Effective Date of Rule: Thirty-one days after filing.

     Purpose: The department is amending and creating new sections to these rules to make editorial and clarifying changes, and to make the rules consistent with current laws and standards.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-78A-2060 Preadmission assessment, 388-78A-2300 Food and nutrition services, 388-78A-2440 Resident register, 388-78A-2470 Criminal history disclosure and background checks, 388-78A-2480 Tuberculosis -- Testing -- Required, 388-78A-2520 Administrator qualifications -- General, 388-78A-2540 Administrator requirements, 388-78A-2590 Management agreements -- General, 388-78A-2910 Applicable building codes, 388-78A-3030 Toilet rooms and bathrooms, 388-78A-3190 Denial, suspension, revocation, or nonrenewal of license statutorily required, 388-78A-3410 Resident protection program -- Notice to the individual of preliminary finding, 388-78A-3420 Resident protection program -- Notice to others of preliminary findings, 388-78A-3430 Resident protection program -- Disputing a preliminary finding, 388-78A-3450 Resident protection program -- Finalizing a preliminary finding, 388-78A-3460 Resident protection program -- Appeal of initial order, 388-78A-3470 Resident protection program -- Reporting final findings, and 388-78A-3480 Resident protection program -- Disclosure of investigative and finding information; and new sections WAC 388-78A-2481 Tuberculosis -- Testing method -- Required, 388-78A-2482 Tuberculosis -- No testing, 388-78A-2483 Tuberculosis -- One test, 388-78A-2484 Tuberculosis -- Two step skin testing, 388-78A-2485 Tuberculosis -- Positive test result, 388-78A-2486 Tuberculosis -- Negative test result, 388-78A-2487 Tuberculosis -- Declining a skin test, 388-78A-2488 Tuberculosis -- Reporting -- Required, 388-78A-2489 Tuberculosis -- Test records, 388-78A-2521 Certification of training, 388-78A-2522 Administrator qualifications -- Prior to 2004, 388-78A-2523 Administrator qualifications -- NH Administrator license, 388-78A-2524 Administrator qualifications -- Certification of training, and three years experience, 388-78A-2525 Administrator qualifications -- Associate degree, certification of training, and two years experience, 388-78A-2526 Administrator qualifications -- Bachelor's degree, certification of training, and one year experience, 388-78A-2527 Administrator qualifications -- Five years experience, 388-78A-2592 Management agreements -- Licensee, 388-78A-2593 Management agreements -- Terms of agreement, 388-78A-2594 Management agreements -- Department review, 388-78A-2595 Management agreements -- Resident funds, 388-78A-2665 Resident rights -- Notice -- Policy on accepting medicaid as a payment source, 388-78A-2732 Liability insurance required -- Ongoing, 388-78A-2733 Liability insurance required -- Commercial general liability insurance or business liability insurance coverage, 388-78A-2734 Liability insurance required -- Professional liability insurance coverage, 388-78A-3390 Resident protection program -- Individual defined, 388-78A-4000 Notice -- Service complete, and 388-78A-4010 Notice -- Proof of service.

     Statutory Authority for Adoption: Chapter 18.20 RCW.

      Adopted under notice filed as WSR 09-20-061 on October 2, 2009.

     Changes Other than Editing from Proposed to Adopted Version: The changes, other than editing changes, follow in track changes below:

AMENDATORY SECTION (Amending WSR 09-01-052, filed 12/10/08, effective 1/10/09)

     WAC 388-78A-2470 Criminal history disclosure and background checks. (1) This section applies to any individual associated with the licensee or boarding home who may have unsupervised access to residents, including but not limited to:

     (a) Employees;

     (b) Managers;

     (c) Volunteers who are not residents;

     (d) Contractors; and

     (e) Students.

     (2) The boarding home must((:

     (a))) ensure that any individual ((associated with the licensee or boarding home who may have unsupervised access to residents)) described in subsection (1) has had a background check ((of conviction records, pending charges and disciplinary board decisions)) completed within the past two years, and that the background check is repeated every two years ((thereafter, and that individual has not been:

     (i))).

     (3) The boarding home must not allow unsupervised access by any individual described in subsection (1), if the individual has been:

     (a) Convicted of a "crime against children or other persons" as defined in RCW 43.43.830 ((or 43.43.842)), unless the crime is simple assault, assault in the fourth degree, or prostitution and more than three years has passed since the last conviction;

     (((ii))) (b) Convicted of "crimes relating to financial exploitation" as defined in RCW 43.43.830 ((or 43.43.842)), unless the crime is theft in the third degree, and more than three years have passed since conviction, or unless the crime is forgery or theft in the second degree and more than five years has passed since conviction;

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

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

     (v) Convicted of criminal mistreatment; or

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

     (b) Not hire or retain, directly or by contract, or accept as a volunteer, any individual prohibited from having unsupervised access to residents under (a) of this subsection, except as provided in subsection (6) of this section and RCW 43.43.842.

     (3))) (c) Convicted of:

     (i) Violation of the imitation controlled substances act (VICSA);

     (ii) Violation of the uniform controlled substances act (VUCSA);

     (iii) Violation of the uniform legend drug act (VULDA); or

     (iv) Violation of the uniform precursor drug act (VUPDA);

     (d) Convicted of sending or bringing into the state depictions of a minor engaged in sexually explicit conduct;

     (e) Convicted of criminal mistreatment; or

     (f) Convicted of a crime in federal court or in any other state, and the department determines that the crime is equivalent to a crime described in this subsection.

     (4) The boarding home must not allow unsupervised access by any individual described in subsection (1), if the individual has:

     (a) Been found to have abused, neglected, financially exploited or abandoned a minor or vulnerable adult by a court of law or a disciplining authority, including the department of health;

     (b) A finding of abuse or neglect of a child that is:

     (i) Listed on the department's background check central unit (BCCU) report; or

     (ii) Disclosed by the individual, except for finding made before December, 1998.

     (c) A finding of abuse, neglect, exploitation or abandonment of a vulnerable adult that is:

     (i) Listed on any registry, including the department's registry;

     (ii) Listed on the department's background check central unit (BCCU) report; or

     (iii) Disclosed by the individual, except for adult protective services findings made before October, 2003.

     (5) Prior to first starting his or her duties, the boarding home must((:

     (a))) require each ((prospective employee, manager, volunteer, contractor and student associated with the licensee or boarding home who may have unsupervised access to residents to disclose)) individual described in subsection (1) to make disclosures, consistent with RCW 43.43.834(2)((,)). The disclosures must be in writing and signed by the individual under penalty of perjury. Each individual must disclose whether he or she:

     (((i))) (a) Has been convicted of ((a)) any crime, including ((any of the following as defined in RCW 43.43.830:

     (A) All crimes against children or their persons;

     (B) All crimes relating to financial exploitation; and

     (C) All crimes relating to drugs;

     (ii))) the crimes listed in subsection (3);

     (b) Has had findings made against him or her in any civil adjudicative proceeding ((as defined in RCW 43.43.830)); or

     (((iii) Has both convictions for (i) and findings made against him or her under (ii).

     (b) Require each individual making the disclosures required in subsection (3)(a) of this section:

     (i) To make the disclosures in writing;

     (ii) To swear under penalty of perjury that the contents of the disclosure are accurate; and

     (iii) To sign the disclosure statement.

     (4))) (c) Has one or more convictions and one or more civil adjudicative proceeding findings.

     (6) Prior to first starting his or her duties, for each individual described in subsection (1), the boarding home must take one or more of the ((following three)) actions ((for each prospective employee, manager, volunteer, contractor and student associated with the licensee or boarding home who may have unsupervised access to residents)) described in (a), (b) and (c):

     (a) Initiate a background check ((on the individual through the department, which includes taking the following actions:

     (i) Informing the individual that a background check is required.

     (ii) Requiring the individual to complete and sign a DSHS background authorization form prior to the individual having unsupervised access to residents;

     (iii) Submitting)) by submitting all background check authorization forms to the department's((:

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

     (B) Background check central unit for currently licensed boarding homes.

     (iv) Verbally informing the named individual of his/her individual background check results and offering to provide him or her a copy of the background check results within ten days of receipt.)) background check central unit (BCCU), except the forms should be submitted to the aging and disability services administration with an initial license application;

     (b) Obtain from the individual's prior employer a copy of the completed criminal background inquiry information for the individual, subject to the following conditions:

     (i) The prior employer ((was)) is a nursing home licensed under chapter 18.51 RCW, a boarding home licensed under chapter 18.20 RCW, or an adult family home licensed under chapter 70.128 RCW;

     (ii) The ((nursing home, boarding home or adult family home)) employer providing ((completed criminal background inquiry)) the information ((for the individual)) is reasonably known to be the individual's most recent employer;

     (iii) No more than twelve months has elapsed ((from)) between the date the individual was last employed ((by the nursing home, boarding home or adult family home)) and the date of the individual's current application;

     (iv) The background ((inquiry for the individual)) information is no more than two years old; and

     (v) The boarding home has no reason to believe the individual has or may have a disqualifying conviction or finding as described in ((RCW 43.43.842.)) subsections (3) and (4); or

     (c) ((When using staff persons from a home health, hospice, or home care agency licensed under chapter 70.127 RCW, or a nursing pool registered under chapter 18.52C RCW, the boarding home must)) Establish, maintain and follow a written agreement with ((the agency or pool)) home health, hospice, or home care agencies licensed under chapter 70.127 RCW or nursing pools registered under chapter 18.52C RCW in order to ensure that the agency or pool staff meet the requirements of ((subsection (2) of this section are met for the agency or pool staff who may work in the boarding home)) subsections (3) and (4).

     (((5))) (7) The boarding home must verbally inform the named individual of his or her background check results from the department and offer to provide him or her a copy of the results within ten days of receipt.

     (8) The boarding home must ensure that all disclosure statements, and background check results ((obtained by the boarding home,)) are:

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

     (b) Used for employment purposes only;

     (c) Not disclosed to ((any individual)) anyone except((:

     (i))) to the individual ((named on the background check result;

     (ii))), authorized state and federal employees((;

     (iii))), the Washington state patrol auditor((; and

     (iv) As otherwise)), or persons authorized ((in)) by chapter 43.43 RCW.

     (d) Retained and available for department review((:

     (i))) during the individual's ((employment or association with a facility; and

     (ii) At least two years following termination of)) employment or association with a facility and for at least two years after termination of the employment or association.

     (((6))) (9) The boarding home may conditionally hire an individual described in subsection (1), ((directly or by contract, an individual having unsupervised access to residents)) pending a background inquiry, provided that the boarding home:

     (a) Obtains a criminal history background check authorization form from the individual ((prior to the individual beginning work)) before he or she is allowed unsupervised access to resident;

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

     (c) Has received three positive references for the individual before he or she is allowed unsupervised access to residents.

     (((7))) (10) The department may require the boarding home or any ((other)) individual ((associated with the boarding home who has unsupervised access to residents)) described in subsection (1) to complete additional disclosure statements or background inquiries if the department has reason to believe that offenses specified ((under RCW 43.43.830)) in subsections (3) and (4) of this section have occurred since completion of the previous disclosure statement or background inquiry.

     (11) Nothing in this section should be interpreted as requiring the employment of any person against the better judgment of the boarding home.

     (12) In addition to chapter 18.20 RCW, these rules are authorized by RCW 43.20A.710, 43.43.830 through 43.43.842 and 74.39A.050(8).

     (13) As used in this section, "civil adjudicative proceeding" means judicial or administrative adjudicative proceeding that results in a finding of, or upholds an agency finding of, domestic violence, abuse, sexual abuse, neglect, abandonment, violation of a professional licensing standard regarding a child or vulnerable adult, or exploitation or financial exploitation of a child or vulnerable adult under any provision of law, including but not limited to chapter 13.34, 26.44, or 74.34 RCW, or rules adopted under chapters 18.51 and 74.42 RCW. "Civil adjudication proceeding" also includes judicial or administrative finding that become final due to the failure of the alleged perpetrator to timely exercise a legal right to administratively challenge such findings.

[Statutory Authority: Chapters 18.20 and 74.34 RCW. 09-01-052, § 388-78A-2470, filed 12/10/08, effective 1/10/09. Statutory Authority: RCW 18.20.090 and chapters 18.20 and 74.34 RCW. 08-05-099, § 388-78A-2470, filed 2/15/08, effective 3/17/08. Statutory Authority: RCW 18.20.090. 06-01-047, § 388-78A-2470, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2470, filed 7/30/04, effective 9/1/04.]

NEW SECTION

     WAC 388-78A-2483 Tuberculosis -- One step testing. The boarding home is only required to have a staff person take a one step skin or blood test if the staff person has any of the following:

     (1) A documented history of a negative result from a previous two step skin testing done no more than one to three weeks apart; or

     (2) A documented negative result from one step skin or blood testing in the previous twelve months.

NEW SECTION

     WAC 388-78A-2484 Tuberculosis -- Two step skin testing. Unless the staff person meets the requirement for having no skin testing or only a one step skin test, the boarding home choosing to do skin testing, must ensure that each staff person has the following two-step skin testing:

     (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 IGRA blood test, which is only a one step test.

NEW SECTION

     WAC 388-78A-2485 Tuberculosis -- Positive test result. When there is a positive result to tuberculosis skin or blood testing the boarding home must:

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

     (2) Ensure Evaluate each resident or staff person with a positive test result is evaluated for signs and symptoms of tuberculosis; and

     (3) Follow the recommendation of the resident or staff person's health care provider.

NEW SECTION

     WAC 388-78A-2731 Liability insurance required -- Application. (1) The applicant must submit insurer executed evidence of liability insurance coverage with the application.

     (2) The coverage and evidence of coverage must comply with the requirements of WAC 388-78A-2733 and 388-78A-2734.

NEW SECTION

     WAC 388-78A-2732 Liability insurance required -- Ongoing. The boarding home must:

     (1) Obtain liability insurance upon licensure and mMaintain liability the insurance as required in WAC 388-78A-2733 and 388-78A-2734; and

     (2) Have evidence of liability insurance coverage available if requested by the department.

NEW SECTION

     WAC 388-78A-4000 Notice -- Service complete. Service of the The department's notices is complete when:

     (1) Personal service is made;

     (2) The notice is properly stamped addressed to the individual or facility at his or her last known address, and deposited in the United States mail;

     (3) The notice is faxed and the department receives evidence produces proof of transmission;

     (4) Notice is delivered to a commercial delivery service with charges prepaid; or

     (5) Notice is delivered to a legal messenger service with charges prepaid.

     The changes were made to make the requirements clearer.

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.
WAC 388-78A-2470 The section needs to be reorganized for clarity and ease of reading.	Changes were made to clarify this section.
WAC 388-78A-2483 - 388-78A-2484 Use of the word "step" to describe one step test is confusing.	A change was made in response to this comment to take out the word "step" when referring to one skin test and clarifying that one test could be skin or blood test.
WAC 388-78A-2485 The resident also needs to be evaluated if he or she has a positive test result.	A change was make [made] to clarify that both residents and staff need to be evaluated when there is a positive test result.
WAC 388-78A-2731 and 388-78A-2732 It may be a long time before an applicant receives a license and the applicant man [may] not have enough information to get the liability insurance ahead of time.	A change was made to delete the section requiring the insurance with application and clarifying that the boarding home must obtain the insurance upon licensure.
WAC 388-78A-4000 The process of when the department's notice is complete needs clarification.	A change was made to clarify this section.

     A final cost-benefit analysis is available by contacting Judy Johnson, P.O. Box 45600, Olympia, WA 98405-5600 [98504-5600], phone (360) 725-2591, fax (360) 438-7903, e-mail johnsjm1@dshs.wa.gov.

     SUMMARY OF PROPOSED RULES: The department of social and health services, residential care services (RCS), is proposing amendments to chapter 388-78A WAC, Boarding homes.

     The purpose of the proposed rule making is to make editorial and clarifying changes and to make the rules consistent with current laws and standards.

     Highlights of proposed changes:

     •     Editorial and housekeeping changes in the following sections: Preadmission assessment, food and nutrition services, sections related to preliminary findings.

     •     Clarified medicaid issues to be consistent with RCW 18.20.440 and SSB 6009.

     •     Deleted construction tables to eliminate redundancy, and clarified that new construction must comply with rules in effect at the time of plan approval.

     •     Clarified management agreement requirements.

     •     Clarified tuberculosis requirements to be consistent with current standards

     •     Clarified when notice is considered complete and proof of notice.

     •     Updated disqualifying crime requirements.

     •     Added liability insurance requirement to rule.

     SMALL BUSINESS IMPACT STATEMENT: Chapter 19.85 RCW, the Regulatory Fairness Act, requires that the economic impact of proposed regulations be analyzed in relation to small businesses and outlines the information that must be included in a small business economic impact statement (SBEIS). Preparation of an SBEIS is required when a proposed rule has the potential of placing more than a minor impact on a business.

     RCW 19.85.020 defines a "small business" as "any business entity, including a sole proprietorship, corporation, partnership, or other legal entity, that is owned and operated independently from all other businesses, and that has fifty or fewer employees."

     RCS has analyzed its proposed rules and concludes that the new requirements of liability insurance may impose a new cost to the boarding home that does not already have liability insurance. Approximately three hundred fifty-one (63.3%) boarding homes currently have contracts and are required to have liability insurance. Although 36.4% of the boarding homes do not have contracts, many of those facilities may already have liability insurance, including those who may have liability insurance coverage required by their banks or landlords.

     The cost of liability insurance ranges in price depending on many variables such as level of care, number of residents, expertise of staff, outcome of inspections, loss history, and the length of time the administrator has been working. According to three insurance companies, the estimated average cost for a combination of liability insurance that also covers professionals for the boarding home is approximately $150 to $200 per bed.

     RCS understands that some of the cost of the liability insurance can be deducted as a legitimate business expense when taxes are filed with the Internal Revenue Service. RCS does not believe that the proposed rules will result in any job losses or gains for boarding homes. The proposed rule amendments do not disproportionately impact small businesses more than larger businesses.

     EVALUATION OF PROBABLE COSTS AND BENEFITS: RCS has determined that some of the proposed rules are "significant legislative rules" as defined by legislature. As required by RCW 34.05.328 (1)(c), RCS has analyzed the probable costs and probable benefits of the proposed amendments, taking into account both the qualitative and quantitative benefits and costs.

     COSTS:

     •     The liability insurance requirement for all boarding homes may impose additional costs to the small number of boarding homes that currently do not have insurance coverage.

     •     DSHS has shared the draft language with interested parties who participated in a stakeholder meeting to discuss the proposed rule changes. At the meeting, liability insurance was brought up by a stakeholder as a potential cost.

     •     In addition, the draft language was posted on the aging and disability services administration internet web site for anyone in the public to review and comment.

     •     DSHS used the input from internal and external stakeholders to determine cost impacts for the drafting of the rule.

     •     To date, the department has received and considered written comments on the draft language and one comment on the cost impact of the proposed liability insurance requirement.

     COST SAVINGS: Clarity of the proposed rule could save providers costs in time and dollars by:

     •     Reducing unnecessary confusion, citations, hearing and appeals;

     •     Reducing time and legal costs of appealing unclear rules; and

     •     Reducing the amount of technical support requests and dear provider letters mailed to providers for clarification of rule issues which reduces the amount of time providers need to keep current with requirements.

     OTHER BENEFITS: The proposed rule amendments result in several benefits which include:

     •     The liability insurance requirement will provide a consistent standard among all boarding homes in Washington.

     •     The liability insurance requirement will provide all residents with another level of consumer protection.

     •     The liability insurance requirement may help boarding homes defend themselves and pay awarded damages without threatening their financial stability.

     •     The amendments are clearer, and easier to read, understand and apply; and

     •     Residents will ultimately benefit from the rule revision because providers will be able to better understand and follow the requirements.

     CONCLUSION: RCS concludes that the benefits of the proposed amendments exceed the possible cost. These rules continue to implement state laws and regulations related to boarding homes. RCS has complied with the appropriate sections of the Administrative Procedure Act and is prepared to proceed with the rule filing.

     Please contact Judy Johnson by e-mail at johnsjm1@dshs.wa.gov or by telephone at (360) 725-2591 if you have questions.

     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 27, Amended 18, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 27, Amended 18, Repealed 0.

     Date Adopted: January 14, 2010.

Susan N. Dreyfus

Secretary

     (1) Medical history;

     (2) Necessary and contraindicated medications;

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

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

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

     (6) Level of personal care needs;

     (7) Activities and service preferences; and

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

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2060, filed 7/30/04, effective 9/1/04.]

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

     (i) At regular intervals;

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

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

     (c) Ensure all menus:

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

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

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

     (iv) Are kept at least six months;

     (v) Provide a variety of foods; and

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

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

     (e) Serve nourishing, palatable and attractively served meals adjusted for:

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

     (ii) Individual preferences to the extent reasonably possible.

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

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

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

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

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

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

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

     (ii) Approved by a dietitian; and

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

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

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

     (a) Modified or therapeutic diets;

     (b) Nutritional concentrates or supplements.

[Statutory Authority: RCW 18.20.090. 06-01-047, § 388-78A-2300, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2300, filed 7/30/04, effective 9/1/04.]

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

     (a) Authorized department staff;

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

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

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

     (a) ((Date of moving in)) Move-in date;

     (b) Full name;

     (c) Date of birth;

     (d) Date of moving out;

     (e) Reason for moving out; and

     (f) ((New address if known)) Location and address to which the resident was discharged.

     (3) The boarding home must make this register immediately available to:

     (a) Authorized department staff;

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

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

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2440, filed 7/30/04, effective 9/1/04.]

     (a) Employees;

     (b) Managers;

     (c) Volunteers who are not residents;

     (d) Contractors; and

     (e) Students.

     (2) The boarding home must((:

     (a))) ensure that any individual ((associated with the licensee or boarding home who may have unsupervised access to residents)) described in subsection (1) has had a background check ((of conviction records, pending charges and disciplinary board decisions)) completed within the past two years, and that the background check is repeated every two years ((thereafter, and that individual has not been:

     (i))).

     (3) The boarding home must not allow unsupervised access by any individual described in subsection (1), if the individual has been:

     (a) Convicted of a "crime against children or other persons" as defined in RCW 43.43.830 ((or 43.43.842)), unless the crime is simple assault, assault in the fourth degree, or prostitution and more than three years has passed since the last conviction;

     (((ii))) (b) Convicted of "crimes relating to financial exploitation" as defined in RCW 43.43.830 ((or 43.43.842)), unless the crime is theft in the third degree, and more than three years have passed since conviction, or unless the crime is forgery or theft in the second degree and more than five years has passed since conviction;

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

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

     (v) Convicted of criminal mistreatment; or

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

     (b) Not hire or retain, directly or by contract, or accept as a volunteer, any individual prohibited from having unsupervised access to residents under (a) of this subsection, except as provided in subsection (6) of this section and RCW 43.43.842.

     (3))) (c) Convicted of:

     (i) Violation of the imitation controlled substances act (VICSA);

     (ii) Violation of the uniform controlled substances act (VUCSA);

     (iii) Violation of the uniform legend drug act (VULDA); or

     (iv) Violation of the uniform precursor drug act (VUPDA);

     (d) Convicted of sending or bringing into the state depictions of a minor engaged in sexually explicit conduct;

     (e) Convicted of criminal mistreatment; or

     (f) Convicted of a crime in federal court or in any other state, and the department determines that the crime is equivalent to a crime described in this subsection.

     (4) The boarding home must not allow unsupervised access by any individual described in subsection (1), if the individual has:

     (a) Been found to have abused, neglected, financially exploited or abandoned a minor or vulnerable adult by a court of law or a disciplining authority, including the department of health;

     (b) A finding of abuse or neglect of a child that is:

     (i) Listed on the department's background check central unit (BCCU) report; or

     (ii) Disclosed by the individual, except for finding made before December, 1998.

     (c) A finding of abuse, neglect, exploitation or abandonment of a vulnerable adult that is:

     (i) Listed on any registry, including the department's registry;

     (ii) Listed on the department's background check central unit (BCCU) report; or

     (iii) Disclosed by the individual, except for adult protective services findings made before October, 2003.

     (5) Prior to first starting his or her duties, the boarding home must((:

     (a))) require each ((prospective employee, manager, volunteer, contractor and student associated with the licensee or boarding home who may have unsupervised access to residents to disclose)) individual described in subsection (1) to make disclosures, consistent with RCW 43.43.834(2)((,)). The disclosures must be in writing and signed by the individual under penalty of perjury. Each individual must disclose whether he or she:

     (((i))) (a) Has been convicted of ((a)) any crime, including ((any of the following as defined in RCW 43.43.830:

     (A) All crimes against children or their persons;

     (B) All crimes relating to financial exploitation; and

     (C) All crimes relating to drugs;

     (ii))) the crimes listed in subsection (3);

     (b) Has had findings made against him or her in any civil adjudicative proceeding ((as defined in RCW 43.43.830)); or

     (((iii) Has both convictions for (i) and findings made against him or her under (ii).

     (b) Require each individual making the disclosures required in subsection (3)(a) of this section:

     (i) To make the disclosures in writing;

     (ii) To swear under penalty of perjury that the contents of the disclosure are accurate; and

     (iii) To sign the disclosure statement.

     (4))) (c) Has one or more convictions and one or more civil adjudicative proceeding findings.

     (6) Prior to first starting his or her duties, for each individual described in subsection (1), the boarding home must take one or more of the ((following three)) actions ((for each prospective employee, manager, volunteer, contractor and student associated with the licensee or boarding home who may have unsupervised access to residents)) described in (a), (b) and (c):

     (a) Initiate a background check ((on the individual through the department, which includes taking the following actions:

     (i) Informing the individual that a background check is required.

     (ii) Requiring the individual to complete and sign a DSHS background authorization form prior to the individual having unsupervised access to residents;

     (iii) Submitting)) by submitting all background check authorization forms to the department's((:

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

     (B) Background check central unit for currently licensed boarding homes.

     (iv) Verbally informing the named individual of his/her individual background check results and offering to provide him or her a copy of the background check results within ten days of receipt.)) background check central unit (BCCU), except the forms should be submitted to the aging and disability services administration with an initial license application;

     (b) Obtain from the individual's prior employer a copy of the completed criminal background inquiry information for the individual, subject to the following conditions:

     (i) The prior employer ((was)) is a nursing home licensed under chapter 18.51 RCW, a boarding home licensed under chapter 18.20 RCW, or an adult family home licensed under chapter 70.128 RCW;

     (ii) The ((nursing home, boarding home or adult family home)) employer providing ((completed criminal background inquiry)) the information ((for the individual)) is reasonably known to be the individual's most recent employer;

     (iii) No more than twelve months has elapsed ((from)) between the date the individual was last employed ((by the nursing home, boarding home or adult family home)) and the date of the individual's current application;

     (iv) The background ((inquiry for the individual)) information is no more than two years old; and

     (v) The boarding home has no reason to believe the individual has or may have a disqualifying conviction or finding as described in ((RCW 43.43.842 .)) subsections (3) and (4); or

     (c) ((When using staff persons from a home health, hospice, or home care agency licensed under chapter 70.127 RCW, or a nursing pool registered under chapter 18.52C RCW, the boarding home must)) Establish, maintain and follow a written agreement with ((the agency or pool)) home health, hospice, or home care agencies licensed under chapter 70.127 RCW or nursing pools registered under chapter 18.52C RCW in order to ensure that the agency or pool staff meet the requirements of ((subsection (2) of this section are met for the agency or pool staff who may work in the boarding home)) subsections (3) and (4).

     (((5))) (7) The boarding home must verbally inform the named individual of his or her background check results from the department and offer to provide him or her a copy of the results within ten days of receipt.

     (8) The boarding home must ensure that all disclosure statements, and background check results ((obtained by the boarding home,)) are:

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

     (b) Used for employment purposes only;

     (c) Not disclosed to ((any individual)) anyone except((:

     (i))) to the individual ((named on the background check result;

     (ii))), authorized state and federal employees((;

     (iii))), the Washington state patrol auditor((; and

     (iv) As otherwise)), or persons authorized ((in)) by chapter 43.43 RCW.

     (d) Retained and available for department review((:

     (i))) during the individual's ((employment or association with a facility; and

     (ii) At least two years following termination of)) employment or association with a facility and for at least two years after termination of the employment or association.

     (((6))) (9) The boarding home may conditionally hire an individual described in subsection (1), ((directly or by contract, an individual having unsupervised access to residents)) pending a background inquiry, provided that the boarding home:

     (a) Obtains a criminal history background check authorization form from the individual ((prior to the individual beginning work)) before he or she is allowed unsupervised access to resident;

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

     (c) Has received three positive references for the individual before he or she is allowed unsupervised access to residents.

     (((7))) (10) The department may require the boarding home or any ((other)) individual ((associated with the boarding home who has unsupervised access to residents)) described in subsection (1) to complete additional disclosure statements or background inquiries if the department has reason to believe that offenses specified ((under RCW 43.43.830)) in subsections (3) and (4) of this section have occurred since completion of the previous disclosure statement or background inquiry.

     (11) Nothing in this section should be interpreted as requiring the employment of any person against the better judgment of the boarding home.

     (12) In addition to chapter 18.20 RCW, these rules are authorized by RCW 43.20A.710, 43.43.830 through 43.43.842 and 74.39A.050(8).

     (13) As used in this section, "civil adjudicative proceeding" means judicial or administrative adjudicative proceeding that results in a finding of, or upholds an agency finding of, domestic violence, abuse, sexual abuse, neglect, abandonment, violation of a professional licensing standard regarding a child or vulnerable adult, or exploitation or financial exploitation of a child or vulnerable adult under any provision of law, including but not limited to chapter 13.34, 26.44, or 74.34 RCW, or rules adopted under chapters 18.51 and 74.42 RCW. "Civil adjudication proceeding" also includes judicial or administrative finding that become final due to the failure of the alleged perpetrator to timely exercise a legal right to administratively challenge such findings.

[Statutory Authority: Chapters 18.20 and 74.34 RCW. 09-01-052, § 388-78A-2470, filed 12/10/08, effective 1/10/09. Statutory Authority: RCW 18.20.090 and chapters 18.20 and 74.34 RCW. 08-05-099, § 388-78A-2470, filed 2/15/08, effective 3/17/08. Statutory Authority: RCW 18.20.090. 06-01-047, § 388-78A-2470, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2470, filed 7/30/04, effective 9/1/04.]

     (iii) Follow precautions ordered by a physician or public health authority)) within three days of employment.

     (2) ((The boarding home must:

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

     (i) Tuberculin test results;

     (ii) Reports of X-ray findings; and

     (iii) Physician or public health official orders.

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

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

     (ii) When requested by the staff person.

     (3) The boarding home must ensure that caregivers caring for a resident with suspected tuberculosis comply with the WISHA standard for respiratory protection)) For purposes of WAC 388-78A-2481 through 388-78A-2489, "staff person" means any boarding home employee or temporary employee of the boarding home, excluding volunteers and contractors.

[Statutory Authority: RCW 18.20.090. 06-24-073, § 388-78A-2480, filed 12/4/06, effective 1/4/07; 06-01-047, § 388-78A-2480, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2480, filed 7/30/04, effective 9/1/04.]

     (1) Intradermal (mantoux) administration with test results read:

     (a) Within forty-eight to seventy-two hours of the test; and

     (b) By a trained professional; or

     (2) A blood test for tuberculosis called interferon-gamma release assay (IGRA).

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     (1) A documented history of a previous positive skin test, with ten or more millimeters induration;

     (2) A documented history of a previous positive blood test; or

     (3) Documented evidence of:

     (a) Adequate therapy for active disease; or

     (b) Completion of treatment for latent tuberculosis infection preventive therapy.

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     (1) A documented history of a negative result from a previous two step skin test done no more than one to three weeks apart; or

     (2) A documented negative result from one skin or blood test 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.

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

     (2) Ensure each resident or staff person with a positive test result is evaluated for signs and symptoms of tuberculosis; and

     (3) Follow the recommendation of the resident or staff person's health care provider.

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     (1) After exposure to active tuberculosis;

     (2) When tuberculosis symptoms are present; or

     (3) For periodic testing as determined by the public health provider.

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     (1) Report any staff person or resident with tuberculosis symptoms or a positive chest X-ray to the appropriate health care provider, or public health provider;

     (2) Follow the infection control and safety measures ordered by the staff person's health care provider including a public health provider;

     (3) Institute appropriate infection control measures;

     (4) Apply living or work restrictions where residents or staff persons are, or may be, infectious and pose a risk to other residents and staff persons; and

     (5) Ensure that staff person's caring for a resident with suspected tuberculosis comply with the WISHA standard for respiratory protection found in chapter 296-842 WAC.

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     (1) Keep the records of tuberculin test results, reports of X-ray findings, and any physician or public health provider orders in the boarding home;

     (2) Make the records readily available to the appropriate health provider and licensing agency,

     (3) Retain the records for at least two years after the date the staff person either quits or is terminated; and

     (4) Provide the staff person a copy of his/her test results.

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     (a) At least twenty-one years old ((and who is));

     (b) Not a resident((, and is)) of the boarding home; and

     (c) Qualified to perform the administrator's duties specified in WAC 388-78A-2560.

     (2) The licensee must only appoint as a boarding home administrator an individual who meets the requirements of at least one of the following ((qualifications listed in (a) through (f) of this subsection:

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

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

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

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

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

     (B) The American College of Health Care Administrators; or

     (C) The American Health Care Association; or

     (D) The Assisted Living Federation of America; or

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

     (ii) Three years paid experience:

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

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

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

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

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

     (B) The American College of Health Care Administrators; or

     (C) The American Health Care Association; or

     (D) The Assisted Living Federation of America; or

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

     (ii) Has two years paid experience:

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

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

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

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

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

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

     (B) The American College of Health Care Administrators; or

     (C) The American Health Care Association; or

     (D) The Assisted Living Federation of America; or

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

     (ii) Has one year paid experience:

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

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

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

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

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

     (ii) Managing persons providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living)) sections in WAC 388-78A-2522 through 388-78A-2527.

[Statutory Authority: RCW 18.20.090. 06-01-047, § 388-78A-2520, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2520, filed 7/30/04, effective 9/1/04.]

     (1) The American association of homes and services for the aging;

     (2) The American college of health care administrators;

     (3) The American health care association;

     (4) The assisted living federation of America; or

     (5) The national association of board of examiners of long term care administrators.

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     (1) Obtained certification of completing a recognized administrator training as referenced in WAC 388-78A-2521; and

     (2) Has three years paid experience:

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

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

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     (1) Obtains certification of completing a recognized administrator training course as referenced in WAC 388-78A-2521 within six months of beginning duties as the administrator; or

     (2) Has two years paid experience:

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

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

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

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     (1) Obtains certification of completing a recognized administrator training course and referenced in WAC 388-78A-2521 within six months of beginning duties as the administrator; or

     (2) Has one year paid experience:

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

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

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

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

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

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

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

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

     (i) Chapter 18.20 RCW, Boarding homes;

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

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

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

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

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

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

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

     (3) Meets the administrator qualification requirements referenced in WAC 388-78A-2520 through 388-78A-2527.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2540, filed 7/30/04, effective 9/1/04.]

     (d) Modification of existing management agreement)) If the proposed or current licensee uses a manager, the licensee must have a written management agreement approved by the department that is consistent with this chapter.

     (2) The proposed or current licensee must notify the department of its use of a manager upon:

     (a) Initial application for a license;

     (b) Retention of a manager following initial application;

     (c) Change of managers; and

     (d) Modification of existing management agreement.

     (3) The proposed or current licensee must provide a written management agreement, including an organizational chart showing the relationship between the proposed or current licensee, management company, and all related organizations.

     (4) The written management agreement must be submitted:

     (a) Sixty days before:

     (i) The initial licensure date;

     (ii) The proposed change of ownership date; or

     (iii) The effective date of the management agreement; or

     (b) Thirty days before the effective date of any amendment to an existing management agreement.

     (5) The proposed licensee or the current licensee must notify the resident and their representatives sixty days before entering into a management agreement.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2590, filed 7/30/04, effective 9/1/04.]

     (a) The daily operations and provisions of services in the boarding home (See 388-78A-2730 (1)(a));

     (b) Ensuring the boarding home is operated in a manner consistent with all laws and rules applicable to boarding homes (See 388-78A-2730 (1)(b));

     (c) Ensuring the manager acts in conformance with a department approved management agreement; and

     (d) Ensuring the manager does not represent itself as, or give the appearance that it is the licensee.

     (2) The licensee must not give the manager responsibilities that are so extensive that the licensee is relieved of daily responsibility for the daily operations and provision of services in the boarding home. If the licensee does so, then the department must determine that a change of ownership has occurred.

     (3) The licensee and manager must act in accordance with the terms of the department-approved management agreements. If the department determines they are not, then the department may take licensing action.

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

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     (1) Describe the responsibilities of the licensee and manager, including items, services, and activities to be provided;

     (2) Require the licensee's governing body, board of directors, or similar authority to appoint the facility administrator;

     (3) Provide for the maintenance and retention of all records in accordance with this chapter and other applicable laws;

     (4) Allow unlimited access by the department to documentation and records according to applicable laws or regulations;

     (5) Require the manager to immediately send copies of inspections and notices of noncompliance to the licensee;

     (6) State that the licensee is responsible for reviewing, acknowledging and signing all boarding home initial and renewal license applications;

     (7) State that the manager and licensee will review the management agreement annually and notify the department of any change according to applicable regulations;

     (8) Acknowledge that the licensee is the party responsible for complying with all laws and rules applicable to boarding homes;

     (9) Require the licensee to maintain ultimate responsibility over personnel issues relating to the operation of the boarding home and care of the residents, including but not limited to, staffing plans, orientation and training;

     (10) State the manager will not represent itself, or give the appearance it is the licensee; and

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

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     (1) The proposed or current licensee or manager to provide additional information or clarification;

     (2) Any changes necessary to:

     (a) Bring the management agreement into compliance with this chapter; and

     (b) Ensure that the licensee has not been relieved of the responsibility for the daily operations of the facility.

     (3) The licensee to participate in monthly meetings and quarterly on-site visits to the boarding home.

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     (a) Retains all fiduciary and custodial responsibility for funds that have been deposited with the boarding home by the resident;

     (b) Is directly accountable to the residents for such funds; and

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

     (2) If responsibilities for the day-to-day management of the resident funds are delegated to the manager, the manager must:

     (a) Provide the licensee with a monthly accounting of the resident funds; and

     (b) Meet all legal requirements related to holding, and accounting for, resident funds.

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     (1) Clearly state the circumstances under which the boarding home provides care for medicaid eligible residents and for residents who become eligible for medicaid after admission;

     (2) Be provided both orally and in writing in a language that the resident understands;

     (3) Be provided to prospective residents, before they are admitted to the home;

     (4) Be provided to any current residents who were admitted before this requirement took effect or who did not receive copies prior to admission;

     (5) Be written on a page that is separate from other documents and be written in a type font that is at least fourteen point; and

     (6) Be signed and dated by the resident and be kept in the resident record after signature.

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     (1) Obtain liability insurance upon licensure and maintain the insurance as required in WAC 388-78A-2733 and 388-78A-2734; and

     (2) Have evidence of liability insurance coverage available if requested by the department.

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     (1) Coverage for the acts and omissions of any employee and volunteer;

     (2) Coverage for bodily injury, property damage, and contractual liability;

     (3) Coverage for premises, operations, independent contractor, products-completed operations, personal injury, advertising injury, and liability assumed under an insured contract; and

     (4) Minimum limits of:

     (a) Each occurrence at one million dollars; and

     (b) General aggregate at two million dollars.

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     (1) Coverage for losses caused by errors and omissions of the boarding home, its employees, and volunteers; and

     (2) Minimum limits of:

     (a) Each occurrence at one million dollars; and

     (b) Aggregate at two million dollars.

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     (2) Existing licensed boarding homes must continue to meet the building codes in force at the time of their ((initial licensing)) plan approval by construction review services, except that the boarding home may be required to meet current building code requirements if the construction poses a risk to the health and safety of residents.

     (3) The boarding home must ensure that construction is completed in compliance with the final construction review services approved documents. Compliance with these standards and regulations does not relieve the boarding home of the need to comply with applicable state and local building and zoning codes.

[Statutory Authority: RCW 18.20.090. 06-01-047, § 388-78A-2910, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2910, filed 7/30/04, effective 9/1/04.]

     (2) The boarding home must provide each toilet room and bathroom with:

     (a) Water resistant, smooth, low gloss, nonslip and easily cleanable materials;

     (b) Washable walls to the height of splash or spray;

     (c) Grab bars installed and located to minimize accidental falls including one or more grab bars at each:

     (i) Bathing fixture; and

     (ii) Toilet.

     (d) Plumbing fixtures designed for easy use and cleaning and kept in good repair; and

     (e) Adequate ventilation to the outside of the boarding home. For boarding homes issued a project number by construction review services on or after September 1, 2004 for construction related to this section, must provide mechanical ventilation to the outside.

     (3) The boarding home must provide each toilet room with a:

     (a) Toilet with a clean, nonabsorbent seat free of cracks;

     (b) Handwashing sink in or adjacent to the toilet room. For boarding homes issued a project number by construction review services on or after September 1, 2004 for construction related to this section, the handwashing sink must be in the toilet room or in an adjacent private area that is not part of a common use area of the boarding home; and

     (c) Suitable mirror with adequate lighting for general illumination.

     (4) For boarding homes approved for construction or initially licensed after August 1, 1994, the boarding home must provide a toilet and handwashing sink in, or adjoining, each bathroom.

     (5) When providing common-use toilet rooms and bathrooms, the boarding home must provide toilets and handwashing sinks for residents in the ratios of one toilet and one handwashing sink for every eight residents ((or fraction as listed in the following table:)). For example: one toilet and one handwashing sink for one to eight residents, two for nine to sixteen residents, three for seventeen to twenty-four residents, and so on, who do not have access to a private toilet room.

((Number of Residents	Number of Toilets*	Number of Handwashing Sinks
1-8	1	1
9-16	2	2
17-24	3	3
25-32	4	4
33-40	5	5
41-48	6	6
49-56	7	7
57-64	8	8
65-72	9	9
73-80	10	10
81-88	11	11
89-96	12	12
97-104	13	13
105-112	14	14
113-120	15	15
121-128	16	16
129-136	17	17
137-144	18	18
145-152	19	19
153-160	20	20
161-168	21	21
169-176	22	22
177-184	23	23))

((*)) When two or more toilets are contained in a single bathroom, they are counted as one toilet.

     (6) When providing common-use toilet rooms and bathrooms, the boarding home must provide bathing fixtures for residents in the ratio of one bathing fixture for every twelve residents ((or fraction thereof as listed in the following table:)). For example: one bathing fixture for one to twelve residents, two for twelve to twenty-four residents, three for twenty-five to thirty-six residents, and so on, who do not have access to a private toilet room.

((Number of Residents	Number of Bathing Fixtures
1-12	1
13-24	2
25-36	3
37-48	4
49-60	5
61-72	6
73-84	7
85-96	8
97-108	9
109-120	10
121-132	11
133-144	12
145-160	13
161-172	14
173-184	15
185-196	16))

     (7) When providing common-use toilet rooms and bathrooms, the boarding home must:

     (a) Designate toilet rooms containing more than one toilet for use by men or women;

     (b) Designate bathrooms containing more than one bathing fixture for use by men or women;

     (c) Equip each toilet room and bathroom designed for use by, or used by, more than one person at a time, in a manner to ensure visual privacy for each person using the room. The boarding home is not required to provide additional privacy features in private bathrooms with a single toilet and a single bathing fixture located within a private apartment;

     (d) Provide a handwashing sink with soap and single use or disposable towels, blower or equivalent hand-drying device in each toilet room, except that single-use or disposable towels or blowers are not required in toilet rooms or bathrooms that are located within a private apartment;

     (e) Provide reasonable access to bathrooms and toilet rooms for each resident by:

     (i) Locating a toilet room on the same floor or level as the sleeping room of the resident served;

     (ii) Locating a bathroom on the same floor or level, or adjacent floor or level, as the sleeping room of the resident served;

     (iii) Providing access without passage through any kitchen, pantry, food preparation, food storage, or dishwashing area, or from one bedroom through another bedroom; and

     (f) Provide and ensure toilet paper is available at each common-use toilet.

     (8) In boarding homes issued a project number by construction review services on or after September 1, 2004 for construction related to this section, the boarding home must ensure twenty-five percent of all the bathing fixtures in the boarding home are roll-in type showers that have:

     (a) One-half inch or less threshold that may be a collapsible rubber water barrier;

     (b) A minimum size of thirty-six inches by forty-eight inches; and

     (c) Single lever faucets located within thirty-six inches of the seat so the faucets are within reach of persons seated in the shower.

[Statutory Authority: Chapters 18.20 and 74.34 RCW. 09-01-052, § 388-78A-3030, filed 12/10/08, effective 1/10/09. Statutory Authority: RCW 18.20.090. 06-01-047, § 388-78A-3030, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-3030, filed 7/30/04, effective 9/1/04.]

     (e) Found in any final decision issued by a disciplinary board to have sexually or physically abused or neglected or exploited any minor or any vulnerable adult, or has a stipulated finding of fact, conclusion of law, an agreed order, or finding of fact, conclusion of law, or final order issued by a disciplining authority, a court of law, or entered into a state registry finding him or her guilty of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW)) has a conviction or finding described in WAC 388-78A-2470 (3) and (4).

     (2) This section applies to any boarding home:

     (a) Applicant;

     (b) Partner, officer or director;

     (c) Manager or managerial employee; or

     (d) Owner of five percent or more of the applicant:

     (i) Who is involved in the operation of the boarding home; or

     (ii) ((Who may have direct access to the boarding home residents; or

     (iii))) Who controls or supervises the provision of care or services to the boarding home residents; or

     (((iv))) (iii) Who exercises control over daily operations.

[Statutory Authority: RCW 18.20.090. 06-01-047, § 388-78A-3190, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-3190, filed 7/30/04, effective 9/1/04.]

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     (4) The department will serve notice of the preliminary finding as provided in chapter 388-02 WAC)) The department will serve notice of the preliminary finding as provided in WAC 388-78A-4000.

     (2) The department may establish proof of service as provided in WAC 388-78A-4010.

[Statutory Authority: RCW 18.20.090 and chapters 18.20 and 74.34 RCW. 08-05-099, § 388-78A-3410, filed 2/15/08, effective 3/17/08.]

     (((a))) (1) Other divisions within the department;

     (((b))) (2) The agency ((or)), program ((identified under RCW 74.34.068 with which the individual alleged to have abandoned, abused, neglected, exploited, or financially exploited a resident is associated as an employee)), or employer where the incident occurred;

     (((c))) (3) The employer or program that is currently associated with the individual ((alleged to have abandoned, abused, neglected, exploited, or financially exploited a resident, if known));

     (((d))) (4) Law enforcement; ((and))

     (((e))) (5) Other ((investigative authorities consistent with)) entities as authorized by law including chapter 74.34 RCW and this chapter((.

     (2) The notification will identify the finding as a preliminary finding)); and

     (6) The appropriate licensing agency.

[Statutory Authority: RCW 18.20.090 and chapters 18.20 and 74.34 RCW. 08-05-099, § 388-78A-3420, filed 2/15/08, effective 3/17/08.]

     (2) The request must be made in writing to the office of administrative hearings.

     (3) The office of administrative hearings must receive the individual's written request for an administrative hearing within thirty calendar days of the date written on the notice of the preliminary finding.

     (4) The written request for a hearing must include:

     (a) The individual's full legal name, current mailing address and the telephone number;

     (b) A brief explanation of why the individual ((alleged to have abandoned, abused, neglected, exploited, or financially exploited a resident)) disagrees with the preliminary finding;

     (c) A description of any assistance needed in the administrative appeal process by the individual, including a foreign or sign language interpreter or any reasonable accommodation for a disability; and

     (d) The individual's signature.

[Statutory Authority: RCW 18.20.090 and chapters 18.20 and 74.34 RCW. 08-05-099, § 388-78A-3430, filed 2/15/08, effective 3/17/08.]

     (a) The department notifies the individual ((alleged to have abandoned, abused, neglected, exploited, or financially exploited a resident)) there is a preliminary finding ((pursuant to)) under WAC 388-78A-3410; and

     (b) The individual ((alleged to have abandoned, abused, neglected, exploited or financially exploited a resident)) does not ask for an administrative hearing; or

     (c) The administrative law judge:

     (i) Dismisses the ((hearing)) appeal following withdrawal of the appeal or default;

     (ii) Dismisses the appeal for failure to comply with time limits under WAC 388-78A-3430; or

     (iii) Issues an initial order upholding the finding and the individual ((alleged to have abandoned, abused, neglected, exploited, or financially exploited a resident)) fails to appeal the initial order to the department's board of appeals.

     (d) The board of appeals issues a final order upholding the finding.

     (2) A final finding is permanent.

     (3) A final finding will only be removed from the department or agency list of individuals found to have abandoned, abused, neglected, exploited, or financially exploited a vulnerable adult if it is rescinded following judicial review.

     (((4) The department may remove a single finding of neglect from its records based upon a written petition by the individual found to have neglected a resident provided that at least one calendar year must have passed between the date a request was made to remove the finding of neglect and the date the final finding was finalized and recorded. If the department denies the petition, its decision may not be appealed.))

[Statutory Authority: Chapters 18.20 and 74.34 RCW. 09-01-052, § 388-78A-3450, filed 12/10/08, effective 1/10/09. Statutory Authority: RCW 18.20.090 and chapters 18.20 and 74.34 RCW. 08-05-099, § 388-78A-3450, filed 2/15/08, effective 3/17/08.]

     (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.

[Statutory Authority: Chapters 18.20 and 74.34 RCW. 09-01-052, § 388-78A-3460, filed 12/10/08, effective 1/10/09. Statutory Authority: RCW 18.20.090 and chapters 18.20 and 74.34 RCW. 08-05-099, § 388-78A-3460, filed 2/15/08, effective 3/17/08.]

     (1) The individual ((found to have abandoned, abused, neglected, exploited, or financially exploited a resident and for)) against whom ((there is a)) the final finding was made;

     (2) The boarding home licensee or entity representative that was associated with the individual ((alleged to have abandoned, abused, neglected, exploited, or financially exploited a resident)) during the time of the incident;

     (3) The employer or program that is currently associated with the individual against whom the final finding was made, if known;

     (4) The appropriate licensing, certification or registration authority;

     (5) ((The)) Any federal or state ((department)) registry or ((agency)) list of individuals found to have abandoned, abused, neglected, exploited, or financially exploited a vulnerable adult; and

     (6) The findings may be disclosed to the public upon request subject to applicable public disclosure laws.

[Statutory Authority: RCW 18.20.090 and chapters 18.20 and 74.34 RCW. 08-05-099, § 388-78A-3470, filed 2/15/08, effective 3/17/08.]

     (2) Confidential information such as the name and other personal identifying information of the reporter, witnesses, or the resident will be redacted from documents unless release of that information is consistent with chapter 74.34 RCW and other applicable state and federal laws.

[Statutory Authority: RCW 18.20.090 and chapters 18.20 and 74.34 RCW. 08-05-099, § 388-78A-3480, filed 2/15/08, effective 3/17/08.]

     (1) Personal service is made;

     (2) The notice is addressed to the individual or facility at his or her last known address, and deposited in the United States mail;

     (3) The notice is faxed and the department receives evidence of transmission;

     (4) Notice is delivered to a commercial delivery service with charges prepaid; or

     (5) Notice is delivered to a legal messenger service with charges prepaid.

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     (1) A declaration of personal service;

     (2) An affidavit or certificate of mailing to the boarding home or to the individual to whom notice is directed;

     (3) A signed receipt from the person who accepted the certified mail, the commercial delivery service, or the legal messenger service package; or

     (4) Proof of fax transmission.

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