combined into a single load.

     (4) The boarding home or a resident washing an individual resident's personal laundry, separate from other laundry, may wash the laundry at temperatures below 140°F and without the use of a chemical sanitizer.

     (5) The boarding home must ventilate laundry rooms and areas to the outside of the boarding home, including areas or rooms where soiled laundry is held for processing by off site commercial laundry services.

     (6) The boarding home must locate laundry equipment in rooms other than those used for open food storage, food preparation or food service.

     (7) For all boarding homes issued a project number by construction review services on or after September 1, 2004, the boarding home must provide a laundry area where residents' may do their personal laundry that is:

     (a) Equipped with:

     (i) A utility sink;

     (ii) A table or counter for folding clean laundry;

     (iii) At least one washing machine and one clothes dryer; and

     (iv) Mechanical ventilation to the outside of the boarding home.

     (b) Is arranged to reduce the chances of soiled laundry contaminating clean laundry.

     (8) The boarding home may combine areas for soiled laundry with other areas when consistent with WAC 388-78A-3110.

     (9) The boarding home may combine areas for handling and storing clean laundry with other areas when consistent with WAC 388-78A-3120.

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     (a) Solariums;

     (b) Enclosed sun porches;

     (c) Recreation rooms;

     (d) Dining rooms; and

     (e) Living rooms.

     (2) The boarding home must provide a total minimum floor space for day room areas of:

     (a) One hundred fifty square feet, or ten square feet per resident, whichever is larger, in boarding homes licensed on or before December 31, 1988; or

     (b) One hundred fifty square feet, or twenty square feet per resident, whichever is larger, in boarding homes licensed after December 31, 1988.

     (3) The boarding home must provide day room areas with comfortable furniture and furnishings that meet the residents' needs.

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     (1) Provide adequate storage space for supplies, equipment and linens;

     (2) Provide separate, locked storage for disinfectants and poisonous compounds; and

     (3) Maintain storage space to prevent fire or safety hazards.

[]

[]

     (a) In halls and corridors, if necessary for resident safety;

     (b) On each side of interior and exterior stairways with more than one step riser, unless the department approves in writing having a handrail on one side only; and

     (c) On each side of interior and exterior ramps with slopes greater than one to twenty.

     (2) The boarding home must install guardrails if the department determines guardrails are necessary for resident safety.

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     (a) Provide a safe, sanitary and well-maintained environment for residents;

     (b) Keep exterior grounds, boarding home structure, and component parts safe, sanitary and in good repair;

     (c) Keep facilities, equipment and furnishings clean and in good repair;

     (d) Ensure each resident or staff person maintains the resident's quarters in a safe and sanitary condition; and

     (e) Equip a housekeeping supply area on the premises with:

     (i) A utility sink or equivalent means of obtaining and disposing of mop water, separate from food preparation and service areas;

     (ii) Storage for wet mops, ventilated to the outside of the boarding home; and

     (iii) Locked storage for cleaning supplies.

     (2) For boarding homes issued a project number by construction review services on or after September 1, 2004, the boarding home must provide housekeeping supply room(s):

     (a) Located on each floor of the boarding home;

     (b) In proximity to laundry and kitchen areas; and

     (c) Equipped with:

     (i) A utility sink or equivalent means of obtaining and disposing of mop water, away from food preparation and service areas;

     (ii) Storage for wet mops;

     (iii) Locked storage for cleaning supplies; and

     (iv) Mechanical ventilation to the outside of the boarding home.

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     (1) The residents' characteristics and needs;

     (2) The degree of hazardousness or toxicity posed by the supplies or equipment;

     (3) Whether or not the supplies and equipment are commonly found in a private home, such as hand soap or laundry detergent; and

     (4) How residents with special needs are individually protected without unnecessary restrictions on the general population.

[]

     (a) A two-compartment sink for handwashing and sanitizing;

     (b) A clinical service sink or equivalent for rinsing and disposing of waste material;

     (c) A work counter or table;

     (d) Mechanical ventilation to the outside of the boarding home; and

     (e) Locked storage for cleaning supplies, if stored in the area.

     (2) The boarding home must ensure that any work or function performed in or around a combined utility area as described in subsection (1) of this section is performed without significant risk of contamination to:

     (a) Storing or handling clean or sterile nursing supplies or equipment;

     (b) Storing or handling clean laundry;

     (c) Providing resident care;

     (d) Food storage, preparation, or service; or

     (e) Other operations, services of functions in the boarding home sensitive to infection control practices.

[]

     (1) Equips the area with:

     (a) A handwashing sink; and

     (b) A work counter or table.

     (2) Ensures that any work or function performed in the area is performed without significant risk of contamination from other sources; and

     (3) Stores medications separate from all other stored items consistent with WAC 388-78A-2260.

[]

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     (1) Cooperate with the department during any on-site inspection or complaint investigation;

     (2) Provide requested records to the representatives of the department; and

     (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.

[]

     (2) The licensee must respond to a statement of deficiencies by submitting to the department within a time acceptable to the department, a signed written plan of correction for each deficiency stated in the report. The licensee must include in the plan of correction, for each cited deficiency:

     (a) A specific plan of what will be or was done to correct the problem;

     (b) A description of what will be done to prevent future problems of this type;

     (c) Who will be responsible for monitoring the corrections to ensure the problems do not recur; and

     (d) The date by which lasting correction will be achieved.

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     (a) Denying a boarding home license;

     (b) Suspending a boarding home license;

     (c) Revoking a boarding home license;

     (d) Refusing to renew a boarding home license;

     (e) Suspending admissions to a boarding home;

     (f) Suspending admissions to a boarding home of a specific category or categories of residents as related to cited problems;

     (g) Imposing conditions on the boarding home license; and/or

     (h) Imposing civil penalties of not more than one hundred dollars per day per violation.

     (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).

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     (a) A history of significant noncompliance with federal or state laws or regulations in providing care or services to frail elders, vulnerable adults or children, whether as a licensee, contractor, managerial employee or otherwise. Evidence of significant noncompliance may include, without limitation:

     (i) Citations for violation of laws or regulations imposed by regulating entities;

     (ii) Sanctions for violation of laws or regulations imposed by regulating entities;

     (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;

     (iv) Been denied a license relating to the care of frail elders, vulnerable adults or children; or

     (v) Relinquished or failed to renew a license relating to care of frail elders, vulnerable adults or children following written notification of the licensing agency's initiation of denial, suspension, cancellation or revocation of a license.

     (b) Failed to provide appropriate care to frail elders, vulnerable adults or children under a contract, or having such contract terminated or not renewed by the contracting agency due to such failure;

     (c) Been convicted of a felony, or a crime against a person, if the conviction reasonably relates to the competency of the person to operate a boarding home;

     (d) Failed or refused to comply with the requirements of chapter 18.20 RCW, applicable provisions of chapter 70.129 RCW or this chapter;

     (e) Retaliated against a staff person, resident or other individual for:

     (i) Reporting suspected abuse or other alleged improprieties;

     (ii) Providing information to the department during the course of the department conducting an inspection of the boarding home; or

     (iii) Providing information to the department during the course of the department conducting a complaint investigation in the boarding home.

     (f) Operated a facility for the care of children or adults without a current, valid license or under a defunct or revoked license;

     (g) Been convicted of a crime committed on a boarding home premises; 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;

     (h) Abused, neglected or exploited a vulnerable adult or knowingly failed to report alleged abuse, neglect or exploitation of a vulnerable adult as required by chapter 74.34 RCW;

     (i) Failed to exercise fiscal accountability and responsibility involving a resident, the department, public agencies, or the business community; or to have insufficient financial resources or unencumbered income to sustain the operation of the boarding home;

     (j) Knowingly or with reason to know, made false statements of material fact in the application for the license or the renewal of the license or any data attached thereto, or in any matter under investigation by the department;

     (k) 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;

     (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;

     (m) Moved all residents out of the boarding home without the department's approval and to be no longer operating as a boarding home; or

     (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.

     (2) This section applies to any boarding home:

     (a) Applicant;

     (b) Partner, officer or director;

     (c) Manager or managerial employee; or

     (d) Majority owner of the applicant or licensee:

     (i) Who is involved in the management or operation of the boarding home;

     (ii) Who may have direct access to boarding home residents;

     (iii) Who controls or supervises the provision of care or services to boarding home residents; or

     (iv) Who exercises control over daily operations of the boarding home.

     (3) For other circumstances resulting in discretionary enforcement remedies, see WAC 388-78A-3200.

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     (1) A serious problem, a recurring problem, or an uncorrected problem;

     (2) Created a hazard that causes or is likely to cause death or serious harm to one or more residents;

     (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

     (4) Willfully interfered with the performance of official duties by a long-term care ombudsman.

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     (a) Convicted of a crime against a person or a crime related to financial exploitation as defined under RCW 43.43.830 or 43.43.842; or

     (b) Found by a court in a protection proceeding or in a civil damages lawsuit under chapter 74.34 RCW to have abused, neglected, abandoned or exploited a vulnerable adult; or

     (c) Found in any dependency action under chapter 13.34 RCW to have sexually assaulted, neglected, exploited, or physically abused any minor; or

     (d) Found by a court in a domestic relations proceeding under Title 26 RCW to have sexually abused, exploited, or physically abused any minor; or

     (e) Found in any final decision issued by a disciplinary board to have sexually or physically abused or neglected or exploited any minor or any vulnerable adult, or has a stipulated finding of fact, conclusion of law, an agreed order, or finding of fact, conclusion of law, or final order issued by a disciplining authority, a court of law, or entered into a state registry finding him or her guilty of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW.

     (2) This section applies to any boarding home:

     (a) Applicant;

     (b) Partner, officer or director;

     (c) Manager or managerial employee; or

     (d) Owner of five percent or more of the applicant:

     (i) Who is involved in the operation of the boarding home; or

     (ii) Who may have direct access to the boarding home residents; or

     (iii) Who controls or supervises the provision of care or services to the boarding home residents; or

     (iv) Who exercises control over daily operations.

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     (a) Require a plan of correction from the boarding home;

     (b) Impose conditions on the boarding home license; and/or

     (c) Impose a civil penalty.

     (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:

     (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

     (b) The threatening problem is more than an isolated event or occurrence.

     (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:

     (a) There is an imminent threat that a serious degree of harm may occur to residents as a result of a single problem or a combination of problems; and

     (b) The threatening problem is more than an isolated event or occurrence.

     (4) The department may take any of the actions specified in subsections (1), (2) and (3) of this section and/or revoke a boarding home's license when:

     (a) The department has cause to summarily suspend the boarding home's license;

     (b) There is a current problem with the boarding home and the boarding home has a history of having enforcement remedies imposed by the department;

     (c) There is a current problem with the boarding home and the boarding home has a history of noncompliance representing problems that were at least moderate in nature and moderate in scope;

     (d) The 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

     (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:

     (i) The licensee has been found or convicted by a court of competent jurisdiction to have engaged in fraudulent activity; or

     (ii) The licensee is experiencing significant financial problems resulting in poor care or jeopardizing the care and services that can be provided to residents, and possible business failure; or

     (f) The boarding home fails to cooperate with the department during any inspection or complaint investigation.

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[]

     (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.

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     (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;

     (2) Submit an additional one hundred fifty dollars when billed by the department for:

     (a) A third on-site visit required by the boarding home's failure to adequately correct problems identified in a statement of deficiencies; and

     (b) A full out-of-sequence inspection resulting from information gathered during a complaint investigation.

     (3) Submit an additional late fee in the amount of ten dollars per day from the license renewal date until the date of mailing the fee, as evidenced by the postmark; and

     (4) Submit to construction review services a fee for the review of the construction documents per the review fee schedule that is based on the project cost.

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     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.

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