PERMANENT RULES
SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Effective Date of Rule: January 1, 2008.
Purpose: The department is repealing all existing sections in chapter 388-76 WAC, Adult family home minimum licensing requirements, and is adopting new sections in chapter 388-76 WAC, Adult family home minimum licensing requirements.
The purpose of the rules are to:
(1) Comply with the Governor's Executive Order 05-03 plain talk;
(2) Simplify language, eliminate the question and answer format, reorganize and renumber the chapter so that the requirements are clearer for adult family home providers to understand;
(3) Clarify issues that have been brought to the attention of the department; and
(4) Update rules to comply with statute changes.
The department is withdrawing WAC 388-76-11000 through 388-76-11045 and has filled [filed] a new preproposal statement of inquiry (CR-101) for the resident protection program with the code reviser in WSR 07-15-026.
The effective date of this rule is January 1, 2008.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-76-535, 388-76-540, 388-76-545, 388-76-550, 388-76-555, 388-76-560, 388-76-565, 388-76-570, 388-76-575, 388-76-580, 388-76-585, 388-76-590, 388-76-59000, 388-76-59010, 388-76-59050, 388-76-59060, 388-76-59070, 388-76-59080, 388-76-59090, 388-76-595, 388-76-600, 388-76-60000, 388-76-60010, 388-76-60020, 388-76-60030, 388-76-60040, 388-76-60050, 388-76-60060, 388-76-60070, 388-76-605, 388-76-610, 388-76-61000, 388-76-61010, 388-76-61020, 388-76-61030, 388-76-61040, 388-76-61050, 388-76-61060, 388-76-61070, 388-76-61080, 388-76-615, 388-76-61500, 388-76-61510, 388-76-61520, 388-76-61530, 388-76-61540, 388-76-61550, 388-76-61560, 388-76-61570, 388-76-620, 388-76-625, 388-76-630, 388-76-635, 388-76-64010, 388-76-64015, 388-76-64020, 388-76-64025, 388-76-64030, 388-76-64035, 388-76-64040, 388-76-64045, 388-76-64050, 388-76-64055, 388-76-645, 388-76-650, 388-76-655, 388-76-660, 388-76-665, 388-76-670, 388-76-675, 388-76-680, 388-76-685, 388-76-690, 388-76-695, 388-76-700, 388-76-705, 388-76-710, 388-76-715, 388-76-720, 388-76-725, 388-76-730, 388-76-735, 388-76-740, 388-76-745, 388-76-750, 388-76-755, 388-76-760, 388-76-76505, 388-76-76510, 388-76-76515, 388-76-76520, 388-76-770, 388-76-775, 388-76-780, 388-76-785, 388-76-790, and 388-76-795.
Statutory Authority for Adoption: RCW 70.128.040.
Other Authority: Chapters 70.128 and 74.34 RCW.
Adopted under notice filed as WSR 07-14-082 on June 29, 2007.
Changes Other than Editing from Proposed to Adopted Version:
WAC 388-76-10000 Definitions.
"Abandonment" means action or inaction by a person or entity with a duty of care for a frail elder or vulnerable adult that leaves the vulnerable person without the means or ability to obtain necessary food, clothing, shelter, or health care.
"Abuse" means:
(1) Tthe willful action or inaction that inflects injury,
unreasonable confinement, intimidation, or punishment on a
vulnerable adult;:
(21) In instances of abuse of a vulnerable adult 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; and
(32) Abuse includes sexual abuse, mental abuse, physical
abuse, and exploitation of a vulnerable adult, which have the
following meanings:
(a) "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, who is not also a resident or client, of a facility or a staff person of a program authorized under chapter 71A.12 RCW, and a vulnerable adult living in that facility or receiving service from a program authorized under chapter 71A.12 RCW, whether or not consensual.
(b) "Physical abuse" means a 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, chocking choking, kicking,
shoving, prodding, or chemical restraints unless the
restraints are consistent with licensing requirements, and
includes restraints that are otherwise being used
inappropriately.
(c) "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 vulnerable adult from family, friends, or regular activity, and verbal assault that includes ridiculing, intimidating, yelling, or swearing.
(d) "Exploitation" means an act of forcing, compelling, or exerting undue influence over a vulnerable adult causing the vulnerable adult to act in a way that is inconsistent with relevant past behavior, or causing the vulnerable adult to perform services for the benefit of another.
"Adult family home" means:
(1) A residential home in which a person or entity are licensed to provide personal care, special care, room, and board to more than one but not more than six adults who are not related by blood or marriage to the person or persons providing the services; and
(2) For the purposes of this chapter, any person or entity who has been granted a license to operate an adult family home.
"Affiliated with an applicant" means any person listed on the application as a partner, officer, director, resident manager, or majority owner of the applying entity, or is the spouse of the applicant.
"Applicant" means an individual, partnership, corporation, or other entity seeking a license to operate an adult family home.
"Capacity" means:
(1) Tthe maximum number of persons in need of personal or
special care permitted in an adult family home at a given
time; and
(2) Iincludes related children or adults in the home who
receive personal or special care and services.
"Caregiver" for purposes other than training, means any
person eighteen years of age or older responsible for
providing direct personal or special care to a resident and
who is not the provider, entity representative, or a student
or volunteer.
"Dementia" is defined as a condition documented through the assessment process required by WAC 388-76-10335.
"Department" means the Washington state department of social and health services.
"Department case manager" means the department authorized staff person or designee assigned to negotiate, monitor, and facilitate a care and services plan for residents receiving services paid for by the department.
"Developmental disability" means:
(1) A person who meets the eligibility criteria defined by the division of developmental disabilities under WAC 388-823-0040; 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 age twenty-two 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.
"Direct supervision" means oversight by a person who:
(1) Has demonstrated competency in the basic training and specialty training if required, or who has been exempted from the basic training requirements and is:
(a) On the premises; and
(b) Quickly and easily available to the caregiver.
"Direct supervision" means oversight by a person who:
(1) Hhas demonstrated competency in the basic training and specialty training if required, or who has been exempted from the basic training requirements and is:
(a1) On the premises; and
(b2) Quickly and easily available to the caregiver.
"Entity provider" means any corporation, partnership, association, or limited liability company that is licensed under this chapter to operate an adult family home.
"Entity representative" means the individual designated by an entity provider who is responsible for the daily operation of the adult family home.
"Financial exploitation" means the illegal or improper use of the property, income, resources, or trust funds of the vulnerable adult by any person for any person's profit or advantage other than for the vulnerable adult's profit or advantage.
"Home" means adult family home.
"Indirect supervision" means oversight by a person who:
(1) Has demonstrated competency in the basic training and specialty training if required; or
(2) Has been exempted from the basic training requirements; and
(3) Is quickly and easily available to the care giver, but not necessarily on-site.
"Inspection" means an on-site visit by department personnel to determine the adult family home's compliance with this chapter and chapters 70.128, 70.129, 74.34 RCW, and other applicable rules and regulations.
"Mandated reporter" means an employee of the department, law enforcement, officer, social worker, professional school personnel, individual provider, an employee of a facility, an employee of a social service, welfare, mental health, adult day health, adult day care, or hospice agency, county coroner or medical examiner, Christian Science practitioner, or health care provider subject to chapter 18.130 RCW.
For the purpose of the definition of a mandated reporter, "Facility" means a residence licensed or required to be licensed under chapter 18.20 RCW (boarding homes), chapter 18.51 RCW (nursing homes), chapter 70.128 (adult family homes), chapter 72.36 RCW (soldiers' homes), or chapter 71A.20 RCW (residential habilitation centers), or any other facility licensed by the department.
"Medical device" as used in this chapter, means any piece of medical equipment used to treat a resident's assessed need.
(1) A medical device is not always a restraint and should not be used as a restraint;
(2) Some medical devices have considerable safety risks associated with use; and
(3) Examples of medical devices with known safety risks when used are transfer poles, Posey or lap belts, and side rails.
"Medication administration" means giving resident medications by a person legally authorized to do so, such as a physician, pharmacist or nurse.
"Medication organizer" is a container with separate compartments for storing oral medications organized in daily doses.
"Mental illness" is defined as an Axis I or II diagnosed mental illness as outlined in volume IV of the Diagnostic and Statistical Manual of Mental Disorders (a copy is available for review through the aging and disability services administration).
"Multiple facility provider" means an individual or entity provider who is licensed to operate more than one adult family home.
"Neglect" means:
(1) a pattern of conduct or inaction by a person or
entity with a duty to of care that fails to provide the goods
and services that maintain physical or mental health of a
vulnerable adult, or that fails to avoid or prevent physical
or mental harm or pain to a vulnerable adult; 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 vulnerable adult's health, welfare, or safety, including but not limited to conduct prohibited under RCW 9A.41.100.
"Nurse delegation" means a registered nurse transfers the performance of selected nursing tasks to competent nursing assistants in selected situations. The registered nurse delegating the task retains the responsibility and accountability for the nursing care of the resident.
"Over-the-counter medication" is any medication that can be purchased without a prescriptive order, including but not limited to vitamin, mineral, or herbal preparations.
"Personal care services" means:
(1) Bboth physical assistance and/or prompting and
supervising the performance of direct personal care tasks as
determined by the resident's needs; and
(2) Ddoes not include assistance with tasks performed by a licensed health professional.
"Physical restraint" means a manual method, obstacle, or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that restricts freedom of movement or access to his or her body, is used for discipline or convenience, and is not required to treat the resident's medical symptoms.
"Practitioner" includes a physician, osteopathic physician, podiatric physician, pharmacist, licensed practical nurse, registered nurse, advanced registered nurse practitioner, dentist, and physician assistant licensed in the state of Washington.
"Prescribed medication" refers to any medication (legend drug, controlled substance, and over-the-counter) that is prescribed by an authorized practitioner.
"Provider" means any person or entity that is licensed under this chapter to operate an adult family home.
"Qualified staff" means a person who:
(1) Is employed, directly or by contract, by an adult family home; and
(2) Meets all of the requirements of a provider, entity representative, resident manager or caregiver.
"Resident" means:
(1) Aany adult unrelated to the provider who lives in the
adult family home and who is in need of care; and
(2) Ffor decision-making purposes, the term "resident" includes the resident's surrogate decision maker following state law or at the resident's request.
"Resident manager" means a person employed or designated by the provider or entity representative to manage the adult family home.
"Significant change" means:
(1) A lasting change, decline or improvement, in the resident's baseline physical, mental or psychosocial status;
(2) The change is significant enough so the current assessment and/or negotiated care plan do not reflect the resident's current status; and
(3) A new assessment may be needed when the resident's condition does not return to baseline within a two week period of time.
"Special care" means care beyond personal care services as defined in this section.
"Staff" means any person who:
(1) Is employed, directly or by contract, by an adult family home; and
(2) Provides care and services to any resident.
"Unsupervised" means not in the presence of:
(1) Another employee or volunteer from the same business or organization; or
(2) Any relative or guardian of any of the children or developmentally disabled persons or vulnerable adults to which the employee, student or volunteer has access during the course of his or her employment or involvement with the business or organization.
"Usable floor space" means resident bedroom floor space exclusive of:
(1) Toilet rooms;
(2) Closets;
(3) Lockers;
(4) Wardrobes;
(5) Vestibules, and
(6) The space required for the door to swing Iif the
bedroom door opens into the resident bedroom the space
required for the door to swing.
"Willful" means the deliberate or nonaccidental action or inaction by an alleged perpetrator that he/she knew or reasonably should have known could cause a negative outcome, including harm, injury, pain or anguish.
"Vulnerable adult" includes a person:
(1) Sixty years of age or older who has the functional, mental, or physical inability to care for himself or herself;
(2) Found incapacitated under chapter 11.88 RCW;
(3) Who has a developmental disability as defined under RCW 71A.10.020;
(4) Admitted to any facility;
(5) Receiving services from home health, hospice, or home care agencies licensed or required to be licensed under chapter 70.127 RCW; or
(6) Receiving services from a provider.
WAC 388-76-10020 License -- Ability to provide care and
services.
The adult family home must have the understanding,
ability, emotional stability and physical health suited to
meet the emotional and physical personal and special care
needs of vulnerable adults.
WAC 388-76-10040 License requirements -- Provider or entity
representative residence.
(1) The adult family home provider or entity
representative must either:
(a) Live in the home; or
(b) Employ or contract with a qualified resident manager
who lives in the home and is responsible for the care and
services of each resident at all times; or.
(2) The provider, entity representative or resident manager is exempt from the live-in requirement if the home has:
(ac) Provide Ttwenty-four hour staffing; and
(b2) A Ensure that a qualified staff person who can make
needed decisions is always present.
WAC 388-76-10120 License -- Must be denied.
The department must deny a license if the department finds any person or entity unqualified as follows:
(1) Has a history of prior violations of chapter 70.128 RCW or any law regulating to residential care facilities within the past five years that resulted in revocation, suspension, or nonrenewal of a license or contract with the department;
(2) When providing care or services to children or vulnerable adults:
(a) Has been found to be in significant noncompliance with federal or state regulations; or
(b) Had a license for the care of children or vulnerable adults suspended or revoked.
(3) For a period of twenty years after a provider surrendered or relinquished an adult family home license after notification of the department's intention to deny, suspend, not renew or revoke, in lieu of appealing the department's action;
(4) Been enjoined from operating a facility for the care and services of children or adults;
(5) A stipulated finding of fact, conclusion of law, an agreed order, or finding of fact, conclusion of law, final order issued by a disciplining authority or final decision by any federal or state agency or department, a court of law, or entered into a state registry or department or agency list with a finding of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW;
(6) Had a revocation or suspension of a license for the care of children or adults;
(7) Had a revocation, cancellation, suspension or nonrenewal of:
(a) A medicaid or medicare provider agreement by the contracting agency; or
(b) Any agreement with a public agency for the care and treatment of children or vulnerable adults, when the action was taken by the public agency.
(8) Been convicted of any crime listed in RCW 43.43.830 or 43.43.842;
(9) Been found by a court:
(a) In a protection proceeding under chapter 74.34 RCW to have abandoned, neglected, abused, or financially exploited a vulnerable adult; or
(b) In a domestic relations proceeding under Title 26 RCW to have sexually or physically abused, neglected or exploited any minor.
(10) Been found in any final decision issued by a disciplinary board to have:
(a) Sexually or physically abused, neglected or exploited any minor or a person with a developmental disability; or
(b) Abandoned, abused, neglected or financially exploited any vulnerable adult.
(11) Been found in any final decision by any federal or state agency or department to have abandoned, neglected, abused or financially exploited a vulnerable adult;
(12) Found in any dependency action under RCW 13.34.030 (5)(b) to have sexually or physically abused, neglected or exploited any minor;
(13) The home is currently licensed:
(a) As a boarding home; or
(b) To provide care for children in the same home, unless:
(i) It is necessary in order to allow a resident's child(ren) to live in the same home as the resident or to allow a resident who turns eighteen to remain in the home;
(ii) The applicant provides satisfactory evidence to the department of the home's capacity to meet the needs of children and adults residing in the home; and
(iii) The total number of persons receiving care and services in the home does not exceed the number permitted by the licensed capacity of the home.
(14) After January 1, 2007, if If the provider or entity
representative has not successfully completed a
department-approved forty-eight hour adult family home
administration and business planning class.
WAC 388-76-10240 Durable power of attorney for health care or
financial decisions.
The adult family home must not allow a provider, entity
representative, owner, administrator, or employees of the home
to act as a resident's power of attorney in fact for health
care decisions, according to chapter 11.94 RCW, unless the
provider, entity representative, owner, administrator, or
employee is the resident's:
(1) Spouse;
(2) Adult child; or
(3) Brother or sister.
WAC 388-76-10400 Care and services.
The adult family home must ensure each resident receives:
(1) The care and services identified in the negotiated care plan.
(2) The necessary care and services to help the resident reach the highest level of physical, mental, and psychosocial well-being consistent with resident choice, current functional status and potential for improvement or decline.
(3) The care and services in a manner and in an environment that:
(a) Actively supports, maintains or improves each resident's quality of life;
(b) Actively supports the safety of each resident; and
(c) Reasonably accommodates each resident's individual needs and preferences except when the accommodation endangers the health or safety of the individual or another resident.
(4) Services by the appropriate professionals based upon the resident's assessment and negotiated care plan, including nurse delegation if needed.
WAC 388-76-10420 Meals and snacks.
The adult family home must:
(1) Serve at least three meals:
(a) In each twenty-four hour period;
(b) At regular times comparable to normal meal times in the community; and
(c) That meet the nutritional needs of each resident.
(2) Provide Make nutritious snacks available to
residents:
(a) Between meals; and
(b) In the evening.
(3) Get input from residents' in meal planning and
scheduling;
(4) Serve nutrient concentrates, supplements, and modified diets only with written approval of the resident's physician;
(5) Only serve pasteurized milk; and
(6) Process any home-canned foods served in the home, according to the latest guidelines of the county cooperative extension service.
WAC 388-76-10430 Medication system.
(1) If the adult family home admits residents who need
medication assistance or medication administration services by
a legally authorized person, the home must have systems in
place to ensure:
(a) Tthe services provided meet the medication needs of
each resident; and
(b) Mmeet all related laws and rules relating to
medications.
(2) When providing medication assistance or medication administration for any resident, the home must ensure each resident:
(a) Assessment indicates the amount of medication assistance needed by the resident;
(b) Negotiated care plan identifies the medication service that will be provided to the resident;
(c) Medication log is kept current as required in WAC 388-76-1048010475;
(d) Receives medications as required.
(3) Records are kept which include a current list of prescribed and over-the-counter medications including name, dosage, frequency and the name and phone number of the practitioner as needed.
WAC 388-76-10440 Medication -- Assessment -- Identification of
amount of assistance needed when taking medications.
(1) The adult family home must:
(a) Ensure each resident assessment identifies the amount of assistance the resident needs when taking medications; and
(b) Let the practitioner know when the following may affect the resident's ability to take their medications:
(i) Resident's physical or mental limitations; and
(ii) The setting or environment where the resident lives.
(2) The amount of assistance needed by a resident when taking their medications is as follows:
(a) Independent with self-administration is when the
resident does not need help taking medications and is able to
directly take medications by eating or drinking, inhaling, by
shot, through the skin or other means;
(b) Self-administration with assistance, as described in chapter 246-888 WAC, is when a resident is assisted in taking their medication by a non-practitioner; and
(c) Medication administration is when medications are administered to the resident by a person legally authorized to do so, such as but not limited to a physician, nurse or pharmacist or through nurse delegation.
(3) The home must contact the resident's practitioner who will decide if a reassessment is necessary when:
(a) The resident has a change in the health status, medications, physical or mental limitations, or environment that might change the resident's need for medication assistance; or
(b) There is a need for a resident to have more than one type of medication assistance.
WAC 388-76-10445 Medication--Independent--Self-administration.
The adult family home must ensure residents who have
medication assistance assessed as independent with
self-administration:
(1) Administer their own medications; and
(2) Are allowed to keep their prescribed and over-the-counter medications securely locked in either their room or another agreed upon area if documented in the resident negotiated care plan.
WAC 388-76-10470 Medication--Timing--Special directions.
(1) The adult family home must ensure medications are given:
(a) At the specific time(s) ordered by the practitioner; and
(b) As follows, when the practitioner does not order a medication to be given at a specific time:
(i) One time per day, approximately every twenty four hours;
(ii) Two times a day, approximately twelve hours apart;
(iii) Three times a day, approximately six hours apart; and
(iv) Four times a day, approximately four hours apart.
(2) The home must ensure all directions given by the practitioner are followed when assisting or giving each resident medication. This includes but is not limited to:
(a) Before meals;
(b) After meals;
(c) With or without food; and
(d) At bed time.
WAC 388-76-10540 Resident rights -- Disclosure of fees and
notice requirements -- Deposits.
(1) Before admission, if the adult family home requires payment of an admissions fee, deposit, or a minimum stay fee, by or on behalf of a person seeking admission, the home must give the resident full disclosure in writing in a language the resident understands.
(2) The disclosure must include:
(a) A statement of the amount of any admissions fees, deposits, prepaid charges, or minimum stay fees;
(b) The home's advance notice or transfer requirements; and
(c) The amount of the deposits, admission fees, prepaid
charges, or minimum stay fees that will be refunded to the
resident or his - if the resident leaves the home.
(3) The home must ensure that the receipt of the disclosures required under subsection (1) of this section is in writing and signed and dated by the resident and the home.
(4) If the home does not provide these disclosures, the home must not keep the deposits, admission fees, prepaid charges, or minimum stay fees.
(5) If a resident dies, is hospitalized or is transferred and does not return to the home, the adult family home:
(a) Must refund any deposit or charges already paid less the home's per diem rate for the days the resident actually resided, reserved or retained a bed in the home in spite of any minimum stay policy or discharge notice requirements; except that
(b) May keep an additional amount to cover its reasonable and actual expenses incurred as a result of a private-pay resident's move, not to exceed five days per diem charges; unless the resident has given advance notice in compliance with the admission agreement.
(6) All adult family homes covered under this section are
required to refund any and all refunds due the resident or his
or within thirty days from the resident's date of discharge
from the home.
(7) Nothing in this section applies to provisions in contracts negotiated between a home or and a certified health plan, health or disability insurer, health maintenance organization, managed care organization, or similar entities.
(8) If the home requires the implementation of an
admission contract agreement by or on behalf of an individual
seeking admission the home must ensure the terms of the
contract agreement are consistent with the requirements of
this section, chapters 70.128, 70.129 and 74.34 RCW, and other
applicable state and federal laws.
WAC 388-76-10585 Resident rights -- Examination of inspection
results.
The adult family home must:
(1) Ensure each resident is given the ability an
opportunity to examine the most recent inspection report of
the home and related plans of correction; and
(2) Publicly post Post a notice in a visable location in
the home a notice that indicating the inspection report is
available for review.
WAC 388-76-10780 Toilets and bathing facilities.
(1) The adult family home must ensure the home has toilets and bathing facilities that provide each resident with privacy and include:
(a) One indoor flush toilet for each five persons including residents and household members in the home; and
(b) Sinks with hot and cold running water.
(2) Homes licensed after July 1, 2007, must ensure each
resident has access to a toilet, shower and or tub without
going through another resident's room.
WAC 388-76-10810 Fire extinguishers.
(1) The adult family home must have an approved five pound 2A:10B-C rated fire extinguisher on each floor of the home.
(2) The home must ensure the fire extinguishers are:
(a) Installed according to manufacturer recommendations;
(b) Inspected and serviced annually;
(c) In proper working order; and
(d) Readily available for use at all times.
(2) If required by the local fire authority, the home
must provide different fire extinguishers as in place of the
fire extinguishers required in subsection (1) of this section.
WAC 388-76-10845 Emergency drinking water supply.
The adult family home must have an on-site emergency supply of drinking water that:
(1) Will last for a minimum of seventy-two hours for each resident;
(2) Is at least three gallons for each resident; and
(3) Is stored in food grade plastic or glass containers;
rated for the storage of drinking water.
(4) Is chemically treated or replaced every six months; and
(5) Is stored appropriately.
WAC 388-76-10920 Inspection and investigation
reports -- Provided by department.
The department will mail or hand deliver the department's
inspection report to the provider or entity representative:
(1) Within ten working days of completion of the inspection of the home; or
(2) Within ten calendar days of completion of complaint
investigation the investigation if the home does not have a
deficiency.
The department is withdrawing WAC 388-76-11000 through
388-76-11045 and has filed a new preproposal statement of
inquiry (CR-101) for the resident protection program with the
code reviser, WSR 07-15-026.
WAC 388-76-11000 Resident protection program -- Abuse and
neglect reporting -- Required.
(1) In accordance with chapter 74.34 RCW, all adult family home providers, entity representatives, resident managers, owners, caregivers, staff, and students if the students provide care and services to residents; are mandated reporters and must report to the department when there is:
(a) A reasonable cause to believe that a vulnerable adult has been abandoned, abused, neglected, exploited or financially exploited, or
(b) Suspected abandonment, abuse, neglect, exploitation or financial exploitation of a vulnerable adult.
(2) Reports must be made to:
(a) The centralized toll free telephone number for reporting abandonment, abuse, neglect, exploitation or financial exploitation of vulnerable adults, provided by the department; and
(b) Law enforcement agencies, as required under chapter 74.34 RCW.
(3) The home must have policies and procedures complying with state law that specify reporting requirements for abandonment, abuse, neglect, exploitation, and financial exploitation of vulnerable adults.
WAC 388-76-11005 Resident protection
program--Investigation of mandated reports.
(1) The department will decide whether a report of abandonment, abuse, neglect, exploitation, or financial exploitation needs to be investigated, as per established procedures.
(2) The department investigation will include an investigation of allegations about one or more of the following:
(a) A provider;
(b) Entity representative;
(c) Anyone affiliated with a provider;
(d) Caregiver;
(e) Student or volunteer;
(f) Person living in the home who is not a resident; and
(g) A resident receiving care and services under this chapter.
(3) If, after completing an investigation, the department concludes that more likely than not the alleged perpetrator abandoned, abused, neglected, exploited, or financially exploited a resident, the department will make an initial finding against the perpetrator.
WAC 388-76-11010 Resident protection program -- Notice of
initial finding.
(1) The department will notify the alleged perpetrator in writing within ten working days of making an initial finding of abandonment, abuse, neglect, exploitation, or financial exploitation of a resident. The written notice must not include the identities of the alleged victim, reporter and witnesses.
(2) The department must make a reasonable, good faith effort to find the last known address of the alleged perpetrator.
(3) The time frame for notification can be extended beyond ten working days to include the time needed to translate the notification letter or make provisions for the safety of the alleged victim.
(4) Notice of the initial finding will be served as provided in chapter 388-02 WAC.
WAC 388-76-11015 Resident protection program -- Reporting
initial finding.
(1) In a manner consistent with confidentiality requirements concerning the resident, witnesses, and reporter, the department may provide notification of an initial finding to:
(a) Other divisions within the department;
(b) The agency or program identified under RCW 74.34.068 with which the alleged perpetrator is associated as an employee, volunteer, student or contractor;
(c) Law enforcement; and
(d) Other investigative authorities consistent with chapter 74.34 RCW.
(2) The notification will identify the finding as an initial finding.
WAC 388-76-11020 Resident protection program--Disputing
an initial finding.
(1) An alleged perpetrator of abandonment, abuse, neglect, exploitation, or financial exploitation of a resident may ask for an administrative hearing to challenge an initial finding made by the department.
(2) The request must be made in writing to the office of administrative hearings.
(3) The office of administrative hearings must receive the alleged perpetrator's written request for a hearing within thirty calendar days of the date the individual was served with notice of the initial finding.
(4) The written request for a hearing must include:
(a) The full legal name, current address and phone number of the alleged perpetrator;
(b) A brief explanation of why the alleged perpetrator disagrees with the initial finding;
(c) A description of any assistance needed in the administrative appeal process by the alleged perpetrator, including a foreign or sign language interpreter or any accommodation for a disability; and
(d) The alleged perpetrator's signature.
WAC 388-76-11025 Resident protection program -- Disclosure
of investigative and finding information.
(1) The alleged perpetrator may only use confidential information provided by the department as needed to challenge initial findings through the appeal process.
(2) Confidential information such as the name and other personal identifying information of the reporter, witnesses, or the resident will be redacted from documents by the department unless otherwise ordered by the administrative law judge consistent with chapter 74.34 RCW and other applicable state and federal laws.
WAC 388-76-11030 Resident protection program -- Hearing
procedures to dispute initial finding.
(1) Chapters 34.05 and 74.34 RCW, chapter 388-02 WAC, and the provisions of this chapter govern any appeal regarding an initial finding.
(2) If a conflict between the provisions of this chapter and chapter 388-02 WAC, the provisions of this chapter prevail.
(3) The administrative law judge must decide whether a preponderance of the evidence supports the initial finding that the alleged perpetrator abandoned, abused, neglected, exploited, or financially exploited a vulnerable adult, and must issue an initial order.
WAC 388-76-11035 Resident protection program--Appeal of
administrative law judge's initial order or finding.
(1) If the alleged perpetrator or the department disagrees with the administrative law judge's decision, either party may challenge this decision by filing a petition for review with the department's board of appeals under chapter 34.05 RCW and chapter 388-02 WAC.
(2) If the department appeals the administrative law judge's decision, the department will not change the finding in the department's records until a final hearing decision is issued.
WAC 388-76-11040 Resident protection program -- Finalizing
an initial finding.
(1) An initial finding becomes a final finding when:
(a) The department gives the alleged perpetrator notice of the initial finding pursuant to WAC 388-101-1110 and the alleged perpetrator does not ask for an administrative hearing;
(b) The administrative law judge:
(i) Dismisses the hearing following withdrawal of the appeal or default; or
(ii) Issues an initial order upholding the finding and the alleged perpetrator fails to appeal the initial order to the department's board of appeals; or
(c) The board of appeals issues a final order upholding the finding.
(2) The final finding is permanent and will not be removed from the department's records unless:
(a) Rescinded following judicial review; or
(b) The department decides to remove a single finding of neglect from its records based upon a written petition by the alleged perpetrator provided that at least one calendar year has passed since the finding was finalized and recorded.
WAC 388-76-11045 Resident protection program -- Reporting
final findings.
The department will report a final finding of abandonment, abuse, neglect, exploitation, and financial exploitation within ten working days to the following:
(1) The perpetrator;
(2) The provider or entity representative that was associated with the perpetrator during the time of the incident;
(3) The adult family home that is currently associated with the perpetrator, if known;
(4) The appropriate licensing authority; and
(5) The department's list of findings of abandonment, abuse, neglect, exploitation and financial exploitation.
(6) The findings may be disclosed to the public upon request.
The changes were made because:
| SUMMARY OF COMMENTS RECEIVED | THE DEPARTMENT CONSIDERED ALL THE COMMENTS. THE ACTIONS TAKEN IN RESPONSE TO THE COMMENTS, OR THE REASONS NO ACTIONS WERE TAKEN, FOLLOW. | |||
| General comment not tied to any specific
section of the proposed rule: DSHS should reissue the notice of proposed rule making and extend the deadline for public comment for an additional three months to allow for the development and publishing of a "crosswalk" between the existing rule and the proposed rule. |
No change was made in response to this comment. | |||
| • | The rule will not be reissued or delayed as the entire draft of the rule, section-by-section has been shared with multiple representatives of industry, advocacy groups, internal and external stakeholders and persons identified as interested parties throughout the drafting process. | |||
| • | The entire rule section-by-section has been posted on the agency web for review and comment as each area of the proposed rule was developed. | |||
| • | A crosswalk will not be developed as it is not required by law. | |||
| General comment not tied to any specific
section of the proposed rule: The timing of adoption of this rule may be in conflict with the public employee relations commission, WAC 391-25-140(2). |
No change was made in response to this comment. | |||
| • | The adoption of the rule is not in conflict with WAC 391-25-140(2) as the rule does not make any changes to the status quo. | |||
| • | The proposed rule-making process has followed the statutory requirements of chapter 34.05 RCW. | |||
| WAC 388-76-10000 "Neglect" means: (1) a pattern of conduct or inaction by a
person or entity with a duty |
A change was made in response to this comment. | |||
| • | The change was made to mirror the language of "neglect" in chapter 74.34 RCW. | |||
| WAC 388-76-10020 This section uses the phrase "emotional and physical care needs." This may or may not be the same as "personal care needs" or "special care needs" which are defined. The difference is subtle and implied, and leaves the reader to interpret. | A change was made in response to this comment. | |||
| • | The change is made to provide consistent language defined in the rule for "personal care and special care." | |||
| WAC 388-76-10040 Recommend adding
clarifying and simpler language to have the AFH
provider or entity rep either: (a) Live in the home; or (b) Employ or contract with a qualified mgr ... OR (c) Have twenty-four hour staffing and a qualified person who can ... |
A change was made in response to this comment. | |||
| • | The suggested change was made to simplify the rule language. | |||
| WAC 388-76-10085 Recommend adding
clarifying and simpler language to have title
read: "Application--Affiliated parties," and could be combined with WAC 388-76-1190. |
No change was made in response to this comment. | |||
| • | The term "affiliated with the applicant" is consistent with statutory language in chapter 70.128 RCW. | |||
| • | Did not combine WAC 388-76-10085 and 388-76-1190 as recommended: | |||
| ° | WAC 388-76-1185 relates to "provider and coprovider;" and | |||
| ° | WAC 388-76-1190 relates to an "entity." | |||
| WAC 388-76-10095 Clarifying language would
have the title read: "Application--Identification of involved landlord--Required. |
No change was made in response to this comment. | |||
| • | Adding the word "involved" potentially adds confusion to the regulation. | |||
| • | The common definition of "involved" is too broad in context and potentially increases the possibility of different interpretations of the regulation. | |||
| WAC 388-76-10120(14) Leaves the reader to ponder who this rule could "reach back" to. | No change was made in response to this comment. | |||
| • | All providers? | • | The licensing statute, chapter 70.128 RCW, states the department must not license an applicant if the prospective provider has not completed the required training. | |
| • | All making application? | |||
| • | All providers making application for additional licenses? | |||
| The "After January 1, 2007" creates further confusion and is unnecessary as that time has passed. | A change was made in response to this comment. | |||
| • | The "After January 1, 2007" language was deleted from the rule to eliminate confusion. | |||
| WAC 388-76-10240 Recommend the following changes so the regulation is consistent with RCW 11.94.010 (3)(b): | A change was made in response to this comment. | |||
| WAC 388-76-10240 Durable power of attorney for health care or financial decisions. | • | The recommended section title change is consistent with chapter 11.94 RCW and helps to clarify the requirements. | ||
| (1) | The adult family must not allow a provider, entity representative, owner, administrator, or employees of the home to act as a resident's power of attorney for health care or financial decisions, according to chapter 11.94 RCW, unless the provider, entity representative, owner, administrator, or employee is the resident's: ... | • | The term "attorney in fact" was added to mirror the language in chapter 11.94 RCW. | |
| WAC 388-76-10315 The requirement to keep resident records for only three years may put the provider in conflict with the requirements of WAC 296-20-02005 which requires records must be maintained for audit purposes for a minimum of five years. | No change was made in response to this comment. | |||
| • | The proposed rule language does not put the provider in conflict with WAC 296-20-02005. | |||
| • | The provider is required to meet the retention of records requirement of WAC 296-20-02005 only if the provider is receiving payment from the department of labor and industries to provide care and services to a resident who is an industrially injured worker. | |||
| • | The proposed language in WAC 388-76-10315 is consistent with current rule language. | |||
| • | Increasing the resident record retention requirement would be a new requirement and could add additional cost for the provider. | |||
| WAC 388-76-10330(1) Is not a current written assessment the objective of this section, compared to requiring a new assessment? | No change was made in response to this comment. | |||
| • | The objective of this section is to require a "new" assessment to ensure the assessment is current so the new provider can develop an appropriate negotiated care and services plan that meets the needs of the new resident being admitted to the adult family home. | |||
| WAC 388-76-10395 This section allows for the emergency admission of a resident, but only if a true emergency exists. | No change was made in response to this comment. | |||
| The term "emergency" is not defined in WAC 388-76-10000. A resident's "life, health, and safety" may or may not bring some generally accepted understanding, but what constitutes a "serious risk" has a much broader connotation. | • | WAC 388-76-10395(2) establishes the parameters of a "true emergency" and states: To establish that a true emergency exists, the home must verify that the resident's life, health or safety is at serious risk due to circumstances in the resident's current place of residence or harm to the resident has occurred. | ||
| WAC 388-76-10400(3)(c) States that care and services be provided in a manner that reasonably accommodates individual needs and preferences except when it endangers the health and safety of another (but not the person himself?). | Changes were made in response to this comment. | |||
| • | Language was added to the section to mirror the statutory language of RCW 70.129.140 (5)(a) which clarifies the intent to also protect the person themselves. | |||
| WAC 388-76-10405 If an AFH does not provide nursing care, and identifies that a resident has need for such care, this section requires the AFH to hire or contract with a licensed nurse to provide for the care. Is this "care and services," or is this "special care"? Who will pay? The language leaves the impression the AFH must pay for the licensed nurse. Without clarifying language, one must assume there would be an economic impact on the provider, unaddressed by a small business economic impact statement. This section further implies a provider must retain a resident, even though the care and services they now need are not provided by the provider, and may not be reasonably accommodated. This WAC requirement is not consistent with WAC 388-76-10390(1). | No change was made in response to these comments. | |||
| • | The proposed language is consistent with current regulations and poses no new cost requirements on the provider. | |||
| • | The provider must disclose what services and costs the provider offers or will not offer in the preadmission agreement. | |||
| • | The provider must develop a negotiated care plan with the resident based on the resident's assessed needs. | |||
| • | The resident has the right to indicate what services they will accept or not accept from the provider. | |||
| • | If the provider does not disclose the costs of a service such as nursing service, the provider must comply with the requirements of chapter 70.129 RCW and/or work with the agency case manager, if the resident services are paid by the state, to change any costs charged to the resident. | |||
| • | This section of the rule is consistent with WAC 388-76-10390 (1)(b), which requires reasonable accommodation. | |||
| WAC 388-76-10420(2) Says the adult family home must provide nutritious snacks to residents between meals; and in the evening. Some residents have weight problems and lack will power. They do not need to be encouraged to take in additional calories. "Provide" could be modified to read "make available." | A change was made in response to this comment. | |||
| • | The proposed rule was changed to use the term "make available" which is current rule language. | |||
| WAC 388-76-10425 A clarifying language change might be found in subsection (3)(b) reading "Until" served. | No change was made in response to this comment. | |||
| • | The intention of this section is clear. | |||
| • | The food must be at the appropriate and safe temperature when served. | |||
| WAC 388-76-10430 Clarifying language could read: (1) If the adult family home admits residents who need medication assistance by a legally authorized person, the home must have systems in place..." | A change was made in response to this comment. | |||
| • | Recommendation helps to add clarity. | |||
| Subsection [(1)](c) references an incorrect WAC - should be WAC 388-76-10475. | A change was made in response to this comment. | |||
| • | WAC reference corrected. | |||
| WAC 388-76-10440 Recommend changing the title of the section to: "Medication Assistance--Identification of the type of assistance needed when taking medications." | No change was made in response to these comments. | |||
| • | The layout for medication regulations is consistent throughout and includes the word "Medication" followed by an identifying statement for each section. | |||
| Recommend using the terms "type or level" instead of using the term "amount" of assistance. | • | The use of the term "type" of assistance, is not consistent with either the board of pharmacy rules or the Nurse Practice Act language. | ||
| Subsections (2)(a), (b), and (c) terms in italics should match exactly to their following section titles. | Changes were made in response to this comment. | |||
| • | The language in WAC 388-76-11040 and 388-76-11045 was changed to be consistent with the terms in italics which is consistent with the board of pharmacy regulations. | |||
| Subsections (1)(b) and (3): | No change was made in response to these comments. | |||
| • | Require the AFH to communicate with a resident's medical practitioner would constitute a HIPPA violation; and | • | This requirement is consistent with current rule language and is not a violation of HIPPA. | |
| • | The practitioner is not generally privy to the assessments done by the resident's case manager, and is likely not able or involved to decide if a reassessment is necessary. | • | The provider must work with the resident and if the resident has a case manager, the case manager to provide the practitioner with the appropriate information. | |
| WAC 388-76-10460(1) It is recommend[ed] to add the following clarifying language as follows: The adult family home must ensure that each resident's negotiated care plan addresses the type of medication assistance needed ... | No change was made in response to this comment. | |||
| • | The use of the term "type" of assistance, is not consistent with either the board of pharmacy rules or the Nurse Practice Act language. | |||
| WAC 388-76-10470 The special directions do not use "approximately" in WAC 388-76-10470 [(1)](b)(i), but then use the term in (ii). | A change was made in response to this comment.
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| • | The term "approximately" was added to subsection [(1)](b)(i) to be consistent with the term used in subsections [(1)](b)(ii), (iii) and (iv). | |||
| Suggest adding medically acceptable timeframes to each appropriate subsection such as: "plus or minus fifteen minutes" or "within fifteen minutes" or "within a half hour" to provide the necessary detail so the provider is not left to a subjective judgment as to what constitutes an appropriate "approximate." | No change was made in response to these comments. | |||
| • | The text of the proposed rule indicates that medications must be given at a specific time if "ordered by a practitioner." | |||
| • | Medically acceptable timeframes will not be added to the proposed rule. The "approximate" text and examples in subsections (2)(a) through (d) provide a reality based medication administration system. | |||
| WAC 388-76-10510, 388-76-10515, 388-76-10520 A concern is raised that while adult family home WACs are established to protect the rights of residents, they do not afford a resident the right to deny any other person their same and equal rights and all people should be afforded the same civil rights that any other American receives. | No change was made in response to these comments. | |||
| • | The comments made no specific recommend[ation] for changes. | |||
| • | Chapter 388-76 WAC establishes the licensing requirements for the adult family home provider to follow to remain licensed not what other individuals must do for the provider. | |||
| • | The proposed rule enabling chapter 70.129 RCW, Long-term care resident rights is focused on the rights, of the residents and not on other civil rights. | |||
| • | WAC 388-76-10545(4) requires compliance with other state and federal laws regarding nondiscrimination. | |||
| WAC 388-76-10520, 388-76-10530, 388-76-10815 A concern is raised that there is a language of some sort (both written and verbal) that can be understood by a resident with profound mental retardation/developmental disabilities, and that rules and regulations regarding personal rights and personal conduct responsibilities can be clearly communicated with that language and that this is not a realistic expectation to place on providers for a notable number of others, especially providers who serve those severely challenged by a developmental disability. | No change was made in response to these comments. | |||
| • | The comments made no specific recommend[ation] for changes. | |||
| • | The definition of "resident" in the proposed WAC 388-76-10000 includes the following statement in subsection (2): "For decision-making purposes, the term "resident" includes the resident's surrogate decision maker following state law or at the resident's request." | |||
| • | A resident's surrogate decision maker can be appointed to act on behalf of the resident. | |||
| WAC 388-76-10525 Resident rights--Description. To help inform residents how to exercise their rights, it is recommend[ed] to add the following language to subsection (3): | No change was made in response to this comment. | |||
| • | Residents may file a complaint on any issue. | |||
| A statement informing the resident that he or she may file a complaint with the appropriate state licensing agency concerning alleged abandonment, abuse, neglect, or financial exploitation, or violation of any resident right contained within this chapter. | • | Adding the recommended statement may be limiting and may confuse the resident into believing they can only file a complaint if the complaint relates to abandonment, abuse, neglect, exploitation or financial exploitation. | ||
| WAC 388-76-10540(8) It is recommended to add the following language: If the homes require the implementation signing of an admission contract by or on behalf of an individual seeking admission the home must ... | No change was made in response to this comment. | |||
| • | The proposed rule language requires the signing and dating of the admission agreement required in WAC 388-76-10540(3). | |||
| The current term used is: "admission contract." "Admission agreement" would be a better term. | A change was made in response to this comment. | |||
| • | The term was changed to "admission agreement" to be consistent with the language in other sections of the rule. | |||
| WAC 388-76-10545(4) Refers to all applicable federal and state requirements regarding nondiscrimination and is a very broad statement. Suggest DSHS offer an adult family home targeted class on this subject. | No change was made in response to this comment. | |||
| • | The proposed rule language will not be changed as the language clearly informs the provider they must comply with all laws and regulations relating to nondiscrimination. | |||
| WAC 388-76-10550 (2)(e) This section appears to be in conflict with WAC 388-76-10405, wherein the provider must provide a nurse and/or a nurse delegate. May the provider declare they will not provide for these services? | No change was made in response to these comments. | |||
| • | The language is not in conflict with WAC 388-76-10404. | |||
| • | The provider can designate the services the provider will and will not provide in the providers preadmission agreement. | |||
| WAC 388-76-10585 An adult family home cannot give a resident "the ability to examine" reports but can provide the "opportunity" to examine. | Changes were made in response to this comment. | |||
| • | Changed the wording in the section to "opportunity" for clarity. | |||
| Suggest changing the language in subsection (2) to post "in a visible location in the home, a notice ..." | Changes were made in response to this comment. | |||
| • | Changed the wording to help clarify the posting requirement. | |||
| WAC 388-76-10655 Recommend incorporating the following language into the WAC: "A resident who is injuring himself/herself or is threatening physical harm to others may be restrained in an emergency to safeguard the resident and others." | No change was made in response to this comment. | |||
| • | Current proposed rule language clearly states the requirements and limitations for the use of restraints. | |||
| WAC 388-76-10685(2) It is recommended to add the following language to state that window and door screens are in fact required: Ensure there are window and door screens: ... | No change was made in response to this comment. | |||
| • | Screens are not required. However, if windows or doors have screens, they must comply with the requirements in the proposed rule. | |||
| • | The provider is required to keep the bedroom free of flies and other insects as per WAC 388-76-685 (2)(b). | |||
| WAC 388-76-10690 Bedroom usable floor space -- In adult family homes after the effective date of this chapter. A concern was raised for changing bedroom size square footage calculations by the elimination of space for closets and door swing. | No change was made in response to these comments. | |||
| • | Current proposed rule language clarifies preexisting agency practice for calculating bedroom floor space which has been in effect for at least two years. | |||
| WAC 388-76-10750(4) A concern is raised regarding the difficulty a home has in meeting and maintaining the 120° Fahrenheit maximum temperature for hot water due to the limitations of hot water systems. | No change was made in response to this comment. | |||
| • | The maximum temperature is a current regulation requirement and will not be changed for the safety of the residents. | |||
| WAC 388-76-10775 (1)(c) Recommend raising the maximum temperature to 80° instead of the required 79° as on hot days the interior temperature can reach 79 to 80°. | No change was made in response to this comment. | |||
| • | The 78° temperature requirement required by the state adopted energy code. | |||
| WAC 388-76-10780 Refers to "toilet, shower and tub." Must homes licensed after July 1, 2007, actually have a tub? We installed handicapped showers which accept a wheelchair. Is "tub" really required? | A change was made in response to this comment. | |||
| • | The building code requires the installation of a tub or shower. | |||
| • | The word "or" was added to add clarification of the building code requirement. | |||
| WAC 388-76-10810 Suggest adding clarifying language to clarify whether "the home must have different fire extinguishers "in addition to" or "in place of," as required in ...." | A change was made in response to this comment.
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| • | Added clarifying language indicating the required fire extinguishers would be "in place of." | |||
| WAC 388-76-10820 Questions were raised about the definition of grade level. | No change was made in response to this comment. | |||
| • | The comments made no specific recommend[ation] for changes. | |||
| • | The definition of grade level is complex and is established in the state adopted building code. | |||
| • | Building code officials are given the authority to enforce "grade level" facility regulations in chapter 19.27 RCW. | |||
| WAC 388-76-10845 Emergency drinking water supply. Due to the importance of having a good clean supply of drinking water during an emergency, suggest adding very specific language to this section. | A change was made in response to these comments. | |||
| • | Added clarifying language for : | |||
| ° | The type of storage containers used to store the drinking water; | |||
| ° | Chemical treatment or replaced; and | |||
| ° | Appropriate storage. | |||
| WAC 388-76-10850 Emergency medical supplies. Recommend adding very specific language to this section so the expectations required for first-aid supplies are clear. | No change was made in response to these comments. | |||
| • | Current proposed language allows the provider flexibility to provide the required first-aid supplies consistent with: | |||
| ° | The number and needs of the residents served by the home. | |||
| • | Proposed language is consistent with currently adopted language. | |||
| WAC 388-76-10920 The title to this section includes both inspections and investigations, while the body of the text only speaks to the inspection report. Striking the word "inspection" (to read: "the department's report") in the first part allows subsections (1) and (2) to clarify the separate delivery timeframes for inspections and investigations. | Changes were made in response to these comments. | |||
| • | Removed the word "inspection" to provide clarity within the section. | |||
| • | Changed subsection (2) to be consistent with statutory language in chapter 70.128 RCW. | |||
| Subsection (2) refers to calendar days related to a complaint investigation and should refer to calendar days related to an inspection of the facility has no violations. | ||||
| WAC 388-76-10930 Suggest adding the following clarifying language: "If a plan of correction is indicated on the inspection or investigation report. It must: ...." | No change was made in response to this comment. | |||
| • | The department report states if a plan of correction is or is not required. | |||
| WAC 388-76-10955 That the department "must impose" a remedy under subsection (6)(a) in a situation where a medicaid/medicare provider agreement is suspended, rather than "may impose" (WAC 300-76-10960 [388-76-10960]) (until the situation is resolved,) would appear arbitrary, unless required by law. | No change was made in response to this comment. | |||
| • | The proposed language provides the department flexibility relating to the imposition of remedies based upon the specific circumstances of the situation. | |||
| WAC 388-76-10990 Recommend amending this section to clarify that the resident has the right to participate in IDR and will likely encourage them to do so. | No change was made in response to this comment. | |||
| • | Department policy provides an opportunity for residents to participate in the informal dispute resolution process. | |||
| • | Department policy will not be placed in the proposed rule. | |||
| WAC 388-76-11040 (2)(b) A reasonable change would have the department able to decide to remove a "single finding of violation with this chapter" (in lieu of only "neglect"). | No change was made in response to this comment. | |||
| • | The department is withdrawing this section and has filed a new preproposal statement of inquiry (CR-101) for the resident protection program with the code reviser, WSR 07-15-026. | |||
| WAC 388-76-11045(6) Suggest adding the following clarifying language: "the public, upon request." | No change was made in response to this comment. | |||
| • | The department is withdrawing this section and has filed a new preproposal statement of inquiry (CR-101) for the resident protection program with the code reviser, WSR 07-15-026. | |||
A final cost-benefit analysis is available by contacting Roger A. Woodside, P.O. Box 45600, Olympia, WA 98504-5600, phone (360) 725-3204, fax (360) 438-7903, e-mail woodsr@dshs.wa.gov. The cost-benefit analysis was not changed.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 199, Amended 0, Repealed 97.
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 199, Amended 0, Repealed 97.
Date Adopted: October 16, 2007.
Robin Arnold-Williams
Secretary
3891.9ADULT FAMILY HOME MINIMUM LICENSING REQUIREMENTS
"Abuse" means the willful action or inaction that inflects injury, unreasonable confinement, intimidation, or punishment on a vulnerable adult:
(1) In instances of abuse of a vulnerable adult 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; and
(2) Abuse includes sexual abuse, mental abuse, physical abuse, and exploitation of a vulnerable adult, which have the following meanings:
(a) "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, who is not also a resident or client, of a facility or a staff person of a program authorized under chapter 71A.12 RCW, and a vulnerable adult living in that facility or receiving service from a program authorized under chapter 71A.12 RCW, whether or not consensual.
(b) "Physical abuse" means a 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 chemical restraints unless the restraints are consistent with licensing requirements, and includes restraints that are otherwise being used inappropriately.
(c) "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 vulnerable adult from family, friends, or regular activity, and verbal assault that includes ridiculing, intimidating, yelling, or swearing.
(d) "Exploitation" means an act of forcing, compelling, or exerting undue influence over a vulnerable adult causing the vulnerable adult to act in a way that is inconsistent with relevant past behavior, or causing the vulnerable adult to perform services for the benefit of another.
"Adult family home" means:
(1) A residential home in which a person or entity are licensed to provide personal care, special care, room, and board to more than one but not more than six adults who are not related by blood or marriage to the person or persons providing the services; and
(2) For the purposes of this chapter, any person or entity who has been granted a license to operate an adult family home.
"Affiliated with an applicant" means any person listed on the application as a partner, officer, director, resident manager, or majority owner of the applying entity, or is the spouse of the applicant.
"Applicant" means an individual, partnership, corporation, or other entity seeking a license to operate an adult family home.
"Capacity" means the maximum number of persons in need of personal or special care permitted in an adult family home at a given time and includes related children or adults in the home who receive personal or special care and services.
"Caregiver" for purposes other than training, means any person eighteen years of age or older responsible for providing direct personal or special care to a resident and who is not the provider, entity representative, a student or volunteer.
"Dementia" is defined as a condition documented through the assessment process required by WAC 388-76-10335.
"Department" means the Washington state department of social and health services.
"Department case manager" means the department authorized staff person or designee assigned to negotiate, monitor, and facilitate a care and services plan for residents receiving services paid for by the department.
"Developmental disability" means:
(1) A person who meets the eligibility criteria defined by the division of developmental disabilities under WAC 388-823-0040; 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 age 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.
"Direct supervision" means oversight by a person who has demonstrated competency in the basic training and specialty training if required, or who has been exempted from the basic training requirements and is:
(1) On the premises; and
(2) Quickly and easily available to the caregiver.
"Entity provider" means any corporation, partnership, association, or limited liability company that is licensed under this chapter to operate an adult family home.
"Financial exploitation" means the illegal or improper use of the property, income, resources, or trust funds of the vulnerable adult by any person for any person's profit or advantage other than for the vulnerable adult's profit or advantage.
"Entity representative" means the individual designated by an entity provider who is responsible for the daily operation of the adult family home.
"Home" means adult family home.
"Indirect supervision" means oversight by a person who:
(1) Has demonstrated competency in the basic training and specialty training if required; or
(2) Has been exempted from the basic training requirements; and
(3) Is quickly and easily available to the care giver, but not necessarily on-site.
"Inspection" means an on-site visit by department personnel to determine the adult family home's compliance with this chapter and chapters 70.128, 70.129, 74.34 RCW, and other applicable rules and regulations.
"Mandated reporter" means an employee of the department, law enforcement, officer, social worker, professional school personnel, individual provider, an employee of a facility, an employee of a social service, welfare, mental health, adult day health, adult day care, or hospice agency, county coroner or medical examiner, Christian Science practitioner, or health care provider subject to chapter 18.130 RCW. For the purpose of the definition of a mandated reporter, "Facility" means a residence licensed or required to be licensed under chapter 18.20 RCW (boarding homes), chapter 18.51 RCW (nursing homes), chapter 70.128 RCW (adult family homes), chapter 72.36 RCW (soldiers' homes), chapter 71A.20 RCW (residential habilitation centers), or any other facility licensed by the department.
"Medical device" as used in this chapter, means any piece of medical equipment used to treat a resident's assessed need.
(1) A medical device is not always a restraint and should not be used as a restraint;
(2) Some medical devices have considerable safety risks associated with use; and
(3) Examples of medical devices with known safety risks when used are transfer poles, Posey or lap belts, and side rails.
"Medication administration" means giving resident medications by a person legally authorized to do so, such as a physician, pharmacist or nurse.
"Medication organizer" is a container with separate compartments for storing oral medications organized in daily doses.
"Mental illness" is defined as an Axis I or II diagnosed mental illness as outlined in volume IV of the Diagnostic and Statistical Manual of Mental Disorders (a copy is available for review through the aging and disability services administration).
"Multiple facility provider" means an individual or entity provider who is licensed to operate more than one adult family home.
"Neglect" means:
(1) A pattern of conduct or inaction by a person or entity with a duty of care that fails to provide the goods and services that maintain physical or mental health of a vulnerable adult, or that fails to avoid or prevent physical or mental harm or pain to a vulnerable adult; 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 vulnerable adult's health, welfare, or safety, including but not limited to conduct prohibited under RCW 9A.41.100.
"Nurse delegation" means a registered nurse transfers the performance of selected nursing tasks to competent nursing assistants in selected situations. The registered nurse delegating the task retains the responsibility and accountability for the nursing care of the resident.
"Over-the-counter medication" is any medication that can be purchased without a prescriptive order, including but not limited to vitamin, mineral, or herbal preparations.
"Personal care services" means both physical assistance and/or prompting and supervising the performance of direct personal care tasks as determined by the resident's needs and does not include assistance with tasks performed by a licensed health professional.
"Physical restraint" means a manual method, obstacle, or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that restricts freedom of movement or access to his or her body, is used for discipline or convenience, and is not required to treat the resident's medical symptoms.
"Practitioner" includes a physician, osteopathic physician, podiatric physician, pharmacist, licensed practical nurse, registered nurse, advanced registered nurse practitioner, dentist, and physician assistant licensed in the state of Washington.
"Prescribed medication" refers to any medication (legend drug, controlled substance, and over-the-counter) that is prescribed by an authorized practitioner.
"Provider" means any person or entity that is licensed under this chapter to operate an adult family home.
"Qualified staff" means a person who:
(1) Is employed, directly or by contract, by an adult family home; and
(2) Meets all of the requirements of a provider, entity representative, resident manager or caregiver.
"Resident" means any adult unrelated to the provider who lives in the adult family home and who is in need of care and for decision-making purposes, the term "resident" includes the resident's surrogate decision maker following state law or at the resident's request.
"Resident manager" means a person employed or designated by the provider or entity representative to manage the adult family home.
"Significant change" means:
(1) A lasting change, decline or improvement in the resident's baseline physical, mental or psychosocial status;
(2) The change is significant enough so the current assessment and/or negotiated care plan do not reflect the resident's current status; and
(3) A new assessment may be needed when the resident's condition does not return to baseline within a two week period of time.
"Special care" means care beyond personal care services as defined in this section.
"Staff" means any person who:
(1) Is employed, directly or by contract, by an adult family home; and
(2) Provides care and services to any resident.
"Unsupervised" means not in the presence of:
(1) Another employee or volunteer from the same business or organization; or
(2) Any relative or guardian of any of the children or developmentally disabled persons or vulnerable adults to which the employee, student or volunteer has access during the course of his or her employment or involvement with the business or organization.
"Usable floor space" means resident bedroom floor space exclusive of:
(1) Toilet rooms;
(2) Closets;
(3) Lockers;
(4) Wardrobes;
(5) Vestibules, and
(6) The space required for the door to swing if the bedroom door opens into the resident bedroom.
"Willful" means the deliberate or nonaccidental action or inaction by an alleged perpetrator that he/she knew or reasonably should have known could cause a negative outcome, including harm, injury, pain or anguish.
"Vulnerable adult" includes a person:
(1) Sixty years of age or older who has the functional, mental, or physical inability to care for himself or herself;
(2) Found incapacitated under chapter 11.88 RCW;
(3) Who has a developmental disability as defined under RCW 71A.10.020;
(4) Admitted to any facility;
(5) Receiving services from home health, hospice, or home care agencies licensed or required to be licensed under chapter 70.127 RCW; or
(6) Receiving services from a provider.
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LICENSE(2) No person or entity may provide personal care, special care, and room and board for more than one resident without a license.
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(2) The license remains valid unless:
(a) The department takes enforcement action to suspend or revoke the license per law;
(b) The home voluntarily surrenders the license and closes the home;
(c) The home relinquishes the license; or
(d) The home fails to pay the annual licensing fee.
(3) The home license is:
(a) Not transferable; and
(b) Valid only for the provider and address listed on the license.
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(2) The provider or entity representative is ultimately responsible for the operation of the adult family home.
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(2) The home must send the annual license fee to the department upon receipt of notice of fee due.
(3) If the department does not renew the license, the annual license fee is refundable.
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(2) In determining the home's capacity, the department must consider the:
(a) Structural design of the house;
(b) Number and qualifications of staff;
(c) Total number of people living in the home who require personal or special care, including:
(i) Children; and
(ii) Other household members;
(d) The number of people for whom the home provides adult day care; and
(e) The ability for the home to safely evacuate all people living in the home.
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(1) Evidence that the provider or entity representative has successfully completed the forty-eight hour residential care administrator's training to meet the related requirements of chapter 388-112 WAC.
(2) Operated an adult family home in Washington for at least one year without a significant violation of chapters 70.128, 70.129 or 74.34 RCW, this chapter or other applicable laws and regulations; and
(3) The ability to operate more than one home.
(4) The following plans for each home the applicant intends to operate:
(a) A twenty-four hour a day, seven day a week staffing plan;
(b) A plan for how the provider entity representative, or resident manager will manage the daily operations of each home; and
(c) A plan for emergencies, deliveries, staff and visitor parking.
(5) A credit history considered if the history relates to the ability to provide care and services.
(6) An applicant, entity representative or a qualified resident manager at each home who is responsible for the care of each resident at all times.
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(a) Live in the home; or
(b) Employ or contract with a qualified resident manager who lives in the home and is responsible for the care and services of each resident at all times; or
(c) Provide twenty-four hour staffing.
(2) Ensure that a qualified staff person who can make needed decisions is always present.
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(1) Aging and disability services administration; or
(2) The department when the employee's duties include:
(a) Placement of persons in an adult family home; or
(b) Authorizing payments for any resident's care and services in an adult family home.
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(a) Within thirty days of the last resident leaving the home; or
(b) When the home moves all residents out of the home for purposes other than remodeling or construction.
(2) The department may revoke the license if the home does not:
(a) Relinquish the adult family home license; or
(b) Relinquish the adult family home license within the specified timeframe.
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LICENSE APPLICATION(a) An initial adult family home license;
(b) A change of ownership of the adult family home; or
(c) A change of the adult family home location or address.
(2) Prior to sending the application to the department, the applicant must ensure:
(a) The people listed on the application meet the minimum qualifications listed in WAC 388-76-10130 through 388-76-10145 as required; and
(b) After January 1, 2007, the provider and entity representative must successfully complete the department approved forty-eight hour adult family home administration and business planning class as required in chapter 388-112 WAC.
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(2) If an applicant has not obtained an adult family home license within one calendar year of submitting the application to the department the applicant must attend department orientation again.
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(1) Provide all information required on the application form;
(2) Provide any additional information requested by the department; and
(3) Send the complete application form to the department.
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(a) Fifty dollars of this fee is the application processing fee; and
(b) Fifty dollars is the annual license fee.
(2) The fifty dollar annual license fee will be returned to the applicant by the department if the application is withdrawn, voided or the license is denied.
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(1) Does not return information to the department within sixty calendar days of the department's first request for additional information for an incomplete application; or
(2) Has not obtained an adult family home license within one calendar year of first submitting the application to the department.
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(1) May not apply for separate licenses for each spouse; and
(2) May apply jointly as co-providers.
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(1) Include a list of all facilities or homes in which the applicant or persons affiliated with the applicant, managerial employee, or owner of five percent or more of the entity provided care and services to children or vulnerable adults within the last ten years;
(2) Designate an entity representative who:
(a) Is responsible for the daily operations of the adult family home;
(b) Will be considered the department's primary contact person; and
(c) May act as both the entity representative and the resident manager in only one home.
(3) Designate a qualified resident manager for the home if the entity representative is not the designated resident manager in subsection (2)(c) of this section.
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(2) An active interest includes but is not limited to:
(a) The charging of rent as a percentage of the business;
(b) Assistance with start-up and/or operational costs;
(c) Collection of resident fees;
(d) Recruitment of residents;
(e) Management oversight;
(f) Assessment and/or negotiated care plan development of residents; or
(g) The provision of personal or special care of residents.
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(2) The department will not process an incomplete application and will return the application requesting the missing information.
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(2) A change of ownership occurs when there is a change in:
(a) The provider or entity representative ultimately responsible for the daily operational decisions of the home; or
(b) Control of an entity provider.
(3) Events which constitute a change of ownership include, but are not limited to:
(a) The form of legal organization of the provider is changed, such as when a provider forms:
(i) A partnership;
(ii) Corporation;
(iii) Association; or
(iv) A dissolution or merger of a licensed entity with another legal organization.
(b) The provider or entity representative transfers business operations and management responsibility to another party, whether there is a partial or whole transfer of adult family home real property and/or personal property assets.
(c) Two people are both licensed as a married couple to operate an adult family home and an event, such as a divorce or death results in only one person operating the home.
(d) An event dissolves the partnership, if the provider or entity representative is a business partnership.
(e) If the provider or entity representative is a corporation and the corporation:
(i) Is dissolved;
(ii) Merges with another corporation which is the survivor; or
(iii) Consolidates with one or more corporations to form a new corporation;
(iv) Whether by a single transaction or multiple transactions within a continuous twenty-four month period, transfers fifty percent or more of the stock to one or more:
(A) New or former stockholders; or
(B) Present stockholders each having less than five percent of the stock before the initial transaction.
(f) Any other event or combination of events which results in a substitution of or control of the provider or entity representative.
(4) The new owner:
(a) Must correct all deficiencies that exist at the time of the ownership change;
(b) Is subject to the provisions of chapters 70.128, 70.129, 74.34 RCW, this chapter and other applicable laws and regulations;
(c) Must obtain a new license from the department before the transfer of ownership; and
(d) Must not begin operation of the adult family home as the new owner, provider or entity representative until the department has granted the license.
(5) The home must notify each resident, in writing at least thirty days before the effective date of the ownership change.
(6) If a currently licensed provider or entity representative seeking to change ownership wants the department to give priority to processing an application to minimize or prevent disruption of residents that live in the existing home, the applicant must:
(a) Make the request to the department in writing, including the reason for changing the location of the home; and
(b) Explain how or why the reason for the change is beyond the control of the home.
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(2) The home must not start operations of the home at a new location until the department has granted the license for the new location.
(3) The home must notify each resident or resident representative, in writing at least thirty days before the effective date of the change of the home location or address.
(4) If a currently licensed provider or entity representative, seeking to change the home location or address wants the department to give priority to processing an application to minimize or prevent the disruption of residents that live in the existing home, the applicant must:
(a) Make the request in writing, including the reason for changing the location of the home to the department; and
(b) Explain how or why the reason for change is beyond the control of the home.
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GRANTING OR DENYING A LICENSE(1) Separately and jointly as applicants each person and entity named in an application, including each person or entity affiliated with the applicant;
(2) Information in the application;
(3) Other documents and information the department deems relevant which may include, but not be limited to:
(a) Inspection and complaint investigation findings in each facility or home in which the applicant, person affiliated with the applicant, or owner of five percent or more of the entity provided care or services to children or vulnerable adults; and
(b) Credit information.
(4) The history of each individual listed on the application for negative findings identified in WAC 388-76-10120 and 388-76-10125, including, but not limited to the following:
(a) Applicant;
(b) Person affiliated with the applicant;
(c) Entity representative;
(d) Caregiver;
(e) An owner who:
(i) Exercised daily control over the operations; or
(ii) Owns fifty-one percent or more of the entity.
(f) Any person who has unsupervised access to residents in the home; and
(g) Any person who lives in the home and is not a resident.
(5) Applicants who are licensed to care for children in the same home to determine if:
(a) It is necessary to allow a resident's child(ren) to live in the same home as the resident or allow a resident's child(ren) who turn eighteen to stay in the home;
(b) The applicant provides satisfactory evidence to the department of the home's ability to meet the needs of children and adults residing in the home; and
(c) The total number of persons receiving care and services in the home do not exceed the licensed capacity of the adult family home.
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(1) Has a history of prior violations of chapter 70.128 RCW or any law regulating to residential care facilities within the past five years that resulted in revocation, suspension, or nonrenewal of a license or contract with the department;
(2) When providing care or services to children or vulnerable adults:
(a) Has been found to be in significant noncompliance with federal or state regulations; or
(b) Had a license for the care of children or vulnerable adults suspended or revoked.
(3) For a period of twenty years after a provider surrendered or relinquished an adult family home license after notification of the department's intention to deny, suspend, not renew or revoke, in lieu of appealing the department's action;
(4) Been enjoined from operating a facility for the care and services of children or adults;
(5) A stipulated finding of fact, conclusion of law, an agreed order, or finding of fact, conclusion of law, final order issued by a disciplining authority or final decision by any federal or state agency or department, a court of law, or entered into a state registry or department or agency list with a finding of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW;
(6) Had a revocation or suspension of a license for the care of children or adults;
(7) Had a revocation, cancellation, suspension or nonrenewal of:
(a) A medicaid or medicare provider agreement by the contracting agency; or
(b) Any agreement with a public agency for the care and treatment of children or vulnerable adults, when the action was taken by the public agency.
(8) Been convicted of any crime listed in RCW 43.43.830 or 43.43.842;
(9) Been found by a court:
(a) In a protection proceeding under chapter 74.34 RCW to have abandoned, neglected, abused, or financially exploited a vulnerable adult; or
(b) In a domestic relations proceeding under Title 26 RCW to have sexually or physically abused, neglected or exploited any minor.
(10) Been found in any final decision issued by a disciplinary board to have:
(a) Sexually or physically abused, neglected or exploited any minor or a person with a developmental disability; or
(b) Abandoned, abused, neglected or financially exploited any vulnerable adult.
(11) Been found in any final decision by any federal or state agency or department to have abandoned, neglected, abused or financially exploited a vulnerable adult;
(12) Found in any dependency action under RCW 13.34.030 (5)(b) to have sexually or physically abused, neglected or exploited any minor;
(13) The home is currently licensed:
(a) As a boarding home; or
(b) To provide care for children in the same home, unless:
(i) It is necessary in order to allow a resident's child(ren) to live in the same home as the resident or to allow a resident who turns eighteen to remain in the home;
(ii) The applicant provides satisfactory evidence to the department of the home's capacity to meet the needs of children and adults residing in the home; and
(iii) The total number of persons receiving care and services in the home does not exceed the number permitted by the licensed capacity of the home.
(14) If the provider or entity representative has not successfully completed a department-approved forty-eight hour adult family home administration and business planning class.
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(1) Been convicted of a crime:
(a) As defined under RCW 43.43.830 or 43.43.842;
(b) Relating to financial exploitation as defined under RCW 43.43.830 or 43.43.842;
(c) A felony against a person if the conviction reasonably relates to the competency of the person to own or operate an adult family home;
(d) Involving a firearm used in the commission of a felony or in any act of violence against a person; or
(e) Engaged in illegally selling or distributing drugs illegal use of drugs or excessive use of alcohol within the past five years without the evidence of rehabilitation.
(2) Found by a court in a protection proceeding under chapter 74.34. RCW to have abandoned, abused, neglected, or financially exploited a vulnerable adult;
(3) Found in a final decision issued by a disciplinary board to have sexually or physically abused, neglected or exploited any minor person or a person with a developmental disability or to have abused or financially exploited any vulnerable adult;
(4) Found in any dependency action under RCW 13.34.030(5) to have sexually abused, neglected or exploited any minor or to have physically abused any minor;
(5) Found in a court in a domestic relations proceeding under Title 26 RCW to have:
(a) Sexually abused, neglected or exploited any minor or to have physically abused any minor; or
(b) Committed an act of domestic violence toward a family or household member.
(6) Had sanction, corrective, or remedial action taken by federal, state, county, or municipal officials or safety officials related to the care or treatment of children or vulnerable adults;
(7) Obtained or attempted to obtain a license by fraudulent means or misrepresentation;
(8) Knowingly, or with reason to know, made a false statement of material fact on his or her application for a license or any data attached to the application or in any matter under investigation by the department;
(9) Permitted, aided, or abetted the commission of any illegal act on the adult family home premises;
(10) Willfully prevented or interfered with or failed to cooperate with any inspection, investigation or monitoring visit made by the department;
(11) Failed or refused to comply with:
(a) A condition imposed on a license or a stop placement order; or
(b) The applicable requirements of chapters 70.128, 70.129, 74.34 RCW or this chapter.
(12) Misappropriated property of a resident;
(13) Denied a license or license renewal to operate a facility that was licensed to care for children or vulnerable adults;
(14) Exceeded licensed capacity in the operation of an adult family home;
(15) Operated a facility for the care of children or adults without a license or revoked license;
(16) Relinquished or returned a license in connection with the operation of any facility for the care of children or adults, or did not seek license renewal following written notification of the licensing agency's intention of denial, suspension, cancellation or revocation of a license;
(17) Had resident trust funds or assets of an entity providing care to children or vulnerable adults seized by the Internal Revenue Service or a state entity for failure to pay income or payroll taxes;
(18) Failed to meet financial obligations as the obligations fell due in the normal course of business, thereby impeding the ability to provide care and services to residents;
(19) Refused to permit authorized department representatives to interview residents or to have access to resident records or home;
(20) Interfered with a long-term care ombudsman or department staff in the performance of his or her duties; or
(21) Found to be in non-compliance with the requirements established in chapters 70.128, 70.129, 74.34 RCW, this chapter or other applicable laws and regulations.
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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.QUALIFICATIONS OF INDIVIDUALS PROVIDING CARE AND SERVICES
NEW SECTION
WAC 388-76-10130
Qualifications--Provider, entity
representative and resident manager.
The adult family home
must ensure that the provider, entity representative and
resident manager have the following minimum qualifications:
(1) Be twenty-one years of age or older;
(2) Have a United States high school diploma or general education development certificate, or any English translated government document of the following:
(a) Successful completion of government approved public or private school education in a foreign country that includes an annual average of one thousand hours of instruction a year for twelve years, or no less than twelve thousand hours of instruction;
(b) Graduation from a foreign college, foreign university, or United States community college with a two-year diploma, such as an Associate's degree;
(c) Admission to, or completion of coursework at a foreign or United States college or university for which credit was awarded;
(d) Graduation from a foreign or United States college or university, including award of a Bachelor's degree;
(e) Admission to, or completion of postgraduate coursework at, a United States college or university for which credits were awarded, including award of a Master's degree; or
(f) Successful passage of the United States board examination for registered nursing, or any professional medical occupation for which college or university education was required.
(3) Meet the department's training requirements of chapter 388-112 WAC;
(4) Have good moral and responsible character and reputation;
(5) Be literate in the English language, or meet alternative requirements by assuring that a person is on staff and available at the home who is:
(a) Able to communicate or make provisions for communicating with the resident in his or her primary language; and
(b) Capable of understanding and speaking English well enough to be able to respond appropriately to emergency situations and be able to read, understand and implement resident negotiated care plans.
(6) Be able to carry out the management and administrative requirements of chapters 70.128, 70.129 and 74.34 RCW, this chapter and other applicable laws and regulations;
(7) Have completed at least three hundred and twenty hours of successful direct care experience obtained after age eighteen to vulnerable adults in a licensed or contracted setting before operating or managing a home;
(8) Have no criminal convictions listed in RCW 43.43.830 or 43.43.842 or state or federal findings of abandonment, abuse, neglect or financial exploitation;
(9) Obtain and keep valid cardio-pulmonary resuscitation (CPR) and first-aid card or certificate as required in chapter 388-112 WAC; and
(10) Have tuberculosis screening to establish tuberculosis status per this chapter.
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(1) Be eighteen years of age or older;
(2) Have a clear understanding of the caregiver job responsibilities and knowledge of each resident's negotiated care plan to provide care specific to the needs of each resident;
(3) Have basic communication skills to:
(a) Be able to communicate or make provisions to communicate with the resident in his or her primary language;
(b) Understand and speak English well enough to:
(i) Respond appropriately to emergency situations; and
(ii) Read, understand and implement resident negotiated care plans.
(4) Meet the department's training requirements of chapter 388-112 WAC;
(5) Have no criminal convictions listed in RCW 43.43.830 or 43.43.842 or state or federal findings of abandonment, abuse, neglect or financial exploitation;
(6) Have a current valid first-aid and cardio-pulmonary resuscitation (CPR) card or certificate as required in chapter 388-112 WAC; and
(7) Have tuberculosis screening to establish tuberculosis status per this chapter.
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(1) Be eighteen years old or older;
(2) Meet the department's training requirements of chapter 388-112 WAC;
(3) Have no criminal convictions listed in RCW 43.43.830 and 43.43.842 or state or federal findings of abandonment, abuse, neglect or financial exploitation; and
(4) Tuberculosis screening to establish tuberculosis status per this chapter.
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(1) No criminal convictions listed in RCW 43.43.830 or 43.43.842 or state or federal findings of abandonment, abuse, neglect or financial exploitation; and
(2) A current valid first-aid and cardio-pulmonary resuscitation (CPR) card or certificate as required in chapter 388-112 WAC.
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(a) 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
(b) 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
(c) Have a valid Washington state license to practice as a nurse under chapter 18.79 RCW and three years of clinical nursing experience; or
(d) Is currently a licensed physician, including an osteopathic physician, in Washington State.
(2) The home must ensure than an assessor who meets the requirements of subsections (1)(a), (b), or (c) of this section does not have unsupervised access to any resident unless the assessor has:
(a) A current criminal history background check; and
(b) Has not been convicted of any crime listed in RCW 43.43.830 or 43.43.842 or state or federal findings of abandonment, abuse, neglect or financial exploitation.
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CRIMINAL HISTORY BACKGROUND CHECK(1) Caregivers;
(2) Staff;
(3) Volunteers or students acting as a caregiver; and
(4) Household members over the age of eleven.
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(1) Require the person to complete the residential care services background inquiry form which includes:
(a) A disclosure statement; and
(b) A statement authorizing the home, the department, and the Washington state patrol to conduct a background inquiry.
(2) Verbally inform the person:
(a) That he or she may ask for a copy of the background inquiry result; and
(b) Of the inquiry result within ten days of receiving the result.
(3) Send the information to the department and any additional documentation and information as requested by the department to satisfy the requirements of this section; and
(4) Notify the appropriate licensing or certification agency of any person resigning or terminated as a result of having a conviction record.
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(2) The adult family home must have a valid criminal history background check for all persons in the home who may have unsupervised access to any resident; and
(3) The home must submit, receive and keep the results of the check every two years.
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(1) Establish and implement procedures that ensure:
(a) All disclosure statements background inquiry applications, responses, related information, and all copies are kept in a confidential and secure manner;
(b) All background inquiry results and disclosure statements are used for employment purposes only;
(c) Background inquiry results and disclosure statements are not disclosed to any person except:
(i) The person about whom the home made the disclosure or background inquiry;
(ii) Authorized state and federal employees; and
(iii) The Washington state patrol auditor.
(2) Keep a record of inquiry results for eighteen months after the date an employee either quits or is terminated.
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(1) Asks the individual if they have been convicted of a crime listed under RCW 43.43.830 or 43.43.842 and the individual denies they have a conviction;
(2) Requests the background inquiry within seventy-two hours of the conditional employment;
(3) Does not allow, the conditionally hired person, to have unsupervised access to any resident without direct supervision; and
(4) Ensures the individual is competent and receives the necessary training to perform assigned tasks and meets the staff training requirements in chapter 388-112 WAC.
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(1) A stipulated finding of fact, conclusion of law, an agreed order, or finding of fact, conclusion of law, final order issued by a disciplining authority or final decision by any federal or state agency or department, a court of law, or entered into a state registry or department or agency list with a finding of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW; or
(2) Convicted of a crime against persons as defined under RCW 43.43.830 or 43.43.842.
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(2) The adult family home may choose to employ a person if the person has one or more convictions for a past offense and the offense was:
(a) Simple assault, assault in the fourth degree and three or more years has passed between the most recent conviction and the date of the application for employment;
(b) Prostitution and three or more years has passed between the most recent conviction and the date of the application for employment;
(c) Theft in the third degree and three or more years has passed between the most recent conviction and the date of the application for employment;
(d) Theft in the second degree and five or more years has passed between the most recent conviction and the date of the application for employment; or
(e) Forgery and five or more years has passed between the most recent conviction and the date of the application for employment.
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ADMINISTRATION GENERAL(1) This chapter;
(2) Chapters 70.128, 70.129 and 74.34 RCW; and
(3) Other applicable state and federal laws.
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(1) Enough staff is available in the home to meet the needs of each resident if residents are in the home or not, except as per WAC 388-76-10200;
(2) Staff are readily available to meet resident needs if the home takes the resident out to another location and the resident negotiated care plan does not indicate it is safe for the resident to be left unattended for a specific time period; and
(3) All staff are skilled and able to do the tasks assigned to meet the needs of each resident.
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(1) Designate an experienced, capable staff member of responding on behalf of the provider or entity representative:
(a) By phone or pager;
(b) At all times including:
(i) When no residents are present in the home; and
(ii) When the provider entity representative and residents are on vacation or away from the home.
(2) Give residents the telephone or pager number for the contact required in subsection (1) of this section;
(3) Ensure the provider, entity representative or resident manager is readily available to:
(a) Each resident;
(b) Residents' representatives;
(c) Caregivers; and
(d) Authorized state staff.
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(1) Notify the following in writing of the closure at least thirty days before the home closes:
(a) The department;
(b) Each resident; and
(c) Each resident's representative.
(2) Develop, organize, and carry out a discharge plan that meets the needs of each resident.
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(2) If a deceased resident had some of his or her adult family home care paid for by the department, then the home must:
(a) Send the final accounting and funds payable to:
Secretary, Department of Social and Health Services
Office of Financial Recovery
Estate Recovery Unit
(b) Include with the final accounting required in
subsection (2)(a) of this section:
(i) The deceased resident's name; and
(ii) The deceased resident's social security number.
(3) When a resident is missing from the home, in addition to other licensing requirements, the home must make a reasonable effort to find the missing resident before transferring resident funds to the department of revenue as per subsection (4) of this section.
(4) The adult family home must notify the department of revenue of abandoned property when:
(a) A resident is missing from the home for more than ninety days; and
(b) The missing resident:
(i) Gave money to the home to manage or for safekeeping;
(ii) Does not have a legal guardian;
(iii) Did not appoint a power of attorney to handle his or her financial affairs;
(iv) Did not name a family member to act on the resident's behalf; and
(v) Did not have his or her care paid for by the department.
(5) The home must send any money received from the missing resident, to the department of revenue:
(a) According to chapter 63.29 RCW;
(b) Within twenty days of notifying the department of revenue per subsection (2) of this section.
(6) Before the adult family home changes its owner, the home must:
(a) Give each resident a written statement that accounts for any personal funds held by the home;
(b) Give the prospective adult family home owner a written statement that accounts for all of the residents' funds that home will transfer to the new adult family home owner; and
(c) Get a written receipt of the transferred residents' funds from the new adult family home owner.
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(1) Alleged or suspected instances of abandonment, neglect, abuse or financial exploitation;
(2) Accidents or incidents affecting a resident's welfare; and
(3) Any injury to a resident.
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(a) Report suspected abuse, neglect, exploitation or abandonment of a resident:
(i) According to chapter 74.34 RCW;
(ii) To the department by calling the complaint toll-free hotline number; and
(iii) To the local law enforcement agency when required by RCW 74.34.035.
(b) Report the following to the department by calling the complaint toll-free hotline number:
(i) Any actual or potential event requiring any resident to be evacuated;
(ii) Conditions that threaten the provider's or entity representative's ability to continue to provide care or services to each resident; and
(iii) A missing resident.
(2) When there is a significant change in a resident's condition, or a serious injury, trauma, or death of a resident, the adult family home must immediately notify:
(a) The resident's family;
(b) The resident's representative, if one exists;
(c) The resident's physician;
(d) Other appropriate professionals working with the resident;
(e) Persons identified in the negotiated care plan; and
(f) The resident's case manager if the resident is a department client.
(3) Whenever an outbreak of suspected food poisoning or communicable disease occurs, the adult family home must notify:
(a) The local public health officer; and
(b) The department's complaint toll-free hotline number.
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(1) Does not compromise any resident rights, preferences or medical needs;
(2) Has a suitable temperament, is clean and healthy, and otherwise poses no significant health or safety risks to any resident, staff, or visitors; and
(3) Has proof of regular immunizations.
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HEALTH CARE DECISION MAKING(1) A court has appointed the home to be the guardian under chapter 11.88 RCW; and
(2) The home has petitioned the court in writing according to RCW 11.92.040(6) to:
(a) Inform the court:
(i) The home provides care for the resident in the home;
(ii) The fees the home is paid to care for the resident, the home's duties, and the types of care provided to the resident for those fees; and
(iii) Why the guardianship fees would not be duplicative of the fees paid.
(b) Request the court to direct payment to the home from the resident's funds for the resident's care, maintenance and education.
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(1) Spouse;
(2) Adult child; or
(3) Brother or sister.
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(1) Chapter 7.70 RCW;
(2) Chapter 70.122 RCW;
(3) Chapter 11.88 RCW;
(4) Chapter 11.92 RCW; and
(5) Chapter 11.94 RCW.
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(a) Unless the caregiver, present at the time of the emergency, is a licensed physician or registered nurse acting within his or her scope of practice;
(b) Whether or not:
(i) Any order exists directing medical care for the resident;
(ii) The resident has provided an advance directive for medical care; or
(iii) The resident has expressed any wishes involving medical care.
(2) If available, the home must immediately give arriving emergency medical services personnel a copy of:
(a) Any order that exists directing medical care for the resident; and
(b) The resident's advance directive for medical care.
(3) The home must inform the resident of the requirements in this section.
(4) The home is not required to contact emergency medical services when a resident is receiving hospice care by a licensed hospice agency and the:
(a) Emergency relates to the expected hospice death; and
(b) Situation is monitored by the hospice agency.
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INFECTION CONTROL AND COMMUNICABLE DISEASE(1) Uses nationally recognized infection control standards;
(2) Emphasizes frequent hand washing and other means of limiting the spread of infection;
(3) Follows the requirements of chapter 49.17 RCW, Washington Industrial Safety and Health Act to protect the health and safety of each resident and employees; and
(4) Directs all staff to:
(a) Dispose of razor blades, syringes, and other sharp items in a manner that will not risk the health and safety of residents, staff, other persons residing in the home or the public; and
(b) Use all disposable and single-service supplies and equipment only one time as specified by the manufacturer.
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TUBERCULOSIS SCREENING(a) Provider;
(b) Entity representative;
(c) Resident manager;
(d) Caregiver;
(e) Staff; and
(f) Any student or volunteer providing any resident care and services.
(2) For the purposes of the tuberculosis sections "person" means the people listed in this section as required to have tuberculosis testing.
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(1) Within forty-eight to seventy-two hours of the test; and
(2) By a trained professional.
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(1) A documented history of a previous positive test, ten or more millimeters in duration; or
(2) Documented evidence of:
(a) Adequate therapy for active disease; or
(b) Preventive therapy of infection.
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(1) A positive result from the person's first skin test -a person who has a positive result from an initial first step test should not have a second test;
(2) A documented history of a negative result from previous two step testing; or
(3) A documented negative result from one step testing in the previous twelve months.
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(1) An initial skin test within three days of employment; and
(2) A second test done one to three weeks after the first test; except
(3) A two-step test is not required for the TB Gold Test which is only a one-step test.
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(1) After exposure to active tuberculosis;
(2) When tuberculosis symptoms are present; or
(3) For periodic testing as determined by health official.
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(1) The signed statement includes the reason for declining; and
(2) Additional evidence is provided to support the reason.
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(1) Report any person with tuberculosis symptoms or a positive chest x-ray to the appropriate public health authority; and
(2) Follow the infection control and safety measures ordered by the public health authority, the person's personal physician, or other licensed health care professional.
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(1) Keep the records of tuberculosis test results, reports of x-ray findings, and physician or public health orders and waivers;
(2) Make them readily available to the appropriate health authority and licensing agency; and
(3) Keep them for eighteen months after the date an employee either quits or is terminated.
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RESIDENT RECORDS(1) Create, maintain, and keep records for residents in the home where the resident lives and ensure that the records:
(a) Contain enough information so home can provide the needed care and services to each resident;
(b) Be in a format useful to the home;
(c) Be kept confidential so that only authorized persons see their contents;
(d) Are only released to the following persons:
(i) A health care institution;
(ii) When requested by the law;
(iii) To department representatives; and
(iv) To the resident;
(e) Be protected to prevent loss, alteration or destruction and unauthorized use;
(f) Be kept for three years after the resident leaves the home or death of the resident;
(g) Be available so that department staff may review them when requested; and
(h) Provide access to the resident to review their record and obtain copies of their record at a reasonable cost.
(2) Ensure staff has access to the parts of residents' records needed by staff to provide care and services; and
(3) Allow representatives of the long-term care ombudsman access to a resident record if approved by the resident.
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(1) Identifying information about the resident;
(2) The name, address and telephone number of the resident's:
(a) Representative;
(b) Health care providers;
(c) Significant family members identified by the resident; and
(d) Other individuals the resident wants involved or notified.
(3) Current medical history;
(4) The resident assessment information;
(5) The preliminary service plan;
(6) The negotiated care plan;
(7) List of resident medications;
(8) The resident's social security number;
(9) When the resident was:
(a) Admitted to the home;
(b) Absent from the home; and
(c) Discharged from the home.
(10) A current inventory of the resident's personal belongings dated and signed by:
(a) The resident; and
(b) The adult family home.
(11) Financial records.
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(1) Any powers of attorney granted by the resident, including for health care decision making and financial; and
(2) Court order of guardianship for the resident.
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RESIDENT ASSESSMENT(1) Obtain a new written assessment before admitting a resident to the home;
(2) Not admit a resident without an assessment except in cases of a genuine emergency;
(3) Ensure the assessment contains all of the information required in WAC 388-76-10335 unless the assessor can not:
(a) Obtain an element of the required assessment information; and
(b) The assessor documents the attempt to obtain the information in the assessment.
(4) Be knowledgeable about the needs and preferences of each resident documented in the assessment.
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(a) How the resident performs with passive range of motion, applications of dressings and ointments or lotions to the body and pedicure to trim toenails and apply lotion to feet; and
(b) Dressing changes using clean technique and topical ointments must be performed by a licensed nurse or through nurse delegation in accordance with chapter 246-840 WAC.
(2) Body care includes:
(a) Foot care if the resident is diabetic or has poor circulation; or
(b) Changing bandages or dressings when sterile procedures are required.
(3) The adult family home must ensure that each resident's assessment includes the following minimum information:
(a) Recent medical history;
(b) Current prescribed medications, and contraindicated medications, including but not limited to, medications known to cause adverse reactions or allergies;
(c) Medical diagnosis reported by the resident, the resident representative, family member, or by a licensed medical professional;
(d) Medication management:
(i) The ability of the resident to be independent in managing medications;
(ii) The amount of medication assistance needed;
(iii) If medication administration is required; or
(iv) If a combination of the elements in (i) through (iii) above is required.
(e) Food allergies or sensitivities;
(f) Significant known behaviors or symptoms that may cause concern or require special care, including:
(i) The need for and use of medical devices;
(ii) The refusal of care or treatment; and
(iii) Any mood or behavior symptoms that the resident has had within the last five years.
(g) Cognitive status, including an evaluation of disorientation, memory impairment, and impaired judgment;
(h) History of depression and anxiety;
(i) History of mental illness, if applicable;
(j) Social, physical, and emotional strengths and needs;
(k) Functional abilities in relationship to activities of daily living including:
(i) Eating;
(ii) Toileting;
(iii) Walking;
(iv) Transferring;
(v) Positioning;
(vi) Specialized body care;
(vii) Personal hygiene;
(viii) Dressing; and
(ix) Bathing.
(l) Preferences and choices about daily life that are important to the resident, including but not limited to:
(i) The food that the resident enjoys;
(ii) Meal times; and
(iii) Sleeping and nap times.
(m) Preferences for activities; and
(n) A preliminary service plan.
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(1) The resident's specific problems and needs identified in the assessment;
(2) The needs for which the resident chooses not to accept or refuses care or services;
(3) What the home will do to ensure the resident's health and safety related to the refusal of any care or service;
(4) Resident defined goals and preferences; and
(5) How the home will meet the resident's needs.
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(1) A qualified assessor; or
(2) For a resident who receives care and services paid for by the department, an authorized department case manager.
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(1) When there is a significant change in the resident's physical or mental condition;
(2) When the resident's negotiated care plan no longer reflects the resident's current status, needs and preferences;
(3) At the resident's request or at the request of the resident's representative; or
(4) At least every twelve months.
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NEGOTIATED CARE PLAN(1) A list of the care and services to be provided;
(2) Identification of who will provide the care and services;
(3) When and how the care and services will be provided;
(4) How medications will be managed, including how the resident will get their medications when the resident is not in the home;
(5) The resident's activities preferences and how the preferences will be met;
(6) Other preferences and choices about issues important to the resident, including, but not limited to:
(a) Food;
(b) Daily routine;
(c) Grooming; and
(d) How the home will accommodate the preferences and choices.
(7) If needed, a plan to:
(a) Follow in case of a foreseeable crisis due to a resident's assessed needs;
(b) Reduce tension, agitation and problem behaviors;
(c) Respond to resident's special needs, including, but not limited to medical devises and related safety plans;
(d) Respond to a resident's refusal of care or treatment, including when the resident's physician or practitioner should be notified of the refusal;
(8) Identification of any communication barriers the resident may have and how the home will use behaviors and nonverbal gestures to communicate with the resident;
(9) A statement of the ability for resident to be left unattended for a specific length of time; and
(10) A hospice care plan if the resident is receiving services for hospice care delivered by a licensed hospice agency.
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(1) The resident, to the greatest extent he or she can participate;
(2) The resident's family, if approved by the resident;
(3) The resident's representative, if the resident has a representative;
(4) Professionals involved in the care of the resident;
(5) Other individuals the resident wants included; and
(6) The department case manager, if the resident is receiving care and services paid for by the department.
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(1) Resident; and
(2) Adult family home.
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(1) After an assessment for a significant change in the resident's physical or mental condition;
(2) When the plan, or parts of the plan, no longer address the resident's needs and preferences;
(3) At the request of the resident or the resident representative; or
(4) At least every twelve months.
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CARE AND SERVICES(1) The home can safely and appropriately meet the assessed needs and preferences of the person:
(a) With available staff; and
(b) Through reasonable accommodation.
(2) Admitting the resident does not negatively affect the ability of the home to:
(a) Meet the needs and does not endanger the safety of other residents; or
(b) Safely evacuate all people in the home during an emergency.
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(2) To establish that a true emergency exists, the home must verify that the resident's life, health or safety is at serious risk due to circumstances in the resident's current place of residence or harm to the resident has occurred.
(3) After establishing that a true emergency exists, the home must:
(a) Ensure the assessment and preliminary service plan are completed within five working days after admitting the resident, if the resident pays for services with private funds; or
(b) Obtain approval from an authorized department case manager before admission if the resident's care and services are paid by the department; and
(c) If approval is obtained verbally, document the time, date, and name of the case manager who gave approval.
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(1) The care and services identified in the negotiated care plan.
(2) The necessary care and services to help the resident reach the highest level of physical, mental, and psychosocial well-being consistent with resident choice, current functional status and potential for improvement or decline.
(3) The care and services in a manner and in an environment that:
(a) Actively supports, maintains or improves each resident's quality of life;
(b) Actively supports the safety of each resident; and
(c) Reasonably accommodates each resident's individual needs and preferences except when the accommodation endangers the health or safety of the individual or another resident.
(4) Services by the appropriate professionals based upon the resident's assessment and negotiated care plan, including nurse delegation if needed.
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(1) Contract with a nurse currently licensed in the state of Washington to provide the nursing care and service; or
(2) Hire or contract with a nurse to provide nurse delegation.
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(1) Provide laundry services as needed; and
(2) Launder sheets and pillowcases weekly or more often if soiled.
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FOOD SERVICES(1) Ensure the provider, entity representative and all staff meet the safe food handling training requirements of chapter 388-112 WAC; and
(2) Serve meals:
(a) In the home where each resident lives; and
(b) That accommodate each resident's:
(i) Preferences;
(ii) Food allergies and sensitivities;
(iii) Caloric needs;
(iv) Cultural and ethnic background; and
(v) Physical condition that may make food intake difficult such as being hard for the resident to chew or swallow.
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(1) Serve at least three meals:
(a) In each twenty-four hour period;
(b) At regular times comparable to normal meal times in the community; and
(c) That meet the nutritional needs of each resident.
(2) Make nutritious snacks available to residents:
(a) Between meals; and
(b) In the evening.
(3) Get input from residents in meal planning and scheduling;
(4) Serve nutrient concentrates, supplements, and modified diets only with written approval of the resident's physician;
(5) Only serve pasteurized milk; and
(6) Process any home-canned foods served in the home, according to the latest guidelines of the county cooperative extension service.
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(1) Persons preparing food, at a location separate from the home, have a current food handler's permit issued by the department of health;
(2) Prepared food transported to the home is in airtight containers; and
(3) Food stays at the appropriate and safe temperature:
(a) During transportation; and
(b) When served.
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RESIDENT MEDICATIONS(2) When providing medication assistance or medication administration for any resident, the home must ensure each resident:
(a) Assessment indicates the amount of medication assistance needed by the resident;
(b) Negotiated care plan identifies the medication service that will be provided to the resident;
(c) Medication log is kept current as required in WAC 388-76-10475;
(d) Receives medications as required.
(3) Records are kept which include a current list of prescribed and over-the-counter medications including name, dosage, frequency and the name and phone number of the practitioner as needed.
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(2) If the adult family home is assisting with or administering a resident's medications and the resident refuses to take or does not receive a prescribed medication:
(a) The home must notify the resident's practitioner; unless
(b) The provider, entity representative, resident manager or caregiver is a nurse or other health professional, acting within their scope of practice, is able to make a judgment about the impact of the resident's refusal.
(3) If the home becomes aware that a resident who self-administers, or takes their own medications, refuses to take a prescribed medication:
(a) The home must notify the practitioner; unless
(b) The provider, entity representative, resident manager or caregiver is a nurse or other health professional, acting within their scope of practice, is able to make a judgment about the impact of the resident's refusal.
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(a) Ensure each resident assessment identifies the amount of assistance the resident needs when taking medications; and
(b) Let the practitioner know when the following may affect the resident's ability to take their medications:
(i) Resident's physical or mental limitations; and
(ii) The setting or environment where the resident lives.
(2) The amount of assistance needed by a resident when taking their medications is as follows:
(a) Independent self-administration is when the resident does not need help taking medications and is able to directly take medications by eating or drinking, inhaling, by shot, through the skin or other means;
(b) Self-administration with assistance, as described in chapter 246-888 WAC, is when a resident is assisted in taking their medication by a non-practitioner; and
(c) Medication administration is when medications are administered to the resident by a person legally authorized to do so, such as but not limited to a physician, nurse or pharmacist or through nurse delegation.
(3) The home must contact the resident's practitioner who will decide if a reassessment is necessary when:
(a) The resident has a change in the health status, medications, physical or mental limitations, or environment that might change the resident's need for medication assistance; or
(b) There is a need for a resident to have more than one type of medication assistance.
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(1) Administer their own medications; and
(2) Are allowed to keep their prescribed and over-the-counter medications securely locked in either their room or another agreed upon area if documented in the resident negotiated care plan.
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(2) The adult family home must ensure that the resident can:
(a) Put the medication into their own mouth; or
(b) Apply, inject, or instill the medications.
(3) The home must:
(a) Provide set-up assistance just before the resident takes or applies the medication; or
(b) Only give oral medications through a gastrostomy or "g-tube" when ordered by the practitioner; and
(c) Ensure the resident is aware they are taking a medication, however the resident does not have to name the medication, effects or side effects.
(4) Self-administration with assistance:
(a) Does not include shots or intravenous medications as defined in WAC 246-888-020, except for a pre-filled insulin syringe;
(b) May include steadying or guiding a resident's hand while applying or instilling medications such as ointments, eye, ear and nasal preparations, but does not include the practice of "hand-over-hand" (total physical assistance) administration;
(c) May include transferring the medications from one container to another to make a single dose such as pouring a liquid from the medication container to a calibrated spoon or measuring cup;
(d) May include reminding or coaching the resident to take their medication;
(e) Does not include direct assistance with intravenous and injectable medications except the home may carry a pre-filled insulin syringe which the resident can administer;
(f) May include using an enabler; and
(g) Could include delivering a pre-filled insulin syringe to the resident if the resident independently self-administers the injection per WAC 246-888-020.
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(1) Performed by a person as defined in chapter 69.41 RCW; or
(2) By nurse delegation per WAC 246-840-910 through 970; unless
(3) Done by a family member or legally appointed resident representative.
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(1) The amount of medication assistance needed by each resident, including but not limited to:
(a) The reasons why a resident needs that amount of medication assistance; and
(b) When there is a need for the resident to have more than one type of medication assistance.
(2) How the resident will get their medications when the resident is away from the home or when a family member or resident representative is assisting with medications is not available.
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(2) The adult family home must consult with the practitioner or pharmacist before altering a medication and if the practitioner or pharmacist agrees with altering a medication, record the:
(a) Time;
(b) Date; and
(c) Name of the person who provided the consultation.
(3) The home must ensure the resident is aware that a medication is:
(a) Altered; and/or
(b) Put in the resident's food or drink.
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(a) At the specific time(s) ordered by the practitioner; and
(b) As follows, when the practitioner does not order a medication to be given at a specific time:
(i) One time per day, approximately every twenty four hours;
(ii) Two times a day, approximately twelve hours apart;
(iii) Three times a day, approximately six hours apart; and
(iv) Four times a day, approximately four hours apart.
(2) The home must ensure all directions given by the practitioner are followed when assisting or giving each resident medication. This includes but is not limited to:
(a) Before meals;
(b) After meals;
(c) With or without food; and
(d) At bed time.
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(1) Keep an up-to-date daily medication log for each resident except for residents assessed as medication independent with self-administration.
(2) Include in each medication log the:
(a) Name of the resident;
(b) Name of all prescribed and over-the-counter medications;
(c) Dosage of the medication;
(d) Frequency which the medications are taken; and
(e) Approximate time the resident must take each medication.
(3) Ensure the medication log includes:
(a) Initials of the staff who assisted or gave each resident medication(s);
(b) If the medication was refused and the reason for the refusal; and
(c) Documentation of any changes or new prescribed medications including:
(i) The change;
(ii) The date of the change;
(iii) A logged call requesting written verification of the change; and
(iv) A copy of written verification of the change from the practitioner received by the home by mail, facsimile, or other electronic means, or on new original labeled container from the pharmacy.
(4) Ensure that the changed or new medication is received from the pharmacy.
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(1) A licensed nurse, pharmacist, the resident or the resident's family member fills a resident's medication organizer;
(2) Prescribed and over-the-counter medications placed in a medication organizer come from the original container labeled for the resident by the pharmacist or pharmacy service;
(3) Each resident and anyone giving care to a resident can readily identify medications in the medication organizer;
(4) Medication organizer labels clearly show the following:
(a) The name of the resident;
(b) A list of all prescribed and over-the-counter medications;
(c) The dosage of each medication;
(d) The frequency which the medications are given.
(5) The person filling the medication organizer updates the labels on the medication organizer when the practitioner changes a medication.
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(1) In locked storage;
(2) In the original container with legible and original labels; and
(3) Appropriately for each medication, such as if refrigeration is required for a medication and the medication is kept in refrigerator in locked storage.
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SPECIALTY CARE(1) Developmental disability;
(2) Mental illness; and
(3) Dementia.
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(1) The provider, entity representative and resident manager has successfully completed training in one or more of the specialty care designated areas;
(2) The home provides the department with written documentation:
(a) Of successful completion of the required specialty care training or challenge test for each person in subsection (1) of this section; and
(b) For the specialty care training for all caregivers in the adult family home provided by a person knowledgeable in specialty care.
(3) The home ensures the specialty care need of each resident is met.
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RESIDENT RIGHTS(1) Receives appropriate services;
(2) Is treated with courtesy;
(3) Continues to enjoy basic civil and legal rights;
(4) Has the chance to exercise reasonable control over life decisions such as choice, participation, and privacy;
(5) Is provided the opportunity to engage in religious, political, civic, recreational, and other social activities of their choice;
(6) Is cared for in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life including a safe, clean, comfortable, and homelike environment; and
(7) Is allowed to use his or her personal belongings to the extent possible.
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(1) Protect each resident's right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the home;
(2) Protect and promote the rights of each resident and assist the resident to exercise his or her rights as a resident of the home, as a citizen or resident of the United States and the state of Washington.
(3) Be free of interference, coercion, discrimination, and reprisal from the home in exercising his or her rights; and
(4) Ensure the resident's right to choose a representative who may exercise the resident's rights to the extent provided by law.
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(1) Inform each resident both orally and in writing in a language the resident understands of resident rights and all rules and regulations governing resident conduct and responsibilities during the stay in the home;
(2) Ask the resident to sign and date they received the information; and
(3) Provide a statement indicating whether the provider or entity representative will accept medicaid or other public funds as a source of payment for services.
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(1) Description of how the home will protect personal funds;
(2) Posting of names, addresses, and telephone numbers of the:
(a) State survey and certification agency;
(b) State licensing office;
(c) State ombudsmen program; and
(d) Protection and advocacy systems.
(3) Statement informing the resident that he or she may file a complaint with the appropriate state licensing agency concerning alleged abandonment, abuse, neglect, or financial exploitation.
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(1) Services, items, and activities customarily available in the home or arranged for by the home as permitted by the license;
(2) Charges for those services, items, and activities including charges for services, items, and activities not covered by the home's per diem rate or applicable public benefit programs; and
(3) Rules of the home's operations.
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(a) In writing; and
(b) In advance of changes in the availability of, or the charges for services, items, or activities, or of changes in the home's rules.
(2) The home must provide notice:
(a) Thirty days before the change, except in emergencies; or
(b) Fourteen days before the change, if there has been a substantial and continuing change in the resident's condition necessitating substantially greater or lesser services, items, or activities.
(3) The home is not required to give notice:
(a) If the home gives each resident written notice of the availability and charges of services, items and activities before admission, when there are changes and every twenty-four months; and
(b) If the resident is provided different or additional services, items or activities from the home.
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(2) The disclosure must include:
(a) A statement of the amount of any admissions fees, deposits, prepaid charges, or minimum stay fees;
(b) The home's advance notice or transfer requirements; and
(c) The amount of the deposits, admission fees, prepaid charges, or minimum stay fees that will be refunded to the resident if the resident leaves the home.
(3) The home must ensure that the receipt of the disclosures required under subsection (1) of this section is in writing and signed and dated by the resident and the home.
(4) If the home does not provide these disclosures, the home must not keep the deposits, admission fees, prepaid charges, or minimum stay fees.
(5) If a resident dies, is hospitalized or is transferred and does not return to the home, the adult family home:
(a) Must refund any deposit or charges already paid less the home's per diem rate for the days the resident actually resided, reserved or retained a bed in the home in spite of any minimum stay policy or discharge notice requirements; except that
(b) May keep an additional amount to cover its reasonable and actual expenses incurred as a result of a private-pay resident's move, not to exceed five days per diem charges; unless the resident has given advance notice in compliance with the admission agreement.
(6) All adult family homes covered under this section are required to refund any and all refunds due the resident within thirty days from the resident's date of discharge from the home.
(7) Nothing in this section applies to provisions in contracts negotiated between a home or and a certified health plan, health or disability insurer, health maintenance organization, managed care organization, or similar entities.
(8) If the home requires the implementation of an admission agreement by or on behalf of an individual seeking admission the home must ensure the terms of the agreement are consistent with the requirements of this section, chapters 70.128, 70.129 and 74.34 RCW, and other applicable state and federal laws.
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(1) Only admit or keep individuals whose needs the home can safely serve in the home:
(a) With appropriate available staff; and
(b) Through the provision of reasonable accommodations required by state and federal law.
(2) Not admit an individual before obtaining a thorough assessment of the resident's needs and preferences, except in cases of a genuine emergency;
(3) Ensure that the admission of the individual does not negatively affect the ability of the home to meet the needs of or endangers the safety of other residents; and
(4) Comply with all applicable federal and state requirements regarding nondiscrimination.
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(1) Information about the provider, entity representative and resident manager, if there is a resident manager:
(a) Availability in the home, including a general statement about how often he or she is in the home;
(b) Education and training relevant to resident caregiving;
(c) Caregiving experience;
(d) His or her primary responsibilities, including whether he or she makes daily general care management decisions; and
(e) How to contact the provider, entity representative or resident manager when he or she is not in the home.
(2) Information about a licensed practical nurse or registered nurse, if there is one, who is in any way involved in the care of residents:
(a) Who the licensed practical nurse or registered nurse is employed by;
(b) The specific routine hours that the licensed practical nurse or registered nurse is on-site, if they are on-site routinely;
(c) His or her primary responsibilities, including whether he or she makes daily general care management decisions;
(d) The non-routine times when the licensed practical nurse or registered nurse will be available, such as on-call; and
(e) A description of what the provider or entity representative will do to make available the services of a licensed nurse in an emergency or change in a resident's condition.
(3) A statement indicating whether the provider, entity provider, caregiver or staff is qualified or willing to become qualified to perform nurse delegation as allowed under state law.
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(1) Hold, safeguard, manage, and account for the personal funds of the resident deposited with the home;
(2) Have a written authorization from the resident;
(3) Deposit a resident's personal funds in excess of one hundred dollars in an interest-bearing account or accounts separate from any of the home's operating accounts, and that credits all interest earned on residents' funds to that account;
(4) If funds are pooled accounts, there must be a separate accounting for each resident's share; and
(5) Keep a resident's personal funds that do not exceed one hundred dollars in a non-interest-bearing account, interest-bearing account, or petty cash fund.
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(1) Develop and maintain a system that assures a full, complete, and separate accounting of each resident's personal funds given to the home on the resident's behalf;
(2) Ensure the:
(a) System prevents resident funds from being mixed with the home's funds or with the funds of any person other than another resident; and
(b) Individual financial record is available upon request to the resident.
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(a) The home;
(b) Medical treatment;
(c) Clinical or resident records;
(d) Personal care; and
(e) Visits and meetings of family and resident groups; however
(2) The resident right to personal privacy does not require the home to provide a private room for each resident.
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(1) Ensure each resident's right to voice grievances, including those about care and treatment given or not given that has been furnished as well as that which has not been furnished; and
(2) Make prompt efforts to resolve grievances the resident may have, including those about the behavior of other residents.
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(1) Ensure each resident is given an opportunity to examine the most recent inspection report of the home and related plans of correction; and
(2) Post a notice in a visible location in the home indicating the inspection report is available for review.
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(1) Receives information from client advocate agencies; and
(2) Has opportunities to contact client advocate agencies.
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(1) Any representative of the state;
(2) The resident's own physician;
(3) The state long-term care ombudsman program as established under chapter 43.190 RCW;
(4) The agency responsible for the protection and advocacy system for developmentally disabled individuals as established under Part C of the developmental disabilities assistance and bill of rights act;
(5) The agency responsible for the protection and advocacy system for mentally ill individuals as established under the protection and advocacy for mentally ill individuals act;
(6) Immediate family or other relatives of the resident and others who are visiting with the consent of the resident, subject to reasonable limits to protect the rights of others and to the resident's right to deny or withdraw consent at any time;
(7) The agency responsible for the protection and advocacy system for individuals with disabilities as established under section 509 of the rehabilitation act of 1973, as amended, who are not served under the mandates of existing protection and advocacy systems created under federal law; and
(8) The resident's representative or an entity or individual that provides health, social, legal, or other services to the resident, subject to the resident's right to deny or withdraw consent at any time.
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(1) Send and receive unopened mail without delay;
(2) Have writing paper, postage, and pens or pencils available that have been paid for by resident; and
(3) Be able to use a telephone where calls can be made without being overheard.
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(1) Potential liability for losses of personal property or injury; and
(2) Residents' rights set forth in chapters 70.128, 70.129, 74.34 RCW, this chapter or in the applicable licensing laws.
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(a) The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the home;
(b) The safety or health of individuals in the home is or would otherwise be endangered;
(c) The resident has failed to make the required payment for his or her stay; or
(d) The home ceases to operate.
(2) Before a home transfers or discharges a resident, the home must:
(a) First attempt through reasonable accommodations to avoid the transfer or discharge, unless agreed to by the resident;
(b) Notify the resident and representative and make a reasonable effort to notify, if known, an interested family member of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand;
(c) Record the reasons in the resident's record; and
(d) Include in the notice the items described in subsection (5) of this section.
(3) Except as specified in (4) of this section, the home must give notice of the transfer or discharge at least thirty days before the resident is transferred or discharged.
(4) The home may make the notice as soon as practicable before transfer or discharge when:
(a) The safety and health of the individuals in the home would be endangered;
(b) An immediate transfer or discharge is required by the resident's urgent medical needs; or
(c) A resident has not resided in the home for thirty days.
(5) The home must include the following in the written notice specified in subsection (2) of this section:
(a) The reason for transfer or discharge;
(b) The effective date of transfer or discharge;
(c) The location where the resident is transferred or discharged;
(d) The name, address, and telephone number of the state long-term care ombudsman;
(e) For residents with developmental disabilities, the mailing address and telephone number of the agency responsible for the protection and advocacy of developmentally disabled individuals; and
(f) For residents who are mentally ill, the mailing address and telephone number of the agency responsible for the protection and advocacy of mentally ill individuals.
(6) The home must give residents enough preparation and orientation to ensure a safe and orderly transfer or discharge from the home.
(7) If the home discharges a resident in violation of this section, the home must readmit the resident to the home as soon as a gender-appropriate bed becomes available.
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QUALITY OF LIFE(2) Within reasonable home rules designed to protect the rights and quality of life of residents, the home must ensure the resident's right to:
(a) Choose activities, schedules, and health care consistent with his or her interests, assessments, and negotiated care plan;
(b) Interact with members of the community both inside and outside the home;
(c) Make choices about aspects of his or her life in the home that are significant to the resident;
(d) Wear his or her own clothing and decide his or her own dress, hair style, or other personal effects according to individual preference;
(e) Unless adjudged incompetent or otherwise found to be legally incapacitated to:
(i) Be informed in advance about recommended care and services and of any recommended changes in the care and services;
(ii) Participate in planning care and treatment or changes in care and treatment;
(iii) Direct his or her own service plan and changes in the service plan, or
(iv) Refuse any particular service so long as such refusal is documented in the record of the resident.
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(1) A resident's right to:
(a) Organize and take part in resident groups in the home;
(b) Have family meet in the home with the families of other residents; and
(c) Have staff or visitors attend meetings at the group's invitation.
(2) The home must provide a resident or family group, if one exists, with meeting space.
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(1) Receives reasonable accommodation to meet the needs and preferences of the resident, except when the reasonable accommodation endangers the health or safety of the individual or other residents; and
(2) Has the ability to share a double room with his or her spouse when both spouses consent to the arrangement.
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MEDICAL DEVICES AND RESTRAINTS(1) Review the resident assessment to determine the resident's need for and use of a medical device;
(2) Ensure the resident negotiated care plan includes the resident use of a medical device or devices; and
(3) Provide the resident and family with enough information about the significance and level of the safety risk of use of the device to enable them to make an informed decision about whether or not the use the device.
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(1) Each resident's right to be free from physical restraints used for discipline or convenience;
(2) Less restrictive alternatives have been tried;
(3) That physical restraints used have been assessed as necessary to treat the resident's medical symptoms; and
(4) That if physical restraints are used to treat a resident's medical symptoms that the restraints are applied and immediately supervised on-site by a:
(a) Licensed registered nurse;
(b) Licensed practical nurse; or
(c) Licensed physician; and
(d) For the purposes of this subsection, immediate supervised means that the licensed person is in the home and quickly and easily available.
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(2) The adult family home must ensure that:
(a) Each resident is free from chemical restraints used for discipline or convenience;
(b) The resident assessment indicates that a chemical restraint is necessary to treat the resident's medical symptoms;
(c) In situations when a psychopharmacological drug is used for a resident, the home must ensure that the:
(i) Drug is prescribed by a physician or health care professional with prescriptive authority;
(ii) Resident's negotiated care plan includes strategies and modifications of the environment and staff behavior to address the symptoms for which the medication is prescribed;
(iii) Changes in medication only occur when the prescriber decides it is medically necessary; and
(iv) Resident has given informed consent for its use.
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ABUSE(1) Meet the requirements of chapter 74.34 RCW;
(2) Ensure each resident's right to be free from abandonment, verbal, sexual, physical and mental abuse, exploitation, financial exploitation, neglect, and involuntary seclusion;
(3) Protect each resident who is an alleged victim of abandonment, verbal, sexual, physical and mental abuse, exploitation, financial exploitation, neglect, and involuntary seclusion; and
(4) Prevent future potential abandonment, verbal, sexual, physical and mental abuse, exploitation, financial exploitation, neglect, and involuntary seclusion from occurring.
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(1) Do not allow abandonment, abuse, neglect of any resident, exploitation or financial exploitation of any resident;
(2) Require staff to report possible abuse, and other related incidents, as required in chapter 74.34 RCW; and
(3) Do not interfere with the requirement that employees and other mandated reporters file reports directly with the department, and with law enforcement, if they suspect sexual or physical assault to have occurred.
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PHYSICAL PLANT BASIC REQUIREMENTS(1) Ensure each resident's bedroom is an outside room, which allows entrance of natural light;
(2) Ensure window and door screens:
(a) Do not hinder emergency escape; and
(b) Prevent entrance of flies and other insects.
(3) Ensure each resident's bedroom has direct access to hallways and corridors and unrestricted or free access to common use areas;
(4) Make separate bedrooms available for each sex;
(5) Make reasonable efforts to accommodate residents wanting to share the room;
(6) Provide each bedroom with a minimum usable floor space as required in WAC 388-76-10690.
(7) Ensure no more than two residents to a bedroom;
(8) Unless the resident chooses to provide their own furniture and bedding, the home must provide each resident a bed thirty-six inches or more wide with:
(a) A clean, comfortable mattress;
(b) A waterproof cover for use when needed or requested by the resident;
(c) Clean sheets and pillow cases;
(d) Adequate clean blankets to meet the needs of each resident; and
(e) Clean pillows.
(9) Not use the upper bunk of double-deck beds for a resident's bed;
(10) Provide a call bell or intercom system if the provider, entity representative, resident manager or caregiver bedroom is not within hearing distance of each resident bedroom and the system is required by the department;
(11) Ensure that members of the household, other than residents, do not share bedrooms with residents; and
(12) Ensure a resident does not share a bedroom with a person under eighteen years of age, unless the person is the resident's own child.
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(2) The adult family home must ensure each resident bedroom has a minimum usable floor space as follows, excluding the floor space for toilet rooms, closets, lockers, wardrobes and vestibules:
(a) Single occupancy bedrooms with at least eighty square feet; and
(b) Double occupancy bedrooms with at least one-hundred twenty square feet.
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(a) New; or
(b) An existing building converted for use as an adult family home.
(2) For buildings licensed as a home before July 1, 2007, the requirement of subsection (1) of this section does not apply if:
(a) The building sells or transfers to a new owner; and
(b) The new owner takes possession of the building before the issuance of the license.
(3) The home must ensure that every area used by residents:
(a) Has direct access to at least one exit which does not pass through other areas such as a room or garage subject to being locked or blocked from the opposite side; and
(b) Is not accessible only by or with the use of a:
(i) Ladder;
(ii) Folding stairs; or
(iii) Trap door.
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(1) Before licensing; and
(2) After any construction changes that:
(a) Affect resident's ability to exit the home; or
(b) Change, add or modify a resident's bedroom.
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(a) Are areas and rooms of the adult family home that residents use each day for tasks such as eating, visiting, and leisure activities; and
(b) Include but are not limited to dining and eating rooms, living and family rooms, and any entertainment and recreation areas.
(2) The adult family home must ensure common use areas are:
(a) Homelike, with furnishings that each resident may use;
(b) Large enough for all residents to use at the same time; and
(c) Not used as bedrooms or sleeping areas.
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(1) Notify the residents of the move date and the resident's options consistent with chapter 70.129 RCW;
(2) Notify the department at least thirty days before the anticipated move, including:
(a) The location to which the residents will be moved;
(b) The home's plans for providing and ensuring care and services during the relocation;
(c) The home's plans for returning residents to the building; and
(d) The projected timeframe for completing the construction or remodeling.
(3) Obtain the department's approval of the relocation plans before moving the residents.
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(1) Every bedroom and bathroom door opens from the inside and outside;
(2) Every closet door opens from the inside and outside; and
(3) All exit doors leading to the outside will open from the inside without a key or any special knowledge or effort by residents.
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(a) In the home;
(b) In combination with video monitoring equipment; and
(c) Except as provided in section WAC 388-76-10725.
(2) The home may video monitor and video record activities in the home, without an audio component, only in the following areas:
(a) Entrances and exits if the cameras are:
(i) Focused only on the entrance or exit doorways; and
(ii) Not focused on areas where residents gather.
(b) Outdoor areas not commonly used by residents; and
(c) Designated smoking areas, subject to the following conditions when:
(i) Residents are assessed as needing supervision for smoking;
(ii) A staff person watches the video monitor at any time the area is used by such residents;
(iii) The video camera is clearly visible;
(iv) The video monitor is not viewable by general public; and
(v) The home notifies all residents in writing of the video monitoring equipment.
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(2) If the resident requests audio or video monitoring, before any electronic monitoring occurs the home must ensure:
(a) Appropriate actions are taken to ensure electronic monitoring is consistent with and does not violate chapter 9.73 RCW;
(b) The resident has identified a threat to the resident's health, safety or personal property and has requested electronic monitoring;
(c) The resident's roommate has provided written consent to electronic monitoring, if the resident has a roommate; and
(d) The resident and the home have agreed upon a specific duration for the electronic monitoring documented in writing.
(3) The home must reevaluate the need for the electronic monitoring with the resident at least quarterly and:
(a) Must document the reevaluation in writing; and
(b) Have each reevaluation signed and dated by the resident.
(4) The home must immediately stop electronic monitoring if the:
(a) Resident no longer wants electronic monitoring;
(b) Roommate objects or withdraws the consent to the electronic monitoring, or
(c) Resident becomes unable to give consent.
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(2) At a minimum, grab bars must be installed and securely fastened in:
(a) Bathing facilities such as tubs and showers; and
(b) Next to toilets, if needed by any resident.
(3) If needed by any resident, hand rails must be installed and conveniently located on:
(a) A step or steps; and
(b) Ramps.
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(a) Food handling;
(b) Preparation; and
(c) Food storage.
(2) The home must keep the kitchen and equipment in a clean and sanitary manner.
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(1) Adequate light fixtures for each task a resident or staff does; and
(2) Emergency lighting, such as working flashlights for staff and residents that are readily accessible.
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(1) Meet all applicable local licensing, zoning, building and housing codes as they pertain to a single family dwelling;
(2) Meet state and local fire safety regulations as they pertain to a single family dwelling; and
(3) Check with local authorities to ensure the home meets all local codes and ordinances.
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(1) Keep the home both internally and externally in good repair and condition with a safe, comfortable, sanitary, homelike environment that is free of hazards;
(2) Provide clean, functioning, safe, adequate household items and furnishings to meet the needs of each resident;
(3) Provide safe and functioning systems for:
(a) Heating;
(b) Cooling, which may include air circulating fans;
(c) Hot and cold water;
(d) Electricity;
(e) Plumbing;
(f) Garbage disposal;
(g) Sewage;
(h) Cooking;
(i) Laundry;
(j) Artificial and natural light;
(k) Ventilation; and
(l) Any other feature of the home.
(4) Ensure water temperature does not exceed one hundred twenty degrees Fahrenheit at all fixtures used by or accessible to residents, such as:
(a) Tubs;
(b) Showers; and
(c) Sinks.
(5) Provide storage for toxic substances, poisons, and other hazardous materials that is only accessible to residents under direct supervision, unless the resident is assessed for and the negotiated care plan indicates it is safe for the resident to use the materials unsupervised;
(6) Provide rapid access for all staff to any bedroom, toilet room, shower room, closet, other room occupied by each resident;
(7) Keep all firearms locked and accessible only to authorized persons; and
(8) Keep the home free from:
(a) Rodents;
(b) Flies;
(c) Cockroaches, and
(d) Other vermin.
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(1) A public sewer system; or
(2) An independent sewage system approved by the local health authority.
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(1) Is on a well drained site free from:
(a) Hazardous conditions;
(b) Excessive noise;
(c) Dust; and
(d) Smoke or odors.
(2) Has a road accessible at all times to emergency vehicles.
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(1) Supply each resident with adequate and reasonable storage space for:
(a) Clothing;
(b) Personal possessions; and
(c) Upon request, lockable container or storage space for small items, unless the:
(i) Resident has a private room; and
(ii) The resident room can be locked by the resident.
(2) Provide locked storage for all prescribed and over-the-counter medications as per WAC 388-76-10485.
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(1) At least one working non-pay telephone in the home;
(2) Residents reasonable access to the telephone; and
(3) Privacy for the resident when making or receiving calls.
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(1) Keep room temperature at:
(a) Sixty-eight degrees Fahrenheit or more during waking hours;
(b) Sixty degrees Fahrenheit or more during sleeping hours; and
(c) Not more than seventy-eight degrees Fahrenheit day or night.
(2) Provide ventilation in the home to ensure the health and comfort of each resident is met.
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(a) One indoor flush toilet for each five persons including residents and household members in the home; and
(b) Sinks with hot and cold running water.
(2) Homes licensed after July 1, 2007, must ensure each resident has access to a toilet, shower or tub without going through another resident's room.
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(a) In-ground, above-ground, and on-ground pools;
(b) Hot tubs, spas; or
(c) Fixed-in-place wading pools.
(2) The adult family home must:
(a) Protect each resident from risks of bodies of water of any depth and water hazards;
(b) Ensure that water hazard protection complies with this section and the requirements of the:
(i) International Residential Code (IRC); and
(ii) Washington state amendments to the International Residential Code (IRC).
(c) Provide each area which allows direct access to a water hazard with:
(i) A minimum of forty-eight inch high fences and gates to enclose or protect each resident from the water hazard;
(ii) Alarms that produce an audible warning when opened on all doors and screens, if present and gates.
(3) After July 1, 2007, existing adult family homes are required to meet the requirements of this section when installing or making construction changes to the following:
(a) In-ground, above-ground and on-ground pools;
(b) Hot tubs, spas;
(c) Decorative water features; or
(d) Fixed-in-place wading pools.
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(1) Obtain local health authority approval to use a private water supply;
(2) Provide a clean and healthy drinking water supply for the home; and
(3) Label any non-potable water to avoid use as a drinking water source.
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(2) For homes licensed after July 1, 2007, the department will not approve alternatives to the sill height requirement such as step(s), raised platform(s) or other devices placed by or under the window openings.
(3) The bedroom window must have the following:
(a) A minimum opening area of 5.7 square feet except a grade level floor window openings may have a minimum clear opening of 5.0 square feet;
(b) A minimum opening height of twenty-four inches; and
(c) A minimum opening width of twenty inches.
(4) The home must ensure the bedroom window can be opened from inside the room without keys or tools.
(5) When resident bedroom windows are fitted with storm windows, the home must equip the storm windows with release mechanisms that:
(a) Easily open from the inside; and
(b) Do not require a key or special knowledge or effort to open.
(6) The home must ensure that each basement and each resident bedroom window, that meets the requirements of subsection (1), (2) and (3) of this section, are kept free from obstructions that might block or interfere with access for emergency escape or rescue.
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FIRE PROTECTION
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(1) Installed, at a minimum, in the following locations:
(a) Every bedroom used by a resident;
(b) In proximity to the area where the resident or adult family home staff sleeps; and
(c) On every level of a multilevel home.
(2) Installed in a manner so that the fire warning is heard in all parts of the home upon activation of a single detector; and
(3) Kept in working condition at all times.
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(2) The home must ensure the fire extinguishers are:
(a) Installed according to manufacturer recommendations;
(b) Inspected and serviced annually;
(c) In proper working order; and
(d) Readily available for use at all times.
(2) If required by the local fire authority, the home must provide different fire extinguishers in place of the fire extinguishers required in subsection (1) of this section.
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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 388-76-10815
Notice required--Compliance with
building code and fire protection.
Before a resident is
admitted, the adult family home must disclose in writing in a
language understood by the prospective resident the following:
(1) Whether or not resident bedrooms comply with the current building code including evacuation standards; and
(2) If the home is located outside a public fire district, the source and plan for on-site fire protection.
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(a) Stairs;
(b) Elevator; or
(c) Lift.
(2) The home must install alternative emergency evacuation protection equipment when serving hearing or visually impaired residents.
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(1) The following space heaters are not used in a home except during a power outage and the portable heater is only safe source of heat:
(a) Oil;
(b) Gas;
(c) Kerosene; and
(d) Electric.
(2) Stoves and heaters do not block residents, staff or household members from escaping.
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DISASTER AND EMERGENCY PREPAREDNESS
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(1) Plans for responding to natural and man-made emergencies and disasters that may reasonably occur at the home;
(2) Actions to be taken by staff and residents when an emergency or disaster strikes; and
(3) The fire drill plan for evacuation of the home.
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(1) Will last for a minimum of seventy-two hours; and
(2) Meets the dietary needs of each resident, including any specific dietary restrictions any resident may have.
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(1) Will last for a minimum of seventy-two hours for each resident;
(2) Is at least three gallons for each resident;
(3) Is stored in food grade or glass containers;
(4) Is chemically treated or replaced every six months; and
(5) Is stored appropriately.
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(1) First aid supplies; and
(2) A first-aid manual.
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FIRE DRILL PLAN FOR EMERGENCY EVACUATION(1) Have a fire drill plan and procedures for the emergency evacuation of all residents from the adult family home; and
(2) Not admit and keep residents the provider or entity representative cannot safely evacuate from the adult family home.
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(1) From the home to a safe location outside the home; and
(2) In five minutes or less.
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(1) Level 1 - resident is capable of walking or traversing a normal pathway to safety without the physical assistance of another individual;
(2) Level 2 - resident is physically and mentally capable of traversing a normal pathway to safety with mobility aids, but unable to ascend or descend stairs without the physical assistance of another individual; and
(3) Level 3 - resident is unable to walk or transverse a normal pathway to safety without the physical assistance of another individual.
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(1) Has at least two means of exiting the bedroom; and
(2) Exiting from the bedroom does not require the use of:
(a) Stairs;
(b) Elevators; or
(c) A platform lift.
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(1) An accurate floor plan of the home, including rooms, hallways, exits (such as doorways and windows) to the outside of the home;
(2) Emergency evacuation routes showing the paths to take to exit the home; and
(3) The location for the residents to meet outside the home.
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(1) A visible location in the home; and
(2) Common areas normally used by residents, staff and visitors.
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(1) Emergency evacuation drills occur at least every two months; and
(2) All residents take part in at least one emergency evacuation drill each calendar year involving full evacuation from the home to a safe location.
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(1) Names of each resident and staff involved in the drill;
(2) Name of the person conducting the drill;
(3) Date and time of the drill; and
(4) The length of time it took to evacuate all residents.
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(1) Any fire; or
(2) Emergency evacuation from the home.
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INSPECTIONS--COMPLAINT INVESTIGATIONS--MONITORING VISITS
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(1) Department staff have access to:
(a) The home, residents, including former residents;
(b) Resident records, includes former residents records; and
(c) Facility staff and relevant staff records.
(2) The home and staff do not willfully interfere or fail to cooperate with department staff in the performance of official duties.
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(1) Within ten working days of completion of the inspection process; or
(2) Within ten calendar days of completion of the inspection if the home does not have a deficiency.
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(1) Inspection and complaint investigation reports as soon as they are completed;
(2) The home's plan of correction, if a copy is available at the time of the request; and
(3) Any final written decision by the department to take an enforcement action.
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(1) Be completed by the adult family home and returned to the department within ten days of receiving the inspection report;
(2) Include an attestation statement stating:
(a) What the home did or will do to correct each deficiency;
(b) That all deficiencies are or will be corrected;
(c) The home will stay in compliance with the licensing requirements;
(d) Dates, acceptable to the department, by which each cited deficiency has been or will be corrected; and
(e) A signature by the home, certifying that the home has or will correct each deficiency.
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RESIDENT ADVOCATE ACCESS(1) Washington protection and advocacy system as defined under RCW 71A.10.080; or
(2) Long-term care ombudsman as defined under chapter 43.190 RCW, the state regulations for the long-term care ombudsman and under federal law.
(3) The department must impose a civil penalty as per WAC 388-76-10975 for any such willful interference with a representative of the long-term care ombudsman program.
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REMEDIES(1) Denial of an application for a license;
(2) Impose reasonable conditions on a license;
(3) Impose civil penalties;
(4) Order stop placement; and/or
(5) Suspension or revocation of a license.
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(1) Applicant;
(2) Provider;
(3) Entity representative;
(4) Person affiliated with the applicant;
(5) Resident manager;
(6) A partner, officer, director or managerial employee of the entity;
(7) Spouse of the provider or entity representative;
(8) An owner:
(a) Of fifty-one percent or more of the entity;
(b) Who exercises control over the daily operations of the home.
(9) A caregiver; or
(10) Any person who:
(a) Has unsupervised access to residents in the home; and
(b) Lives in the home but who is not a resident.
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(1) A history of prior violations of chapter 70.128 RCW or any law relating to residential care facilities within the past five years that resulted in revocation, suspension, or non-renewal of a license or contract with the department;
(2) When providing care or services to children or vulnerable adults:
(a) Been found to be in significant noncompliance with federal or state regulations; or
(b) Had a license for the care of children or vulnerable adults suspended or revoked.
(3) Been enjoined from operating a facility for the care and services of children or adults;
(4) A stipulated finding of fact, conclusion of law, an agreed order, finding of fact, conclusion of law, final order issued by a disciplining authority or final decision by any federal or state agency or department, a court of law, or entered into a state registry or department or agency list with a finding of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW;
(5) Had a revocation or suspension of a license for the care of children or adults;
(6) Had a revocation, cancellation, suspension or nonrenewal of:
(a) A Medicaid or Medicare provider agreement by the contracting agency; or
(b) Any agreement with a public agency for the care and treatment of children or vulnerable adults, when the action was taken by the public agency.
(7) Been convicted of any crime listed in RCW 43.43.830 or 43.43.842;
(8) Been found by a court:
(a) In a protection proceeding under chapter 74.34 RCW to have abandoned, neglected, abused, or financially exploited a vulnerable adult; or
(b) In a domestic relations proceeding under Title 26 RCW to have sexually or physically abused, neglected or exploited any minor.
(9) Been found in any final decision issued by a disciplinary board to have:
(a) Sexually or physically abused, neglected or exploited any minor or a person with a developmental disability; or
(b) Abandoned, abused, neglected or financially exploited any vulnerable adult.
(10) Found in any dependency action under RCW 13.34.030 (5)(b) to have sexually or physically abused, neglected or exploited any minor; or
(11) Failed to pay the annual licensing fee.
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(1) Been convicted of a crime:
(a) As defined under RCW 43.43.830 or 43.43.842;
(b) Relating to financial exploitation as defined under RCW 43.43.830 or 43.43.842;
(c) Or a felony against a person if the conviction reasonably relates to the competency of the person to own or operate an adult family home;
(d) Involving a firearm used in the commission of a felony or in any act of violence against a person;
(e) Or engaged in illegally selling or distributing drugs, illegal use of drugs or excessive use of alcohol within the past five years without the evidence of rehabilitation.
(2) Been found by a court in a protection proceeding under chapter 74.34.RCW to have abandoned, abused, neglected, or financially exploited a vulnerable adult;
(3) Been found in a final decision issued by a disciplinary board to have sexually or physically abused, neglected or exploited any minor person or a person with a developmental disability or to have abused or financially exploited any vulnerable adult;
(4) Been found in any dependency action under RCW 13.34.030(5) to have sexually abused, neglected or exploited any minor or to have physically abused any minor;
(5) Been found in a court domestic relations proceeding under Title 26 RCW to have:
(a) Sexually abused, neglected or exploited any minor or to have physically abused any minor;
(b) Committed an act of domestic violence toward a family or household member.
(6) Had a sanction, corrective, or remedial action taken by federal, state, county, or municipal officials or safety officials related to the care or treatment of children or vulnerable adults;
(7) Obtained or attempted to obtain a license by fraudulent means or misrepresentation;
(8) Knowingly, or with reason to know, made a false statement of material fact on his or her application for a license or any data attached to the application or in any matter under investigation by the department;
(9) Permitted, aided, or abetted the commission of any illegal act on the adult family home premises;
(10) Willfully prevented or interfered with or failed to cooperate with any inspection, investigation or monitoring visit made by the department;
(11) Failed or refused to comply with:
(a) A condition imposed on a license or a stop placement order;
(b) The applicable requirements of chapters 70.128, 70.129, 74.34 RCW or this chapter.
(12) Misappropriated property of a resident;
(13) Been denied a license or license renewal to operate a facility that was licensed to care for children or vulnerable adults;
(14) Exceeded licensed capacity in the operation of an adult family home;
(15) Operated a facility for the care of children or adults without a license or revoked license;
(16) Relinquished or returned a license in connection with the operation of any facility for the care of children or adults, or did not seek license renewal following written notification of the licensing agency's intention of denial, suspension, cancellation or revocation of a license;
(17) Had resident trust funds or assets of an entity providing care to children or vulnerable adults seized by the Internal Revenue Service or a state entity for failure to pay income or payroll taxes;
(18) Failed to meet financial obligations as the obligations fell due in the normal course of business, thereby impeding the ability to provide care and services to residents;
(19) Refused to permit authorized department representatives to interview residents or to have access to resident records or home;
(20) Interfered with a long-term care ombudsman or department staff in the performance of his or her duties; or
(21) Found to be in non-compliance with the requirements established in chapters 70.128, 70.129, 74.34 RCW, this chapter or other applicable laws and regulations.
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(1) WAC 388-76-10115;
(2) WAC 388-76-10120;
(3) WAC 388-76-10125; and
(4) WAC 388-76-10940.
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(2) Conditions the department may impose on a license include, but are not limited to the following:
(a) Correction within a specified time;
(b) Training related to the deficiencies;
(c) Limits on the type of residents the provider or entity representative may admit or serve;
(d) Discharge of any resident when the department finds discharge is needed to meet that resident's needs or for the protection of other residents;
(e) Change in license capacity;
(f) Removal of the adult family home's designation as a specialized home;
(g) Prohibition of access to residents by a specified person; and
(h) Demonstration of ability to meet financial obligations necessary to continue operation.
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(a) Fines up to one thousand dollars can be issued for willful interference with a representative of the long-term care ombudsman per RCW 70.129.150; and
(b) Fines up to three thousand dollars can be issued for retaliation against a resident, employee, or any other person making a complaint, providing information to, or cooperating with, the ombudsman, the department, the attorney's general office, or a law enforcement agency per RCW 74.34.060(7).
(2) When the provider or entity provider fails to pay a fine when due under this chapter, the department may, in addition to other remedies, withhold an amount equal to the fine plus interest, if any, from any contract payment due to the provider or entity provider from the department.
(3) Civil monetary penalties are due twenty-eight days after the provider, entity representative or the owner or operator of an unlicensed adult family home is served with notice of the penalty unless the provider or entity representative requests a hearing in compliance with chapter 34.05 RCW and RCW 43.20A.215. If the hearing is requested, the penalty becomes due ten days after a final decision in the department's favor is issued. Interest accrues beginning thirty days after the department serves the provider or entity provider with notice of the penalty at a rate of one percent per month as per RCW 43.20B.695.
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(2) Once imposed, the adult family home must not admit any person until the stop placement order is terminated.
(3) If the home requests, the department may approve readmission of a resident to the home from a hospital or nursing home during the stop placement.
(4) The department must end the stop placement when the department finds the:
(a) Deficiencies necessitating the stop placement have been corrected; and
(b) Home can show it has the capacity to maintain adequate care and service.
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(2) When the department finds that violations existing in an adult family home are of such nature as to present a serious risk or harm to residents of other homes operated by the same provider or entity representative, and after the department investigates other homes licensed by the same provider or entity representative the department may impose remedies on those other homes.
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INFORMAL DISPUTE RESOLUTION, NOTICE AND APPEALS(2) The purpose of the review is to give the provider or entity representative an opportunity to present information which might warrant modification or deletion of a finding of a violation.
(3) The provider or entity representative may submit a written statement for review.
(4) In addition to a written statement, the provider or entity representative may ask to present the information in person to a department designee.
(5) Requests for review must be made in writing to the department at the address provided in the department's certified letter within ten working days of receipt of the written finding of a violation.
(6) When requested by the provider or entity representative, the department must expedite the dispute resolution process to review violations upon which a department order imposing license suspension, revocation, stop placement, or condition on a license is based.
(7) Orders of the department imposing license suspension, stop placement, or conditions on a license are effective immediately upon notice and shall continue pending dispute resolution.
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(2) A provider contesting any decision by the department to impose a remedy must within twenty-eight days of receipt of the decision:
(a) File a written application for an adjudicative proceeding by a method showing proof of receipt with the board of appeals at the mailing address contained in WAC 388-02-0030; and
(b) Include in or with the application:
(i) The reasons for contesting the department decision; and
(ii) A copy of the contested department decision.
(3) Administrative proceedings are governed by chapter 34.05 RCW, RCW 43.20A.215, where applicable, this section, and chapter 388-02 WAC. If any provision in this section conflicts with chapter 388-02 WAC, the provision in this section governs.
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The following sections of the Washington Administrative Code are repealed:
| WAC 388-76-535 | Authority. |
| WAC 388-76-540 | Definitions. |
| WAC 388-76-545 | License required. |
| WAC 388-76-550 | License application. |
| WAC 388-76-555 | License fees. |
| WAC 388-76-560 | License eligibility. |
| WAC 388-76-565 | Resident manager and live-in requirements. |
| WAC 388-76-570 | Additional license requirements--Multiple facility providers. |
| WAC 388-76-575 | Licensing of state employees. |
| WAC 388-76-580 | License capacity. |
| WAC 388-76-585 | Change of provider or provider address. |
| WAC 388-76-590 | Specialty adult family homes. |
| WAC 388-76-59000 | What authority does the department have to adopt rules related to specialty homes? |
| WAC 388-76-59010 | What types of specialty adult family home designations are there? |
| WAC 388-76-59050 | What is required in order to obtain the specialty designation? |
| WAC 388-76-59060 | Are adult family home providers required to obtain more than one specialty designation if an individual resident has more than one specialty need? |
| WAC 388-76-59070 | Are adult family home providers required to obtain more than one specialty designation if they serve two or more residents with different specialty needs? |
| WAC 388-76-59080 | When will providers be required to become specialty adult family homes in order to serve persons with mental illness or dementia? |
| WAC 388-76-59090 | When will providers be required to become specialty adult family homes in order to serve persons with developmental disabilities? |
| WAC 388-76-595 | Inspections and ombudsman visits. |
| WAC 388-76-600 | General resident rights. |
| WAC 388-76-60000 | What are resident rights? |
| WAC 388-76-60010 | Why do providers need to know resident rights? |
| WAC 388-76-60020 | Is the provider required to supply information to potential residents and current residents, or the resident's representative? |
| WAC 388-76-60030 | When must this information be supplied? |
| WAC 388-76-60040 | Must the information be updated and supplied again in advance of changes? |
| WAC 388-76-60050 | What information is the provider required to supply to potential residents and current residents? |
| WAC 388-76-60060 | Do residents have rights that are not listed here? |
| WAC 388-76-60070 | What are some of the other resident rights that must be considered? |
| WAC 388-76-605 | Restraints. |
| WAC 388-76-610 | Resident assessment. |
| WAC 388-76-61000 | Is an assessment needed before a person can be admitted to an adult family home? |
| WAC 388-76-61010 | Under what circumstances can a provider admit or continue services for a person? |
| WAC 388-76-61020 | What must be included in the resident assessment? |
| WAC 388-76-61030 | How does the preliminary service plan fit within the resident assessment? |
| WAC 388-76-61040 | Is the use of an approved form required for the assessment? |
| WAC 388-76-61050 | Who can do the assessment? |
| WAC 388-76-61060 | In emergency situations, can a provider admit a resident without an assessment? |
| WAC 388-76-61070 | Does the assessment have to be updated? |
| WAC 388-76-61080 | Who is qualified to update the assessment? |
| WAC 388-76-615 | Negotiated care plan. |
| WAC 388-76-61500 | What is a negotiated care plan? |
| WAC 388-76-61510 | When must the negotiated care plan be developed? |
| WAC 388-76-61520 | How does the negotiated care plan fit in with the assessment and preliminary service plan? |
| WAC 388-76-61530 | Who must be involved in the development of the negotiated care plan? |
| WAC 388-76-61540 | Who must sign the negotiated care plan? |
| WAC 388-76-61550 | How often must the negotiated care plan be reviewed and revised? |
| WAC 388-76-61560 | When does the department's case manager get a copy of the negotiated care plan? |
| WAC 388-76-61570 | How are payment rate changes authorized for residents receiving services paid for fully or partially by the department? |
| WAC 388-76-620 | Provision of services and care. |
| WAC 388-76-625 | Nurse delegation--Training and registration. |
| WAC 388-76-630 | Performance of delegated nursing care tasks. |
| WAC 388-76-635 | Nurse delegation--Penalties. |
| WAC 388-76-64010 | What are the rules the provider must follow in all situations involving resident medications? |
| WAC 388-76-64015 | What defines the type of help a resident may need when taking their medication? |
| WAC 388-76-64020 | What must the provider include in the negotiated care plan for residents who are independent with self-administration? |
| WAC 388-76-64025 | How do a resident and provider initiate self-administration with assistance? |
| WAC 388-76-64030 | What must the provider monitor when implementing self-administration with assistance? |
| WAC 388-76-64035 | What other situations must the provider monitor when self-administration with assistance occurs for a resident? |
| WAC 388-76-64040 | What must the provider do when there is a need to alter medications during self-administration with assistance? |
| WAC 388-76-64045 | What other types of assistance can a nonpractitioner provide? |
| WAC 388-76-64050 | Who can fill medication organizers and what is required? |
| WAC 388-76-64055 | What documentation is the provider required to include in the resident's daily medication log? |
| WAC 388-76-645 | Resident activities. |
| WAC 388-76-650 | Food services. |
| WAC 388-76-655 | General management and administration. |
| WAC 388-76-660 | Training. |
| WAC 388-76-665 | Resident records. |
| WAC 388-76-670 | Disaster and emergency preparedness. |
| WAC 388-76-675 | Reporting requirements. |
| WAC 388-76-680 | Infection control and communicable disease. |
| WAC 388-76-685 | Criminal history disclosure and background inquiries. |
| WAC 388-76-690 | Advance directives, guardianship, and decision making. |
| WAC 388-76-695 | Protection of resident funds--Liquidation or transfer. |
| WAC 388-76-700 | Resident relocation due to closure. |
| WAC 388-76-705 | Remedies. |
| WAC 388-76-710 | Notice, hearing rights, and effective dates relating to imposition of remedies. |
| WAC 388-76-715 | Dispute resolution. |
| WAC 388-76-720 | Common use areas. |
| WAC 388-76-725 | Bedrooms. |
| WAC 388-76-730 | Toilets and bathing facilities. |
| WAC 388-76-735 | Kitchen facilities. |
| WAC 388-76-740 | Telephones. |
| WAC 388-76-745 | Storage. |
| WAC 388-76-750 | Laundry. |
| WAC 388-76-755 | Local ordinances. |
| WAC 388-76-760 | Site. |
| WAC 388-76-76505 | What physical structure requirements must the provider ensure that the home meets? |
| WAC 388-76-76510 | What are the resident emergency evacuation requirements that providers must address? |
| WAC 388-76-76515 | What fire safety and emergency requirements must the provider have in the home? |
| WAC 388-76-76520 | What is required of the provider for emergency evacuation drills? |
| WAC 388-76-770 | Safety and maintenance. |
| WAC 388-76-775 | Pets. |
| WAC 388-76-780 | Lighting. |
| WAC 388-76-785 | Temperature and ventilation. |
| WAC 388-76-790 | Water supply. |
| WAC 388-76-795 | Sewage and liquid wastes. |