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

     Purpose: The department is amending these rules as a result of legislative activity during session and to be consistent with newly passed state laws: ESHB 1548 Implementation of long-term care worker requirements regarding background checks and training which was superseded by Initiative 1163, SSB 5042 Vulnerable adults protection, ESHB 1277 Oversight of licensed or certified long-term care settings for vulnerable adults and 2E2SHB 1738 Changing the designation of medicaid state agency.

     The department added WAC 388-76-10037, 388-76-10561, 388-76-10911, and 388-76-10976.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-76-10000, 388-76-10015, 388-76-10025, 388-76-10035, 388-76-10064, 388-76-10070, 388-76-10073, 388-76-10080, 388-76-10105, 388-76-10120, 388-76-10130, 388-76-10146, 388-76-10395, 388-76-10540, 388-76-10570, 388-76-10915, 388-76-10945, 388-76-10960, and 388-76-10975.

     Statutory Authority for Adoption: Chapter 70.128 RCW.

      Adopted under notice filed as WSR 11-18-096 on September 7, 2011.

     Changes Other than Editing from Proposed to Adopted Version: Changes are shown with the new language underlined and deleted text lined through.

WAC 388-76-10000 Definitions.

     "Inspection" means a review by department personnel to determine the health, and safety, and well-being of residents, and the adult family home's compliance with this chapter and chapters 70.128, 70.129, 74.34 RCW, and other applicable rules and regulations. The department's review may include an on-site visit.

WAC 388-76-10015 License -- Adult family home -- Compliance required. (1) The licensed adult family home must comply with all the requirements established in chapters 70.128, 70.129, 74.34 RCW, this chapter and other applicable laws and regulations including chapter 74.39A RCW; and

     (2) The provider is ultimately responsible for the day-to-day operation of the adult family each licensed home.

     (3) The provider must promote the health, safety and well-being of each resident residing in each licensed adult family home.

WAC 388-76-10064 Application -- Forty-eight hour administration and business planning class training requirements. (1) The applicant, and the 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.

     (2) An applicant and entity representative may not be required to take the forty-eight hour class if there is a change in ownership and the applicant and entity representative are already participants in the operation of a currently licensed home.

     (3) An applicant and entity representative must take the forty-eight hour class when the application is for an additional licensed home and the forty-eight hour class has not already been successfully taken.

     (4) The class must be a minimum of forty-eight hours of classroom time and approved by the department.

WAC 388-76-10105 Application -- Change of ownership. (1) Under this section, "control of the provider" means the possession, directly or indirectly, of the power to direct the management, operation and/or policies of the adult family home, whether through ownership, voting control, by agreement, by contract or otherwise.

     (2) A change of ownership of an adult family home requires both a new license application and a new license.

     (3) A change of ownership occurs when there is a change in:

     (a) The provider; or

     (b) The control of a provider.

     (4) Events which constitute a change of ownership include, but are not limited to:

     (a) The form of legal organization of the adult family home is changed, such as when an adult family home forms:

     (i) A partnership;

     (ii) A corporation;

     (iii) A limited liability company; or

     (iv) When it merges with another legal organization.

     (b) The adult family home transfers business operations and management responsibility to another party, whether or not there is a partial or whole transfer of real property, personal property, or both.

     (c) Two people are both licensed as a married couple or domestic partners to operate an adult family home and an event, such as a separation, divorce, or death, results in only one person operating the home.

     (d) Dissolution of a business partnership that is licensed to operate the adult family home.

     (e) If the adult family home is a corporation and the corporation:

     (i) Is dissolved;

     (ii) Merges with another corporation, resulting in a change in the control of the provider; 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 its shares to one or more of the following:

     (A) New or former shareholders; or

     (B) Present shareholders, each having less than five percent of the shares before the initial transaction.

     (f) Any other event or combination of events that results in a substitution, elimination, or withdrawal of the provider's control of the adult family home.

     (5) The new owner:

     (a) Must obtain a new license from the department before transfer of ownership;

     (b) Must not begin operation of the adult family home until the department has granted the license;

     (c) Must correct all deficiencies that exist at the time of the ownership change;

     (d) Is subject to the provisions of chapters 70.128, 70.129, 74.34 RCW, this chapter and other applicable laws and regulations;

     (e) Must ensure that any funds in resident's accounts at the time of the ownership change remain in an equivalent account. If any funds in resident's accounts are moved, the new owner must promptly notify residents or resident's representative, in writing of the name, address, and location of the new depository; and

     (f) Must provide the department with a copy of the written notice of the change of ownership that was given to each resident, or applicable resident representatives.

WAC 388-76-10146 Qualifications -- Training and home care aide certification requirements. (1) The adult family home must ensure staff persons hired before January 7, 2012 meet training requirements in effect on the date hired, including requirements in chapter 388-112 WAC.

     (2) The adult family home must ensure all adult family home caregivers, entity representatives, and resident managers hired on or after January 7, 2012, meet the long-term care worker training requirements of chapter 388-112 WAC, including but not limited to:

     (a) Orientation and safety;

     (b) Basic;

     (c) Specialty for dementia, mental illness and/or developmental disabilities when serving residents with any of those primary special needs;

     (d) Cardiopulmonary resuscitation and first aid; and

     (e) Continuing education.

     (23) All persons listed in subsection (1) of this section must obtain the home care aide certification if required by chapter 246-980 WAC.

     (34) All adult family home applicants on or after January 7, 2012, must meet the long-term care worker training requirements of chapter 388-112 WAC and obtain the home care aide certification if required by chapter 246-980 WAC.

     (45) Under RCW 18.88B.040 and chapter 246-980 WAC, certain persons including registered nurses, licensed practical nurses, certified nursing assistants or persons who are in an approved certified nursing assistant program are exempt from home care aide certification and long-term care worker training requirements. Continuing education requirements still apply as outlined in chapter 388-112 WAC.

     (5) The adult family home must ensure that all staff receive the orientation and training necessary to perform their job duties.

     (6) The adult family home must ensure that a qualified caregiver is on-site whenever a resident is at the adult family home. For purposes of this subsection, a qualified caregiver means someone who has successfully completed orientation and basic training.

WAC 388-76-10911 Inspections -- Multiple adult family home providers. (1) In the event of serious noncompliance leading to the imposition of one or more actions listed in RCW 70.128.160(2) on a home operated by a provider with multiple adult family homes, all other homes operated by the provider must be inspected to determine if the same or related deficiencies are present in those homes.

     (2) The department may issue fines under RCW 70.128.065(5) of up to three hundred dollars for each inspection when one or more actions listed in RCW 70.128.160(2) is imposed on a multiple home provider and inspections of the other homes are required to determine whether the same or related deficiencies are present in those homes.

WAC 388-76-10945 Remedies -- Imposition of remedies. The department must impose a remedy or remedies listed in WAC 388-76-10940 when violations of chapter 70.128, 70.129 and 74.34 RCW and this chapter are:

     (1) Serious Repeated;

     (2) Recurring Uncorrected;

     (3) Uncorrected Pervasive; or

     (4) An immediate Present a threat to the health, safety, or welfare of one or more residents.

NEW SECTION

     WAC 388-76-10946 Remedies -- Increasing severity for certain violations. The department will consider imposing increasingly severe remedies for a provider's deficient practice that is:

     (1) Recurring; or

     (2) Uncorrected.

NEW SECTION

     WAC 388-76-10947 Remedies -- Criteria considered. The department will consider several criteria when determining whether to impose remedies, or whether to impose increasingly more severe remedies, for provider noncompliance with the licensing laws and rules. The criteria to be considered includes but is not limited to:

     (1) The seriousness of the harm or possible harm to residents;

     (2) The specific facts of the case;

     (3) The compliance history of the provider including:

     (a) Which remedies have been imposed;

     (b) When the remedies were imposed; and

     (c) The frequency of remedy imposition.

     (4) Whether the noncompliance is:

     (a) Pervasive;

     (b) Recurring; and

     (c) Uncorrected.

WAC 388-76-10975 Remedies -- Specific -- Civil penalties. (1) The department may impose civil penalties of at least not more than one hundred three thousand dollars per day per violation except that:

     (a) Fines up to one thousand dollars can be issued under RCW 70.128.150 for willful interference with a representative of the long-term care ombudsman; and

     (b) Fines up to three thousand dollars can be issued under RCW 74.39A.060 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.

     (c) Fines up to three hundred dollars for each inspection may be issued under RCW 70.128.065(5) when one or more actions listed in RCW 70.128.160(2) is imposed on a multiple homes provider and inspections of other homes are required to determine whether the same or related deficiencies are present in those homes.

     (d) Fines of up to ten thousand dollars may be issued under RCW 70.128.065(2) for a current or former licensed provider who is operating an unlicensed home.

     (2) When the adult family home fails to pay a fine under this chapter when due, 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 from the department.

     (3) Civil monetary penalties are due twenty-eight days after the adult family home or the owner or operator of an unlicensed adult family home is served with notice of the penalty unless the adult family home requests a hearing in compliance with chapter 34.05 RCW, RCW 43.20A.215, and this chapter. If the hearing is requested, the penalty becomes due ten days after a final decision in the department's favor is issued. Thirty days after the department serves the adult family home with notice of the penalty, interest begins to accrue at a rate of one percent per month as authorized by RCW 43.20B.695.

NEW SECTION

     WAC 388-76-10976 Remedies -- Civil fine grid. The department will consider the guidance in the tiered sanction grid below when imposing civil fine remedies imposing civil fine remedies based upon the guidance of the grid below:

NO HARM	MINIMAL or MODERATE HARM		SERIOUS HARM		IMMINENT DANGER and/or IMMEDIATE THREAT
Repeat/ Uncorrected	Initial	Repeat/ Uncorrected	Initial	Repeat/ Uncorrected	Any Violation
Civil fine ofup to at least $100 per violation	Civil fine up to $500 per violation or a daily civil fine of at least $250 per day	Civil fine up to $1,000 per violation or a daily civil fine of at least $500 per day	Civil fine up to $2,000 per violation or a daily civil fine of at least $1,000 per day	Civil fine up to $3,000 per violation or a daily civil fine of at least $1,500 per day	Civil fine of $3,000 or daily civil fine of at least $1,000 per day

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.
Another state's regulations were provided as an example.	The department has not taken any action because no specific comments or suggestions were provided.
Suggest more direction and specific dimensions for hallways and doorways.	Current language in WAC 388-76-10685(3) is consistent with ESHB 1277. The requirements allow adult family home providers to focus on individual needs of residents as opposed to having an explicit rule about calling out hallway and door dimensions.
WAC 388-76-10000, for the definition of "inspection," please insert the term "welfare" or "wellbeing" as these terms are both used in [ESHB] 1277 sections 201(2) and 206(2) use these terms.	The department has accepted this comment.
WAC 388-76-10000, "recurring" or "repeated," we recommend instead that the department use the definition of "recurring" to be two citations within eighteen months. This would be more similar to nursing home regulations.	The proposed rule would apply if the home received two similar citations anytime within a thirty-six month period thus promoting protections for residents. No change was made.
WAC 388-76-10015(2), take out "the adult family" and replace with "each licensed." This is the language used in section 203(6).	The department has accepted this comment.
WAC 388-76-10015, we recommend including a sentence in this section that was added by section 206(2) of ESHB 1277: "(2) The provider shall promote the health, safety, and well-being of each resident residing in each licensed adult family home."	The department has accepted this comment.
WAC 388-76-10037, 388-76-10070, 388-76-10073, for purposes of these sections; if a coprovider dies is it considered a new application?	Current WAC 388-76-10105 includes the death of a coprovider as requiring a change of ownership. Established procedures require a new application for a change of ownership.
New section WAC 388-76-10038 License requirements -- Financial solvency, it would be helpful to provide a list showing the types of financial information the department will or may look at. There could be a list for applicants and a list for current providers. I suggest creating a new WAC that would contain all the language relating to financial solvency except the definition.	The department cannot introduce a new rule at this stage. ESHB 1277 requires that financial solvency be defined in rule and the department has done so. The new law does not require a rule explaining how the department will determine financial solvency. The department may consider adopting such a rule during subsequent rule-making processes.
WAC 388-76-10064, add subsection (4), the class must be a minimum of forty-eight hours of class time. This is the language used in section 205(11).	The department has accepted this comment.
WAC 388-76-10105 (5)(e), please add to the sentence where it says "promptly notify residents" insert "or resident's representative." This is the language used in section 301(8).	The department has accepted this comment.
WAC 388-76-10130, concerns that the term "qualified person" implies some level of training or certification. Define who is a "qualified person."	This section is the exact language in ESHB 1277 and is not intended to require any additional or specialized training or certification.
WAC 388-76-10146, Initiative 1163 becomes effective January 7, 2012. The WAC should be revised to reflect this effective date.	The department has accepted this comment.
WAC 388-76-10146, this WAC should include language related to ESHB 1277, section 206(16), it requires that the adult family home (AFH) must have a trained caregiver on-site. Under prior law at RCW 70.128.230, the AFH could have a partially trained caregiver on site and the fully trained caregiver off-site but available. Section 206(16) of the new law changed that.	The department has accepted this comment.
WAC 388-76-10146, those exempted still need to meet continuing education requirements.	Department accepted this comment and clarified that continuing education requirements still apply.
WAC 388-76-10395, we recommend that if a genuine emergency admission is necessary, then the AFH should still be required to develop an initial assessment and preliminary service plan, and that this should be done within two calendar days, not five working days.	Through executive order, the governor has limited rule-making activities to changes that are necessary due to emergency or to implement recently enacted federal or state law. This comment will be held for future consideration. This comment is related to language that was not amended as part of this rule-making process and is not necessary to implement newly enacted legislation.
WAC 388-76-10705, ESHB 1277, section 206(5) includes the kitchen as a common use area. Current WAC 388-76-10705 defines common areas but does not include kitchens.	WAC 388-76-10705 is not open at this time. Both the new law and the current rule use a form of the term "including but not limited to" when giving examples of common use areas. Since "kitchens" fall within the definition of "common use areas" under the rule, the adult family home licensing law, chapter 70.128 RCW, includes kitchens, and the provider is required to comply with the law. The department will hold this comment and consider making this change in future rule-making processes.
WAC 388-76-10705, ESHB 1277, section 206 (4) and (5) contained several provisions regarding the physical layout of adult family homes, such as regarding wheelchair accessibility that is nowhere reflected in the proposed WAC amendments. The most appropriate rule to amend is WAC 388-76-10705, as it covers some of the same topics but does not go as far as the new law.	The statutory requirement is already met in current WAC 388-76-10685(3).
WACs do not include several violations for which sanctions are mandatory.	The specific instances of enforcement section is WAC 388-76-10955 and this section is not currently open. The department will keep this suggestion for consideration during future rule making and when the governor's executive order suspending noncritical rule development is lifted.
WAC 388-76-10735, why did you reject our proposed language related to kitchen access?, our language accurately reflects HB 1277, section 206(4).	This is not the appropriate place for this language. This section is not open. The department will hold this comment and consider making this change in future rule-making processes.
WAC 388-76-10911, should include language requiring $300 fine for additional inspections when enforcement action is taken against a multiple home provider.	The department has accepted this comment amending this section and WAC 388-76-10975.
WAC 388-76-10945, need to remove "immediate" as a requirement, and to add the other statutory reasons for a mandatory sanction: (1) A substantiated complaint involving harm to a resident; (2) retaliation against a resident; (3) willful interference with the ombudsman; (4) pervasive deficiencies; and (5) a threat to the health, safety, or welfare of a resident.	The department has amended this section to be consistent with ESHB 1277, section 208.
WAC 388-76-10946 and 388-76-10947, based on ESHB 1277, the WAC should be amended to reflect that the department must impose incrementally more severe penalties for the violations and deficient practices discussed above.	The department has deleted these sections and amended WAC 388-76-10945 to be consistent with ESHB 1277, section 208.
WAC 388-76-10975 (1)(a) needs to be amended to say that the department can impose a fine up to $3000 for willful interference with the ombudsman.	The scope of this rule making has been limited to the newly passed statute and for this section it is chapter 70.128 RCW. The proposed language is consistent with RCW 70.128.150 that states up to a $1000 fine.
WAC 388-76-10975 (1)(c), language requiring $300 fine for additional inspections when enforcement action is taken against a multiple home provider should be located in WAC 388-76-10911.	The department has accepted this comment amending this section and WAC 388-76-10911.
WAC 388-76-10976, per ESHB 1277, civil fine should be at least $100 per violation and not "up to" $100.	The department has accepted this comment.

     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 4, Amended 19, 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 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 4, Amended 19, Repealed 0.

     Date Adopted: December 5, 2011.

Katherine I. Vasquez

Rules Coordinator

     "Abuse" means the willful action or inaction that inflicts 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 contact may include interactions that do not involve touching, including but not limited to sending a resident sexually explicit messages, or cuing or encouraging a resident to perform sexual acts. 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 or physical 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 an entity is 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 a licensed operator, resident manager, or caregiver, who resides in the home.

     (2) As used in this chapter, the term "entity" includes corporations, partnerships and limited liability companies, and the term "adult family home" includes the person or entity that is licensed 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 or domestic partner 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 who are permitted to reside in an adult family home at a given time. The capacity includes:

     (1) The number of related children or adults in the home who receive personal or special care and services; plus

     (2) The number of residents the adult family home may admit and retain - the resident capacity. The capacity number listed on the license is the "resident capacity."

     "Caregiver" 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.

     "Domestic partners" means two adults who meet the requirements for a valid state registered domestic partnership as established by RCW 26.60.030 and who have been issued a certificate of state registered domestic partnership.

     "Financial exploitation" means the illegal or improper use, control over, or withholding of the property, income, resources, or trust funds of the vulnerable adult by any person or entity for any person's or entity's profit or advantage other than for the vulnerable adult's profit or advantage. Some examples of financial exploitation are given in RCW 74.34.020(6).

     "Financial solvency" means that the applicant or provider is able to meet debts or financial obligations with some money to spare.

     "Entity representative" means the individual designated by a provider who is or will be responsible for the daily operation of the adult family home and who meets the requirements of this chapter and chapter 388-112 WAC.

     "Home" means adult family home.

     "Imminent danger" or "immediate threat" means serious physical harm to or death of a resident has occurred, or there is a serious threat to the resident's life, health or safety.

     "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 a review by department personnel to determine the health, safety, and well-being of residents, and the adult family home's compliance with this chapter and chapters 70.128, 70.129, 74.34 RCW, and other applicable rules and regulations. The department's review may include an on-site visit.

     "Management agreement" means a written, executed agreement between the adult family home and another individual or entity regarding the provision of certain services on behalf of the adult family home.

     "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).

     "Minimal" means violations that result in little or no negative outcome and/or little or no potential harm for a resident.

     "Moderate" means violations that result in negative outcome and actual or potential harm for a resident.

     "Multiple facility provider" means a 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.42.100.

     "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.

     "Placement agency" is an "elder or vulnerable adult referral agency" as defined in chapter 18.330 RCW and means a business or person who receives a fee from or on behalf of a vulnerable adult seeking a referral to care services or supportive housing or who receives a fee from a care services provider or supportive housing provider because of any referral provided to or on behalf of a vulnerable adult.

     "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:

     (1) Any person who is licensed to operate an adult family home and meets the requirements of this chapter; or

     (2) Any corporation, partnership, or limited liability company that is licensed under this chapter to operate an adult family home and meets the requirements of this chapter.

     "Recurring" or "repeated" means that the department has cited the adult family home for a violation of applicable licensing laws or rules and the circumstances of (1) and (2) of this definition are present:

     (1) The department previously imposed an enforcement remedy for a violation of the same section of law or rule for substantially the same problem following any type of inspection within the preceding thirty-six months; or

     (2) The department previously cited a violation under the same section of law or rule for substantially the same problem following any type of inspection on two occasions within the preceding thirty-six months.

     (3) If the previous violation in (1) or (2) of this definition was pursuant to a law or rule that has changed at the time of the new violation, a citation to the equivalent current law or rule section is sufficient.

     "Resident" means any adult unrelated to the provider who lives in the adult family home and who is in need of care. Except as specified elsewhere in this chapter, for decision-making purposes, the term "resident" includes the resident's surrogate decision maker acting under state law.

     "Resident manager" means a person employed or designated by the provider to manage the adult family home and who meets the requirements of this chapter.    

     "Serious" means violations that result in one or more negative outcomes and significant actual harm to residents that does not constitute imminent danger; and or, there is reasonable predictability of recurring actions, practices, situations or incidents with potential for causing significant harm to a resident.

     "Severity" means the seriousness of a violation as determined by actual or potential negative outcomes for residents and subsequent actual or potential for harm. Outcomes include any negative effect on the resident's physical, mental or psychosocial well being (i.e., safety, quality of life, quality of care).

     "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 or used by an adult family home, directly or by contract, to provide care and services to any resident.

     (2) Staff must meet all of the requirements in this chapter and chapter 388-112 WAC.

     "Uncorrected" means the department has cited a violation of WAC or RCW following an inspection and the violation remains uncorrected at the time of a subsequent inspection for the specific purpose of verifying whether such violation has been corrected.

     "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.

     "Water hazard" means any body of water over twenty-four inches in depth that can be accessed by a resident, and includes but not limited to:

     (1) In-ground, above-ground, and on-ground pools;

     (2) Hot tubs, spas;

     (3) Fixed-in-place wading pools;

     (4) Decorative water features;

     (5) Ponds; or

     (6) Natural bodies of water such as streams, lakes, rivers, and oceans.

     "Willful" means the deliberate or nonaccidental action or inaction by an individual 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;

     (6) Receiving services from an individual provider; or

     (7) With a functional disability who lives in his or her own home, who is directing and supervising a paid personal aide to perform a health care task as authorized by RCW 74.39.050.

[Statutory Authority: RCW 70.128.040, chapter 74.39A RCW. 10-16-082, § 388-76-10000, filed 7/30/10, effective 1/1/11. Statutory Authority: RCW 70.128.040. 10-03-064, § 388-76-10000, filed 1/15/10, effective 2/15/10; 09-03-029, § 388-76-10000, filed 1/12/09, effective 2/12/09. Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10000, filed 10/16/07, effective 1/1/08.]

     (2) The provider is ultimately responsible for the day-to-day operation of ((the adult family)) each licensed home.

     (3) The provider must promote the health, safety, and well-being of each resident residing in each licensed adult family home.

[Statutory Authority: RCW 70.128.040. 10-03-064, § 388-76-10015, filed 1/15/10, effective 2/15/10. Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10015, filed 10/16/07, effective 1/1/08.]

     (2) The home must send the annual license fee to the department upon receipt of notice of fee due.

     (3) If the home does not pay the fee when due, the department will impose remedies.

[Statutory Authority: RCW 70.128.040. 09-21-075, § 388-76-10025, filed 10/16/09, effective 11/16/09. Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10025, filed 10/16/07, effective 1/1/08.]

     (1) Evidence of successful completion of the forty-eight hour residential care administrator's training to meet the applicable 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))) (3) The following plans for each home the applicant intends to operate. Each of the following plans must be updated and maintained:

     (a) A twenty-four hour a day, seven day a week staffing plan;

     (b) A plan for managing the daily operations of each home; and

     (c) A plan for emergencies, deliveries, staff and visitor parking.

     (((5))) (4) A ((credit)) demonstrated history ((considered if the history relates)) of financial solvency related to the ability to provide care and services((.)); and

     (((6))) (5) An entity representative or a resident manager at each home who is responsible for the care of each resident at all times.

[Statutory Authority: RCW 70.128.040. 10-04-008, § 388-76-10035, filed 1/22/10, effective 2/22/10. Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10035, filed 10/16/07, effective 1/1/08.]

     (1) For a second home, if the applicant has maintained the first adult family home license for at least twenty-four months with no enforcement actions as listed in RCW 70.128.160(2) related to a significant violation of chapters 70.128, 70.129 or 74.34 RCW, this chapter or other applicable laws and regulations; and

     (2) For a third or additional homes, if a minimum of twelve months have passed since the previous adult family home license was granted and no enforcement action was taken against any of the currently licensed homes.

[]

     (2) An applicant and entity representative may not be required to take the forty-eight hour class if there is a change in ownership and the applicant and entity representative are already participants in the operation of a currently licensed home.

     (3) An applicant and entity representative must take the forty-eight hour class when the application is for an additional licensed home and the forty-eight hour class has not already been successfully taken.

     (4) The class must be a minimum of forty-eight hours of classroom time and approved by the department.

[Statutory Authority: RCW 70.128.040. 10-03-064, § 388-76-10064, filed 1/15/10, effective 2/15/10.]

     (2) The applicant must submit the required fees with the application form.

     (((3) The processing fee will be returned as required by chapter 70.128 RCW.

     (4) The license fee will be returned to the applicant if the application is withdrawn, voided or the license is denied.))

[Statutory Authority: RCW 70.128.040. 09-21-075, § 388-76-10070, filed 10/16/09, effective 11/16/09. Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10070, filed 10/16/07, effective 1/1/08.]

[Statutory Authority: RCW 70.128.040. 09-21-075, § 388-76-10073, filed 10/16/09, effective 11/16/09.]

     (1) May not apply for separate licenses; and

     (2) May apply jointly to be coproviders, if they are both qualified. One person may apply to be a provider without requiring the other person to apply.

[Statutory Authority: RCW 70.128.040. 10-03-064, § 388-76-10080, filed 1/15/10, effective 2/15/10; 09-03-030, § 388-76-10080, filed 1/12/09, effective 2/12/09. Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10080, filed 10/16/07, effective 1/1/08.]

     (2) A change of ownership of an adult family home requires both a new license application and a new license.

     (3) A change of ownership occurs when there is a change in:

     (a) The provider; or

     (b) The control of a provider.

     (4) Events which constitute a change of ownership include, but are not limited to:

     (a) The form of legal organization of the adult family home is changed, such as when an adult family home forms:

     (i) A partnership;

     (ii) A corporation;

     (iii) A limited liability company; or

     (iv) When it merges with another legal organization.

     (b) The adult family home transfers business operations and management responsibility to another party, whether or not there is a partial or whole transfer of real property, personal property, or both.

     (c) Two people are both licensed as a married couple or domestic partners to operate an adult family home and an event, such as a separation, divorce, or death, results in only one person operating the home.

     (d) Dissolution of a business partnership that is licensed to operate the adult family home.

     (e) If the adult family home is a corporation and the corporation:

     (i) Is dissolved;

     (ii) Merges with another corporation, resulting in a change in the control of the provider; 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 its shares to one or more of the following:

     (A) New or former shareholders; or

     (B) Present shareholders, each having less than five percent of the shares before the initial transaction.

     (f) Any other event or combination of events that results in a substitution, elimination, or withdrawal of the provider's control of the adult family home.

     (5) The new owner:

     (a) Must obtain a new license from the department before transfer of ownership;

     (b) Must not begin operation of the adult family home until the department has granted the license;

     (c) Must correct all deficiencies that exist at the time of the ownership change;

     (d) Is subject to the provisions of chapters 70.128, 70.129, 74.34 RCW, this chapter and other applicable laws and regulations; and

     (e) Must ensure that any funds in the resident's accounts at the time of the ownership change remain in an equivalent account. If any funds in resident's accounts are moved, the new owner must promptly notify residents or resident's representative in writing of the name, address, and location of the new depository; and

     (f) Must provide the department with a copy of the written notice of the change of ownership that was given to each resident, or applicable resident representatives.

[Statutory Authority: RCW 70.128.040. 10-14-058, § 388-76-10105, filed 6/30/10, effective 7/31/10; 10-04-008, § 388-76-10105, filed 1/22/10, effective 2/22/10; 09-03-030, § 388-76-10105, filed 1/12/09, effective 2/12/09. Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10105, filed 10/16/07, effective 1/1/08.]

     (1) The applicant has not successfully completed a department-approved forty-eight hour adult family home administration and business planning class except as provided in WAC 388-76-10064.

     (2) It has been less than twenty years since the applicant surrendered or relinquished an adult family home license after receiving notice that the department intended to deny, suspend, not renew or revoke the license.

     (3) The applicant or the applicant's spouse, domestic partner, or any partner, officer, director, managerial employee or majority owner of the applying entity:

     (a) Has a history of significant noncompliance with federal or state laws or regulations in the provision of care or services to children or vulnerable adults;

     (b) Has prior violations of federal or state laws or regulations relating to residential care facilities resulting in revocation, suspension, or nonrenewal of a license or contract with the department within the past ten years;

     (c) Has been convicted of a crime in federal court or in any other state, and the department determines that the crime is equivalent to a crime under subsections (3)(c), (d), (e), (f), or (g) below;

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

     (((d))) (e) Has been convicted of "crimes relating to financial exploitation" as defined in RCW 43.43.830, unless the crime is theft in 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;

     (((e))) (f) Has been convicted of:

     (i) Violation of the Imitation Controlled Substance 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).

     (((f))) (g) Has been convicted of sending or bringing into the state depictions of a minor engaged in sexually explicit conduct;

     (((g))) (h) Has been convicted of criminal mistreatment;

     (((h))) (i) Has been found to have abused, neglected, exploited, or abandoned a minor or vulnerable adult by court of law or a disciplining authority, including the department of health. Examples of legal proceedings in which such findings could be made include juvenile court proceedings under chapter 13.34 RCW, domestic relations proceeding under Title 26 RCW, and vulnerable adult protection proceedings under chapter 74.34 RCW;

     (((i))) (j) Has 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 findings made before December, 1998.

     (((j))) (k) Has a finding of abuse, neglect, financial 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.

[Statutory Authority: RCW 70.128.040. 10-03-064, § 388-76-10120, filed 1/15/10, effective 2/15/10; 09-03-028, § 388-76-10120, filed 1/12/09, effective 2/12/09. Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10120, filed 10/16/07, effective 1/1/08.]

     (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 course work 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 course work 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) Completion of the training requirements that were in effect on the date they were hired or became licensed providers, including the requirements described in chapter 388-112 WAC;

     (4) Have good moral and responsible character and reputation;

     (5) Be literate and able to communicate in the English language, ((or meet alternative requirements by assuring)) and assure 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)) 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) Assure that there is a mechanism to communicate with the resident in his or her primary language either through a qualified person on-site or readily available at all times, or other reasonable accommodations, such as a language line.

     (7) 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))) (8) Have completed at least ((three hundred and twenty)) one thousand hours of successful direct care experience in the previous sixty months obtained after age eighteen to vulnerable adults in a licensed or contracted setting before operating or managing a home((;

     (8))). Individuals holding one of the following professional licenses are exempt from this requirement:

     (a) Physician licensed under chapter 18.71 RCW;

     (b) Osteopathic physician licensed under chapter 18.57 RCW;

     (c) Osteopathic physician assistant licensed under chapter 18.57A RCW;

     (d) Physician assistant licensed under chapter 18.71A RCW;

     (e) Registered nurse, advanced registered nurse practitioner, or licensed practical nurse licensed under chapter 18.79 RCW.

     (9) 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))) (10) Obtain and keep valid cardiopulmonary resuscitation (CPR) and first-aid card or certificate as required in chapter 388-112 WAC; and

     (((10))) (11) Have tuberculosis screening to establish tuberculosis status per this chapter.

[Statutory Authority: RCW 70.128.040, chapter 74.39A RCW. 10-16-082, § 388-76-10130, filed 7/30/10, effective 1/1/11. Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10130, filed 10/16/07, effective 1/1/08.]

     (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 or health care authority; and

     (c) If approval is obtained verbally, document the time, date, and name of the case manager who gave approval.

[Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10395, filed 10/16/07, effective 1/1/08.]

     (c) Prior to the receipt of any funds.

     (2) The disclosure must include:

     (a) A statement of the amount of any admissions fees, security deposits, prepaid charges, ((or)) minimum stay fees or any other fees or charges specifying what the funds are paid for and the basis for retaining any portion of the funds if the resident dies, is hospitalized, or is transferred or discharged from the home;

     (b) The home's advance notice or transfer requirements; and

     (c) The amount of the security deposits, admission fees, prepaid charges, ((or)) minimum stay fees or any other fees or charges 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. The home must retain a copy of the disclosure and acknowledgement.

     (4) If the home does not provide these disclosures, the home must not keep the security deposits, admission fees, prepaid charges, ((or)) minimum stay fees, or any other fees or charges.

     (5) If a resident dies, is hospitalized or is transferred to another facility for more appropriate care 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;

     (c) May not require the resident to obtain a refund from a placement agency or person.

     (6) The adult family home may not retain funds for reasonable wear and tear by the resident or for any basis that would violate RCW 70.129.150.

     (((6))) (7) 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))) (8) Nothing in this section applies to provisions in contracts negotiated between a home and a certified health plan, health or disability insurer, health maintenance organization, managed care organization, or similar entities.

     (((8))) (9) If the home requires 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.

[Statutory Authority: RCW 70.128.040. 10-03-064, § 388-76-10540, filed 1/15/10, effective 2/15/10. Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10540, filed 10/16/07, effective 1/1/08.]

     (1) Must be deposited by the adult family home in an interest bearing account that is separate from any of the home's operating accounts and credits all interest earned on the resident's funds to that account. The adult family home must:

     (a) Ensure that a record of the account is available upon the request of the resident or their representative;

     (b) Not commingle resident funds from these accounts with the adult family home's funds or with the funds of any person other than another resident. If resident funds are commingled, the home must provide each resident with a separate accounting for their share;

     (c) Ensure that the account or accounts are held in a financial institution as defined in RCW 30.22.041, and notify each resident in writing of the name, address, and location of the depository.

[]

[Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10570, filed 10/16/07, effective 1/1/08.]

     (2) The department may issue fines under RCW 70.128.065(5) of up to three hundred dollars for each inspection when one or more actions listed in RCW 70.128.160(2) is imposed on a multiple home provider and inspections of the other homes are required to determine whether the same or related deficiencies are present in those homes.

[]

     (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; and

     (d) Financial records of the business if good cause to believe that a financial obligation related to resident care or services will not be met.

     (2) The home and staff do not willfully interfere or fail to cooperate with department staff in the performance of official duties.

[Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10915, filed 10/16/07, effective 1/1/08.]

     (4) Present a threat to the health, safety, or welfare of one or more residents.

[Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10945, filed 10/16/07, effective 1/1/08.]

     (1) Has been convicted of:

     (a) Any felony that the department determines is reasonably related to the competency of the person to be involved in the ownership or operation of an adult family home; or

     (b) A crime involving a firearm used in the commission of a felony or in any act of violence against a person.

     (2) Has engaged in the illegal use, sale or distribution of drugs or excessive use of alcohol or drugs without the evidence of rehabilitation;

     (3) Has committed an act of domestic violence toward a family or household member;

     (4) Has been found in any final decision of a federal or state agency to have abandoned, neglected, abused, or financially exploited a vulnerable adult, unless such decision requires imposition of a remedy under WAC 388-76-10955;

     (5) Has had a license for the care of children or vulnerable adults denied, suspended, revoked, or not renewed;

     (6) Has a history of violations of chapter 70.128 RCW, or any law regulating residential care facilities, that resulted in revocation, suspension, or nonrenewal of a license with the department;

     (7) Has been enjoined from operating a facility for the care and services of children or adults;

     (8) Has had a medicaid or medicare provider agreement or any other contract for the care and treatment of children or vulnerable adults, terminated, cancelled, suspended, or not renewed by any public agency, including a state medicaid agency;

     (9) Has been the subject of 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;

     (10) Has obtained or attempted to obtain a license by fraudulent means or misrepresentation;

     (11) 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 involving the department;

     (12) Permitted, aided, or abetted the commission of any illegal act on the adult family home premises;

     (13) Willfully prevented, interfered with, or failed to cooperate with any inspection, investigation, or monitoring visit made by the department, including refusal to permit authorized department representatives to interview residents or have access to their records;

     (14) Failed or refused to comply with:

     (a) A condition or limit imposed on a license or a stop placement order; or

     (b) The requirements of chapters 70.128, 70.129, 74.34 RCW, this chapter or any other applicable laws.

     (15) Misappropriated property of a resident, unless such action requires a remedy under WAC 388-76-10955;

     (16) Exceeded licensed capacity in the operation of an adult family home;

     (17) Operated a facility for the care of children or adults without a license or with a revoked license;

     (18) In connection with the operation of any facility for the care of children or adults, relinquished or returned a license, or did not seek license renewal following written notification that the licensing agency intends to deny, suspend, cancel or revoke the license, unless such action requires imposition of a remedy under WAC 388-76-10955;

     (19) When providing care to children or vulnerable adults, has had resident trust funds or assets seized by the Internal Revenue Service or a state entity for failure to pay income or payroll taxes;

     (20) Failed to meet financial obligations as the obligations fell due in the normal course of owning or operating a business involved in the provision of care and services to children or vulnerable adults;

     (21) Has failed to meet personal financial obligations and that failure has resulted in a failure to provide necessary care and services to the residents;

     (22) Interfered with a long-term care ombudsman or department staff in the performance of his or her duties; or

     (23) Failed to relinquish or surrender the license as required.

[Statutory Authority: RCW 70.128.040. 10-03-064, § 388-76-10960, filed 1/15/10, effective 2/15/10; 09-03-028, § 388-76-10960, filed 1/12/09, effective 2/12/09. Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10960, filed 10/16/07, effective 1/1/08.]

     (a) Fines up to one thousand dollars can be issued under RCW 70.128.150 for willful interference with a representative of the long-term care ombudsman; and

     (b) Fines up to three thousand dollars can be issued under RCW 74.39A.060 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; and

     (c) Fines up to ten thousand dollars may be issued under RCW 70.128.065(2) for a current or former licensed provider who is operating an unlicensed home.

     (2) When the adult family home fails to pay a fine under this chapter when due, 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 from the department.

     (3) Civil monetary penalties are due twenty-eight days after the adult family home or the owner or operator of an unlicensed adult family home is served with notice of the penalty unless the adult family home requests a hearing in compliance with chapter 34.05 RCW, RCW 43.20A.215, and this chapter. If the hearing is requested, the penalty becomes due ten days after a final decision in the department's favor is issued. Thirty days after the department serves the adult family home with notice of the penalty, interest begins to accrue at a rate of one percent per month as authorized by RCW 43.20B.695.

[Statutory Authority: RCW 70.128.040. 10-04-008, § 388-76-10975, filed 1/22/10, effective 2/22/10. Statutory Authority: RCW 70.128.040 and chapters 70.128 and 74.34 RCW. 07-21-080, § 388-76-10975, filed 10/16/07, effective 1/1/08.]

NO HARM	MINIMAL or MODERATE HARM		SERIOUS HARM		IMMINENT DANGER and/or IMMEDIATE THREAT
Repeat / Uncorrected	Initial	Repeat / Uncorrected	Initial	Repeat / Uncorrected	Any Violation
Civil fine of at least $100 per violation	Civil fine up to $500 per violation or a daily civil fine of at least $250 per day	Civil fine up to $1,000 per violation or a daily civil fine of at least $500 per day	Civil fine up to $2,000 per violation or a daily civil fine of at least $1,000 per day	Civil fine up to $3,000 per violation or a daily civil fine of at least $1,500 per day	Civil fine of $3,000 or daily civil fine of at least $1,000 per day

[]

     (2) The adult family home must ensure all adult family home caregivers, entity representatives, and resident managers hired on or after ((January 1, 2011)) January 7, 2012, meet the long-term care worker training requirements of chapter 388-112 WAC, including but not limited to:

     (a) Orientation and safety;

     (b) Basic;

     (c) Specialty for dementia, mental illness and/or developmental disabilities when serving residents with any of those primary special needs;

     (d) Cardiopulmonary resuscitation and first aid; and

     (e) Continuing education.

     (((2))) (3) All persons listed in subsection (1) of this section, must obtain the home-care aide certification if required by chapter 246-980 WAC.

     (((3))) (4) All adult family home applicants on or after ((January 1, 2011)) January 7, 2012, must meet the long-term care worker training requirements of chapter 388-112 WAC and obtain the home-care aide certification if required by chapter 246-980 WAC.

     (((4))) (5) Under RCW 18.88B.040 and chapter 246-980 WAC, certain persons including registered nurses, licensed practical nurses, certified nursing assistants or persons who are in an approved certified nursing assistant program are exempt from home care aide certification and long-term care worker training requirements. Continuing education requirements still apply as outlined in chapter 388-112 WAC.

     (((5))) (6) The adult family home must ensure that all staff receive the orientation and training necessary to perform their job duties.

     (7) The adult family home must ensure that a qualified caregiver is on-site whenever a resident is at the adult family home. For purposes of this subsection, a qualified caregiver means someone who has successfully completed orientation and basic training.

[Statutory Authority: RCW 70.128.040, chapter 74.39A RCW. 10-16-082, § 388-76-10146, filed 7/30/10, effective 1/1/11.]

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