Effective Date of Rule: September 1, 2007.

     Purpose: The purpose of the new companion home residential services chapter is to consolidate information governing the operation of companion home residential services for ease of reference by the user. This chapter consolidates existing standards in chapters 388-825, 388-845, and 388-101 WAC, and existing requirements found in policy and contract into one chapter for easier reference. There is a new requirement for companion home providers to keep property records for the companion home client.

     This rule is being adopted as chapter 388-829C WAC and has been separated from the rules for alternative living services which will be adopted under chapter 388-829A WAC. These changes will make finding companion home residential services rules easier for the user.

     Reasons support proposal: See Purpose above.

     Statutory Authority for Adoption: RCW 71A.12.30 [71A.12.030].

     Other Authority: Title 71A RCW.

      Adopted under notice filed as WSR 07-11-132 on May 22, 2007.

     A final cost-benefit analysis is available by contacting Debbie Roberts, 640 Woodland Square Loop S.E., Lacey, WA 98504, phone (360) 725-3400, fax (360) 404-0955, e-mail roberdx@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     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 52, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 52, Amended 0, Repealed 0.

     Date Adopted: July 31, 2007.

Robin Arnold-Williams

Secretary

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     "ADSA" means the aging and disability services administration within DSHS and its employees and authorized agents.

     "Adult Protective Services" or "APS" means the investigative body designated by ADSA to investigate suspected cases of abandonment, abuse, financial exploitation and neglect as defined in 74.34 RCW.

     "Calendar year" means the twelve month period that runs from January 1 through December 31.

     "Case Manager" means the DDD case resource manager or social worker assigned to a client.

     "Client" means a person who has a developmental disability as defined in RCW 71A.10.020(3) who also has been determined eligible to receive services by the division under chapter 71A.16 RCW.

     "Competence" means the capacity to do what one needs and wants to do. There are two ways to be competent. A person may be self-reliant and able to do things for themselves or may have the power to identify and obtain the help needed from others.

     "DDD" or "the division" means the division of developmental disabilities, a division within the DSHS aging and disabilities services administration, of the department of social and health services.

     "DDD Specialty Training" means department approved curriculum to provide information and instruction to meet the special needs of people with developmental disabilities.

     "DSHS" or "the department" means the state of Washington department of social and health services and its employees and authorized agents.

     "Health and Safety" means clients should live safely in environments common to other citizens with reasonable supports offered to simultaneously protect their health and safety while promoting community inclusion

     "Individual Support Plan" or "ISP" is a document that authorizes and identifies the DDD paid services that meet a client's assessed needs.

     "Integration" means clients being present and actively participating in the community using the same resources and doing the same activities as other citizens.

     "Mandatory Reporter" means any person working with vulnerable adults required by law to report incidents of abandonment, abuse, neglect, financial exploitation, etc., per chapter 74.34 RCW.

     "NA-R" means nursing assistant-registered under chapter 18.88A RCW.

     "NA-C" means nursing assistant-certified under chapter 18.88A RCW.

     "Positive recognition by self and others" means a client being offered assistance in ways which promote the client's status and creditability. Providers offer assistance in ways that are appropriate to the age of the client, typical to other members of the community and contribute to the client's feelings of self worth and positive regard by others.

     "Positive Relationships" means clients having friends and family that offer essential support and protection. Friends and family lend continuity and meaning through life and open the way to new opportunities and experiences.

     "Power and Choice" means clients experiencing power, control and ownership of personal affairs. Expression of personal power and choice are essential elements in the lives of people. Such expressions help people gain autonomy, become self-governing and pursue their own interests and goals.

     "Registered Nurse Delegation" means the process by which a registered nurse transfers the performance of selected nursing tasks to a registered or certified nursing assistant in selected situations. (For detailed information, please refer to chapter 18.79 RCW and WAC 388-840-910 through 388-840-970.)

     "Regulation" means any federal, state, or local law, rule, ordinance or policy.

     "Respite" means care that is intended to provide short-term intermittent relief for persons providing care for Companion Home clients.

     "RCW" means the Revised Code of Washington, which contains all laws governing the state of Washington.

     "Service Episode Record" or "SER" means documentation by DDD of all client related contacts including contacts during the assessment, service plan, coordination and monitoring of care and termination of services.

     "Unusual Incidents" means a change in circumstances or events that concern a client's safety or well being. Examples include, an increased frequency, intensity, or duration of any medical conditions, adverse reactions to medication, hospitalization, death, severe behavioral incidents, severe injury, running away, physical or verbal abuse to themselves or others.

     "WAC" means the Washington Administrative Code, which contains the rules for administering the state laws (RCW).

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     (2) Companion home residential services provide twenty-four hour instruction and support services.

     (3) Companion home residential services are based on the client's ISP.

     (4) Companion home residential services are provided by an independent contractor.

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     (1) Be at least eighteen years old;

     (2) Have an assessed need for companion home services; and

     (3) Meet one of the following conditions:

     (a) Be authorized by DDD to receive companion home residential services, as outlined in this chapter; or

     (b) Have a written agreement with the provider to purchase companion home residential services using the client's own personal financial resources.

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     (1) Be twenty-one years of age or older;

     (2) Have a high school diploma or GED;

     (3) Clear a background check conducted by DSHS as required by RCW 43.20A710;

     (4) Have an FBI fingerprint-based background check as required by RCW 43.20A.710, if the person has not lived in the state continuously for the previous three years;

     (5) Have a business ID number, as an independent contractor; and

     (6) Meet the minimum skills and abilities described in WAC 388-829C-080.

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     (1) The client's spouse.

     (2) The client's natural, step, or adoptive parents.

     (3) The client's court-appointed legal representative.

     (4) Any person providing department paid services to any other DSHS client.

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     (2) The provider's home must be approved by DDD, to assure client health, safety, and well-being consistent with the requirements in this chapter.

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     (a) Are at least sixteen years old; and

     (b) Reside in the companion home.

     (2) Household residents who have not lived in Washington continuously for the previous three years must also have an FBI fingerprint-based background check as required by RCW 43.20A.710.

     (3) Background checks must be completed every two years or more frequently when requested by the department.

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     (1) Be able to read, understand, and provide services outlined in the ISP;

     (2) Participate in the development of the ISP;

     (3) Communicate in the language of the client served;

     (4) Accommodate the client's individual preferences;

     (5) Know the community resources, such as: medical facilities, emergency resources, and recreational opportunities;

     (6) Enable the client to keep in touch with family and friends in a way preferred by the client;

     (7) Protect the client's financial interests;

     (8) Fulfill reporting requirements as required in this chapter and the companion home contract;

     (9) Know how and when to contact the client's representative and the client's case manager;

     (10) Successfully complete the training required in this chapter;

     (11) Maintain all necessary license, registration and certification required under this chapter, (see WAC 388-829C-110, 388-829C-130, 388-829C-190, and 388-829C-260); and

     (12) Comply with all applicable laws, regulations and contract requirements.

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     (1) Health and safety;

     (2) Personal power and choice;

     (3) Competence and self-reliance;

     (4) Positive recognition by self and others;

     (5) Positive relationships; and

     (6) Integration in the physical and social life of the community.

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     (1) The same legal rights and responsibilities guaranteed to all other individuals by the United States Constitution and federal and state law;

     (2) The right to be free from discrimination because of race, color, national origin, gender, age, religion, creed, marital status, disabled or veteran status, use of a trained service animal or the presence of any physical, mental or sensory handicap;

     (3) The right to treatment and habilitation services to foster developmental potential and protect personal liberty in the least restrictive environment;

     (4) The right to dignity, privacy, and humane care;

     (5) The right to participate in an appropriate program of publicly supported education;

     (6) The right to prompt medical care and treatment;

     (7) The right to social interaction and participation in community activities;

     (8) The right to physical exercise and recreational opportunities;

     (9) The right to work and be paid for the work one does;

     (10) The right to be free from harm, including unnecessary physical restraint, isolation, excessive medication, abuse, neglect, or financial exploitation;

     (11) The right to be free from hazardous or experimental procedures;

     (12) The right to freedom of expression and to make decisions about one's life;

     (13) The right to complain, disagree with, and appeal decisions made by the provider or DDD; and

     (14) The right to be informed of these rights in a language that he or she understands.

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     (1) Obtain CPR and first aid certification;

     (2) Successfully complete Blood-Borne Pathogens training with HIV/AIDS information; and

     (3) Receive contract orientation and client specific training from DDD.

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     (1) Maintain current CPR and First Aid Certification;

     (2) Receive Blood Borne Pathogens training with HIV/AIDS information at least annually and within one year of the previous training; and

     (3) Complete at least ten hours of continuing education each calendar year after the calendar year in which they successfully complete DDD approved specialty training.

     (a) The continuing education must be on topics that will directly benefit the client being served.

     (b) One hour of completed classroom instruction or other form of training (such as a video or on-line course) equals one hour of continuing education.

     (4) Documentation of training attendance must be kept in the provider's files and submitted to DDD upon completion of the training.

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     (2) Companion home providers must comply with DDD's residential reporting requirements specified in the companion home contract.

     (3) Providers must retain a signed copy of the DDD policy on residential reporting requirements specified in the companion home contract and submit a signed copy of the policy to DDD.

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     (1) Adult protective services using the DSHS toll free telephone number, provided by the department. 1-866-END-HARM or 1-866-363-4276;

     (2) DDD in compliance with the DDD residential reporting requirements as specified in the companion home contract; and

     (3) Law enforcement agencies, as required under chapter 74.34 RCW, including when there is reason to suspect sexual or physical abuse.

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     (1) Arranging appointments and accessing health, mental health, and dental services;

     (2) Ensuring the client receives an annual physical and dental examination, unless the physician or dentist gives a written exemption. For client refusal of services, see WAC 388-829C-310;

     (3) Observing the client for changes(s) in health, taking appropriate action and responding to emergencies;

     (4) Managing medication assistance per chapter 246-888 WAC and administration per WAC 246-840-910 to 970 and per the DDD residential medication management requirements specified in the companion home contract;

     (5) Maintaining health records (see WAC 388-829C-280);

     (6) Assisting client with any medical treatment prescribed by health professionals that does not require registered nurse delegation or professionally licensed services;

     (7) Communicating directly with health professionals when needed; and

     (8) Providing a balanced, nutritional diet.

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     (a) Is able to put the medication into his or her mouth or apply or instill the medication; and

     (b) Is aware that they are receiving medication.

     (2) Some tasks that may be provided under the Medication Assistance, chapter 246-888 WAC, are listed in the following chart. Medication assistance may only be provided if the client meets both criteria in (a) and (b) of this section.

Medication Assistance Task	May a companion home provider complete this task if the client meets both criteria in (a) and (b) of this section?
Remind or coach the client to take their medication.	Yes
Open the medication container.	Yes
Hand client the medication container.	Yes
Place medication in the client's hand;	Yes
Transfer medication from a container to another for the purpose of an individual dose (e.g., pouring liquid medication from a container to a calibrated spoon, medication cup or adaptive device).	Yes
Alter a medication by crushing, mixing, etc.	Yes, if the client is aware that the medication is being altered or added to food or beverage. A pharmacist or other qualified practitioner must determine it is safe to alter a medication and this must be documented on the prescription container or in the client's record.
Handing the client a pre-filled insulin syringe.	Yes, but the client must be able to inject the insulin by him or herself.
Guide or assist client to apply or instill skin, nose, eye and ear preparations.	Yes, but hand-over-hand administration is not allowed.
Assistance with injectable or IV medications.	No, this is not allowed.
Hand-over-hand assistance with medication.	No, may only be done under registered nurse delegation.
Assistance with medication beyond the examples provided above.	No, may only be done under registered nurse delegation.

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     (1) Be a registered nurse (RN) or licensed practical nurse (LPN); or

     (2) Be delegated to perform nursing care tasks by a register nurse as described in WAC 388-829C-190.

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     (1) Verify with the delegating registered nurse that they have complied with chapter 18.79 RCW and 18.88 RCW and WAC 246-840-910 through 246-840-990 by presenting:

     (a) A current NA-R or NA-C registration without restriction;

     (b) Certification showing completion of the "Nurse Delegation for Nursing Assistants" class; and

     (c) Certification showing completion of "Fundamentals of Caregiving" if the Companion Home provider is an NA-R.

     (2) Receive client-specific training from the delegating registered nurse; and

     (3) Renew nursing assistant registration/certification annually.

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     (2) If the companion home provider is not eligible to perform nursing tasks, the task must be provided by a person legally authorized to do so such as an RN or LPN.

     (3) The companion home provider must become eligible to perform nursing tasks within thirty days of the client being assessed to need medication administration.

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     (a) Written instructions for performing the delegated task from the delegating RN;

     (b) The most recent six months of documentation showing that the task was performed; and

     (c) Validation of their current nursing assistant registration or certification.

     (2) These records must be kept in the companion home and be accessible to the delegating nurse at all times.

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     (a) Determine and document the client's needs; and

     (b) Identify the services to meet those needs.

     (2) The existing plan of care (POC) for the client remains in effect until a new ISP is developed.

     (3) The ISP must include (see chapter 388-828 WAC):

     (a) The client's identified health and welfare needs;

     (b) Both paid and unpaid services approved to meet the identified health and welfare needs;

     (c) How often the client will receive each service;

     (d) How long the client will need each service; and

     (e) Who will provide each service.

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     (1) The companion home where the client resides;

     (2) Other places as designated in WAC 388-845-1610.

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     (1) Carry automobile insurance per chapters 46.29 and 46.30 RCW; and

     (2) Have a valid driver's license per chapter 46.20 RCW.

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     (1) There is written consent from the client, when the client has no court appointed legal representative; or

     (2) There is written consent from the client's court appointed legal representative for making financial decisions for the client; or

     (3) The companion home provider is the designated payee for the client's earned and unearned income.

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     (1) Keep the client's accounts current by maintaining a running balance;

     (2) Reconcile the client's accounts, including cash accounts, on a monthly basis;

     (3) Prevent the client's account from becoming overdrawn;

     (4) Keep receipts for purchases over twenty-five dollars;

     (5) Assist the client with any checks, if applicable;

     (6) Protect the client's financial interests; and

     (7) Ensure that the client is informed regarding how his or her money is being spent and that the client participates to the maximum extent possible in the decision making regarding his or her funds, consistent with responsible management of funds.

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     (2) DDD may terminate the companion home contract if the provider has mismanaged client funds.

     (3) Suspected exploitation of client finances must be reported to law enforcement and adult protective services.

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     (1) All accounts must include the following documents:

     (a) Monthly bank statements and reconciliations initialed by the provider;

     (b) Checkbook registers and bankbooks;

     (c) Deposit receipts; and

     (d) Receipts for purchases over twenty-five dollars.

     (2) If the companion home provider manages the client's funds or is the payee, they must notify DDD when they are aware that the client's funds reach one-thousand seven hundred dollars.

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     (2) The monthly room and board the client pays to the provider is specified in a room and board agreement and includes rent, utilities, and food.

     (3) The room and board agreement must be:

     (a) Developed by the client and the provider before the client moves into the companion home;

     (b) Signed by the client, the client's legal representative and the provider; and

     (c) Submitted to DDD for approval.

     (4) Changes to the room and board agreement must be submitted to DDD for approval.

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     (a) A safe and healthy environment;

     (b) A separate bedroom;

     (c) Accessible telephone equipment with local 911 access;

     (d) A list of emergency contact numbers accessible to the client;

     (e) An evacuation plan developed, posted, and practiced monthly with the client;

     (f) An entrance and/or exit that does not rely solely upon windows, ladders, folding stairs, or trap doors;

     (g) A safe storage area for flammable and combustible materials;

     (h) Unblocked exits;

     (i) Working smoke detectors which are located close to the client's room and meet the specific needs of the client;

     (j) A flashlight or other non electrical light source in working condition;

     (k) Fire extinguisher meeting the fire department standards; and

     (l) Basic first-aid supplies.

     (2) The companion home must be accessible to meet the client's needs.

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     (1) The water temperature in the household must be kept between 105 degrees and 120 degrees Fahrenheit.

     (2) The provider must check the water temperature when the client first moves into the household and at least every six months from then on. (Note: The water temperature is best measured two hours after substantial hot water usage.)

     (3) The companion home provider must document compliance with this requirement.

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     (1) Client information:

     (a) The client's name, address, and social security number;

     (b) The name, address, and telephone number of the client's legal representative and any of the client's relatives that the client chooses to include;

     (c) Client health records, including:

     (i) The name, address, and telephone number of the client's physician, dentist, mental health service provider, and any other health care service provider;

     (ii) Instructions from health care service providers about necessary health care, including appointment dates;

     (iii) Written documentation that the instructions from health care service providers have been followed;

     (iv) Medication, health, and surgery records; and

     (v) A record of known surgeries and major health events;

     (d) Copies of legal guardianship papers;

     (e) A copy of the client's most recent ISP;

     (f) Copies of any positive behavior support plan or cross systems crisis plan, if applicable;

     (g) Financial records, if managing client funds (see WAC 388-829C-300);

     (h) Client property records (see WAC 388-829C-380);

     (i) Signed release of information forms; and

     (j) Burial plans and wills.

     (2) Provider information:

     (a) Water temperature monitoring records (see WAC 388-829C-330);

     (b) Provider training records (see WAC 388-829C-110 through 388-829C-130);

     (c) Evacuation plan and practice records;

     (d) Emergency response plan (see WAC 388-829C-410);

     (e) All written reports submitted to DDD (see WAC 388-829C-350);

     (f) Signed DDD policy on residential reporting requirements (see WAC 388-829C-140);

     (g) Nurse delegation records (see WAC 388-829C-210); and

     (h) Payment records.

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     (a) Reports that describe the instruction and support activities performed as identified in the ISP. These reports must be submitted every six months or more frequently upon request of DDD.

     (b) Reports on unusual incidents and emergencies as required in the DDD residential reporting requirements specified in the companion home contract.

     (c) Reports on client refusal of services as described in this chapter (WAC 388-829C-370).

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     (a) Note all record entries in ink or electronically;

     (b) Make entries at the time of or immediately following the occurrence of the event recorded;

     (c) Make entries in legible writing; and

     (d) Initial and date entries in ink.

     (2) If a provider makes a mistake on the record, the provider must show both the original and corrected entries.

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     (a) Physical and safety requirements as outlined in WAC 388-829C-320; and

     (b) Health services as outlined in WAC 388-829C-160.

     (2) When a client refuses to participate in these services, companion home providers must:

     (a) Record a description of events relating to the client's refusal to participate in these services;

     (b) Inform the client of the benefits of these services; and

     (c) Provide the client or the client's legal representative and DDD with:

     (i) A description of the service provider's efforts to give the services to the client; and

     (ii) Any health or safety concerns that the refusal may pose.

     (3) Companion home providers must submit this information to DDD in a written report as soon as possible following the client's refusal.

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     (1) A list of items including a description, and serial numbers of items that are valued at seventy-five dollars or over; and were owned by the client when moving into the program.

     (2) A list of items including a description, date of purchase and cost of items that are valued at seventy-five dollars or over and have been acquired by the client while living with the companion home provider.

     (3) The record must contain dates and reasons for all items removed from the client's property record.

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     (1) Any transfer or inspection of records, to parties other than DSHS, must be authorized by a release of information form that:

     (a) Specifically gives information about the transfer or inspection; and

     (b) Is signed by the client or the client's legal representative.

     (2) A signed release of information is valid for up to one year and must be renewed annually from the signature date.

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     (2) In an emergency, the companion home provider must:

     (a) Immediately call 911, in a life threatening emergency;

     (b) Provide emergency services, then notify:

     (i) The client's legal representative; and

     (ii) The division of developmental disabilities.

     (c) Submit a written report to DDD, as required by the DDD residential reporting requirements specified in the companion home contract.

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     (2) Following the initial evaluation, the companion home provider must be evaluated at least every twelve months.

     (3) DDD may conduct additional reviews at its discretion.

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     (1) Allowing scheduled and unscheduled home visits by DDD staff and the DDD contracted evaluators;

     (2) Providing information and documentation as requested by the DDD and the DDD contracted evaluators; and

     (3) Cooperating in setting up appointments with DDD and the DDD contracted evaluators.

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     (1) The corrective action plan must:

     (a) Outline methods for the provider to comply with the required corrections; and

     (b) Provide a time-frame for the provider to complete the corrective actions.

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     (1) Is no longer the client's choice of provider.

     (2) Demonstrates inadequate performance or inability to deliver quality care which is jeopardizing the client's health, safety, or well-being. DDD may terminate the contract based on a reasonable, good faith belief that the client's health, safety, or well-being is in imminent jeopardy.

     (3) Is unable to clear a background check or other individuals living in the companion home are unable to clear a background check required by RCW 43.20A.710.

     (4) Has been convicted of a disqualifying crime, under RCW 43.43.830 and 43.43.842 or of a crime relating to drugs as defined in RCW 43.43.830.

     (5) Has abused, neglected, abandoned, or exploited a minor or vulnerable adult, as defined in chapter 74.34 RCW.

     (6) Has had a license, certification, or a contract for the care of children or vulnerable adults denied, suspended, revoked, or terminated for noncompliance with state and/or federal regulations.

     (7) Does not successfully complete the training requirements within the time limits required in this chapter.

     (8) Does not complete the corrective actions within the agreed upon time frame.

     (9) Fails to comply with the requirements of this chapter or the companion home contract.

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     (1) The person is the client's spouse, under 42 C.F.R. 441.360(g).

     (2) The person is the client's natural/step/adoptive parent.

     (3) The person is the client's court-appointed legal representative, unless the provider was contracted and paid to provide companion home services before February 2005.

     (4) DDD has a reasonable, good faith belief that the provider will be unable to meet the client's needs. Examples of a provider's inability to meet the client's needs may include:

     (a) Evidence of alcohol or drug abuse;

     (b) A reported history of domestic violence, no-contact orders, or criminal conduct (whether or not the conduct is disqualifying under RCW 43.43.830 and 43.43.842);

     (c) A report from the client's health care provider or another knowledgeable person that the requested provider lacks the ability or willingness to provide adequate support;

     (d) Other employment or responsibilities that prevent or interfere with the provision of required services; or

     (e) A reported history of mismanagement of client funds or DSHS contract violations.

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     (a) Give at least thirty days written notice to:

     (i) The client;

     (ii) The client's legal representative; and

     (iii) DDD.

     (2) If an emergency occurs and services must be terminated immediately, the provider must give immediate notice to DDD, the client, and the client's representative.

     (3) The companion home provider will be expected to continue working for thirty days unless otherwise determined by DDD.

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