WSR 17-22-036 PERMANENT RULES
DEPARTMENT OF
SOCIAL AND HEALTH SERVICES
(Aging and Long-Term Support Administration)
[Filed October 24, 2017, 10:54 a.m., effective November 24, 2017]
Effective Date of Rule: Thirty-one days after filing.
Purpose: The department is repealing chapter 388-112 WAC and creating new chapter 388-112A WAC, Residential long-term care services training. The new chapter 388-112A WAC provides requirements for long-term care worker training and home care aide certification, specialty training curriculum and instructor requirements, and a new category of training and certification requirements for long-term care workers in enhanced services facilities. Chapter 388-112A WAC is organized to provide clarity in long-term care worker training, certification, curricula, and instructor requirements. New chapter organization chart available upon request to Suemary Trobaugh.
Citation of Rules Affected by this Order: New WAC 388-112A-0010, 388-112A-0020, 388-112A-0030, 388-112A-0040, 388-112A-0050, 388-112A-0060, 388-112A-0070, 388-112A-0080, 388-112A-0090, 388-112A-0095, 388-112A-0100, 388-112A-0105, 388-112A-0110, 388-112A-0115, 388-112A-0120, 388-112A-0200, 388-112A-0210, 388-112A-0220, 388-112A-0230, 388-112A-0240, 388-112A-0300, 388-112A-0310, 388-112A-0320, 388-112A-0330, 388-112A-0340, 388-112A-0350, 388-112A-0370, 388-112A-0400, 388-112A-0410, 388-112A-0420, 388-112A-0430, 388-112A-0440, 388-112A-0450, 388-112A-0460, 388-112A-0470, 388-112A-0480, 388-112A-0490, 388-112A-0495, 388-112A-0500, 388-112A-0510, 388-112A-0520, 388-112A-0530, 388-112A-0540, 388-112A-0550, 388-112A-0560, 388-112A-0570, 388-112A-0575, 388-112A-0580, 388-112A-0585, 388-112A-0590, 388-112A-0600, 388-112A-0610, 388-112A-0620, 388-112A-0700, 388-112A-0710, 388-112A-0720, 388-112A-0800, 388-112A-0810, 388-112A-0820, 388-112A-0830, 388-112A-0840, 388-112A-0900, 388-112A-0910, 388-112A-0920, 388-112A-0930, 388-112A-0940, 388-112A-0950, 388-112A-1000, 388-112A-1010, 388-112A-1020, 388-112A-1100, 388-112A-1110, 388-112A-1200, 388-112A-1210, 388-112A-1220, 388-112A-1230, 388-112A-1240, 388-112A-1250, 388-112A-1260, 388-112A-1270, 388-112A-1280, 388-112A-1285, 388-112A-1290, 388-112A-1295, 388-112A-1297, 388-112A-1300 and 388-112A-1310; and repealing WAC 388-112-0001, 388-112-0002, 388-112-0003, 388-112-0004, 388-112-0005, 388-112-0010, 388-112-0015, 388-112-0016, 388-112-0018, 388-112-0019, 388-112-0035, 388-112-0045, 388-112-0053, 388-112-0055, 388-112-0062, 388-112-0066, 388-112-0070, 388-112-0075, 388-112-0076, 388-112-0078, 388-112-0079, 388-112-0081, 388-112-0083, 388-112-0088, 388-112-0091, 388-112-0092, 388-112-0106, 388-112-0108, 388-112-0110, 388-112-0115, 388-112-0120, 388-112-0122, 388-112-0125, 388-112-0130, 388-112-0132, 388-112-0135, 388-112-0140, 388-112-0142, 388-112-0145, 388-112-0150, 388-112-0152, 388-112-0155, 388-112-0160, 388-112-0165, 388-112-0170, 388-112-0175, 388-112-0180, 388-112-0185, 388-112-0190, 388-112-0195, 388-112-0196, 388-112-01961, 388-112-01962, 388-112-01963, 388-112-01964, 388-112-0197, 388-112-0200, 388-112-0205, 388-112-0207, 388-112-0210, 388-112-0225, 388-112-0235, 388-112-0240, 388-112-0250, 388-112-0255, 388-112-0260, 388-112-0265, 388-112-0270, 388-112-0275, 388-112-0280, 388-112-0285, 388-112-0290, 388-112-0295, 388-112-0300, 388-112-0305, 388-112-0310, 388-112-0315, 388-112-0320, 388-112-0325, 388-112-0330, 388-112-0335, 388-112-0345, 388-112-0355, 388-112-0360, 388-112-0365, 388-112-0370, 388-112-0380, 388-112-0383, 388-112-0385, 388-112-0390, 388-112-0395, 388-112-0400, 388-112-0405, and 388-112-0410.
Statutory Authority for Adoption: RCW 74.39A.009, 74.39A.070, 74.39A.074, 74.39A.351, 74.39A.341, 18.20.270, 18.88B.021, 18.88B.035, 70.128.230, 71A.12.030.
Adopted under notice filed as WSR 17-11-023 on May 10, 2017.
Changes Other than Editing from Proposed to Adopted Version:
1. In WAC 388-112A-0010(3) added "when developed" in reference to levels 2 and 3 capable caregiving curriculum;
2. As requested, added WAC 388-112A-0010(8) definition of "core basic training"; WAC 388-112A-0010(13) referred to long-term care worker definition;
3. As requested, added WAC 388-112A-0010(28) definition of "seventy-hour long-term care worker basic training" definition;
4. As requested, in WAC 388-112A-0010(30) removed sentence that training entities may only deliver approved curriculum;
5. As requested, added "or administrator" designee to assisted living facility (ALF) and enhanced services facility (ESF) administrator training requirement in WAC 388-112A-0030, 388-112A-0060, and 388-112A-0070;
6. As requested, replaced "prior to employment" with more precise description of "prior to providing client services" in WAC 388-112A-0070 and 388-112A-0495 when describing when long-term care workers must complete specialty training when working in ESFs;
7. As requested, replaced "basic training" reference with more precise description of "seventy-hour long-term care worker basic training" to rule and title, as applicable: WAC 388-112A-0040, 388-112A-0050, 388-112A-0060, 388-112A-0080, 388-112A-0090, 388-112A-0095, 388-112A-0110, 388-112A-0120, 388-112A-0200, 388-112A-0300, 388-112A-0310, 388-112A-0320, 388-112A-0330, 388-112A-0340, 388-112A-0350, 388-112A-0470, 388-112A-0550, 388-112A-0590, 388-112A-1020, and 388-112A-1110;
8. As requested, added "nursing assistant students" to training requirement tables who were previously identified only by reference to WAC 388-112A-0090: WAC 388-112A-0040, 388-112A-0050 and 388-112A-0060;
9. Added "the orientation, safety, and seventy-hour long-term care worker basic training" when describing what is the training in WAC 388-112A-0110;
10. As requested, added "seventy-hour long-term care worker basic training, the two hours of orientation, and the three hours of safety training" when describing what is the seventy-five hours of training in WAC 388-112A-0120.
11. As requested, added in WAC 388-112A-0210 examples of complaint telephone lines and resident grievance procedures, and referenced chapter 74.34 RCW;
12. As requested, combined WAC 388-112A-0360 into 388-112A-0340 by including what are required trainings that may be used as population specific training, thereby eliminating WAC 388-112A-0360;
13. As requested, clarified in WAC 388-112A-0540 that adult family homes (AFH) and ALFs must retain the nurse delegation certificates;
14. As requested, added the term "negotiated service agreement" to WAC 388-112A-0210 and 388-112A-0550;
15. As requested, in WAC 388-112A-0610 added information that continuing education (CE) is not required of licensed practical nurses, and registered nurses, and noted that CE is required for CNAs, and persons with special education training when those professions work in long-term care settings;
16. As requested, clarified the requirement in WAC 388-112A-0800 for ESF administrator training;
17. As requested, removed language in WAC 388-112A-0810 on period of time for certificate to be valid, and removed subsection (2) in its entirety;
18. As requested, added language to WAC 388-112A-0900 that competency tests are department of social and health services (DSHS) developed and distributed;
19. As requested, added language to WAC 388-112A-1100 to reference instructor guides and instructor policies that are distributed at the time of course approval, and clarified that certificate and attendance records may be kept electronically (eliminating the need to retain testing records);
20. As requested, removed language from WAC 388-112A-1210 that requires nonlong-term care worker training to be DSHS approved; and
21. As requested, clarified in WAC 388-112A-1240 and 388-112A-1297 that an instructor qualification for core basic, population specific, on the job training, AFH administrator training, and specialty training include the completion of an adult education class.
A final cost-benefit analysis is available by contacting Suemary Trobaugh, 4450 10th Avenue S.E., Lacey, WA 98503, phone 360-725-2516, fax 360-725-2646, email Suemary.Trobaugh@dshs.wa.gov.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 87, Amended 0, Repealed 94.
Number of Sections Adopted at the 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 87, Amended 0, Repealed 94.
Date Adopted: October 20, 2017.
Cheryl Strange
Secretary
Chapter 388-112A WAC
RESIDENTIAL LONG-TERM CARE SERVICES TRAINING SECTION I—DEFINITIONS, PURPOSE, AND APPLICABILITY
NEW SECTION
WAC 388-112A-0010 What definitions apply to this chapter?
The following definitions apply to this chapter:
(1) "Activities of daily living" means self-care abilities related to personal care such as bathing, eating, using the toilet, dressing, medication assistance, and transfer. Instrumental activities of daily living may also be used to assess a person's functional abilities in the home and the community such as cooking, shopping, house cleaning, doing laundry, working, and managing personal finances.
(2) "Applicant" means:
(a) An individual who is applying for an adult family home license;
(b) An individual with an ownership interest in a partnership, corporation, or other entity that is applying for an adult family home license; or
(c) An individual who is applying for an enhanced services facility license.
(3) "Capable caregiving training" is the name of the DSHS developed training curricula in dementia and mental health that will be available in three class levels. The level one series of the class in both dementia and mental health meets the requirements provided in RCW 18.20.270 and 70.128.230 for specialty training. The level two and level three capable caregiving classes, when developed, in both topics may be completed for continuing education credits.
(4) "Care team" includes the resident and everyone involved in his or her care. The care team may include family, friends, doctors, nurses, long-term care workers, social workers, and case managers. The role of the care team is to support the resident's well-being. However, the resident directs the service plan when able.
(5) "Challenge test" means a competency test taken for specialty training without first taking the class for which the test is designed.
(6) "Competency" defines the integrated knowledge, skills, or behavior expected of a long-term care worker after completing the training in a required topic area. Learning objectives are associated with each competency.
(7) "Competency testing" including challenge testing, evaluates a student to determine if they can demonstrate the required level of skill, knowledge, and behavior with respect to the identified learning objectives of a particular course.
(8) "Core basic training" is the portion of the seventy-hour long-term care worker basic training that covers the core competencies and skills that long-term care workers need in order to provide personal care services efficiently and safely. The core basic training hours also includes hours devoted to student practice and demonstration of skills.
(9) "Date of hire" for determining timeframes related to training and certification, means the day an individual was first hired as a long-term care worker as determined by the department according to WAC 388-112A-0115.
(10) "DDA" means the developmental disabilities administration.
(11) "Designee" means a person in an assisted living facility or enhanced services facility who supervises long-term care workers and is designated by an assisted living facility administrator or enhanced services facility administrator to take the trainings in this chapter required of the facility administrator. An assisted living facility or enhanced services facility administrator may have more than one designee.
(12) "Direct care worker" means a paid individual who provides direct, personal care services to persons with disabilities or the elderly requiring long-term care (see also the definition of long-term care worker, which includes direct care workers).
(13) "Direct supervision" means oversight by a person who has demonstrated competency in basic training and if required, specialty training, or has been exempted from the basic training requirements, and is on the premises and quickly available to the caregiver.
(14) "DSHS" or "department" refers to the department of social and health services.
(15) "Enhancement" means additional time provided for skills practice and additional training materials or classroom activities that help a long-term care worker to thoroughly learn the course content and skills. Enhancements may include new student materials, videos or DVDs, online materials, and additional student activities.
(16) "Entity representative" means the individual designated by an adult family home provider who is or will be responsible for the daily operations of an adult family home.
(17) "Guardian" means an individual as defined in chapter 11.88 RCW.
(18) "Home" refers to adult family homes, enhanced services facilities, and assisted living facilities.
(19) "Home care aide certified" or "home care aide" means a person who obtained and maintains a home care aide certification through the department of health.
(20) "Indirect supervision" means oversight by a person who has demonstrated competency in basic training and if required, specialty training, or was exempted from basic training requirements, and who is quickly and easily available to the long-term care worker, but not necessarily on-site.
(21) "Learning objectives" are measurable, written statements that clearly describe what a long-term care worker must minimally learn to meet each competency. Learning objectives are identified for each competency. Learning objectives provide consistent, common language and a framework for curriculum designers, the curriculum approval process, and testing.
(22) "Long-term care worker" includes:
(a) All persons who provide paid, personal care services for the elderly or persons with disabilities, including but not limited to individual providers of home care services, direct care workers employed by home care agencies, providers of home care services to persons with developmental disabilities under Title 71A RCW, all direct care workers in state-licensed assisted living facilities, adult family homes, respite care providers, community residential service providers, and any other direct care staff who provide home or community-based services to the elderly or persons with functional disabilities or developmental disabilities.
(b) Long-term care workers do not include:
(i) Persons employed by the following facilities or agencies: Nursing homes subject to chapter 18.51 RCW, hospitals or other acute care settings, residential habilitation centers under chapter 71A.20 RCW, facilities certified under 42 C.F.R., Part 483, hospice agencies subject to chapter 70.127 RCW, adult day care centers, and adult day health care centers; or
(ii) Persons who are not paid by the state, by a private agency, or facility licensed by the state to provide personal care services.
(23) "Personal care services" means physical or verbal assistance with activities of daily living, or activities of daily living and instrumental activities of daily living, which is provided to meet the resident's care needs.
(24) "Provider" means any person or entity licensed by the department to operate an adult family home, enhanced services facility, or assisted living facility, or any person or entity certified by the department to provide instruction and support services to meet the needs of persons receiving services under Title 71A RCW.
(25) "Resident" means a person residing and receiving long-term care services at an assisted living facility, enhanced services facility, or adult family home. As applicable, "resident" also means the resident's legal guardian or other surrogate decision maker.
(26) "Resident manager" means a person employed or designated by the provider to manage the adult family home who meets the requirements in WAC 388-76-10000 and this chapter.
(27) "Routine interaction" means regular contact with residents.
(28) "Seventy-hour long-term care worker basic training" means the seventy-hours of required training that a new long-term care worker must complete within one hundred and twenty days of hire. It has three components: core competencies, practice of skills, and population specific topics, which may include specialty and nurse delegation training.
(29) "Specialty training" refers to curricula that meets the requirements of RCW 18.20.270 and 70.128.230 to provide basic core knowledge and skills that caregivers need to learn and understand to effectively and safely provide care to residents living with mental illness, dementia, or developmental disabilities. The specialty training curricula may be DSHS developed or DSHS approved and must be based on the competencies and learning objectives in WAC 388-112A-0430, 388-112A-0440, or 388-112A-0450.
(30) "Training entity" means an organization, including an independent contractor, who provides or may provide training under this chapter using approved curriculum.
NEW SECTION
WAC 388-112A-0020 What are the purposes of this chapter?
The purposes of this chapter are to describe the following:
(1) Training and certification requirements that apply to adult family homes and assisted living facilities on or before January 6, 2012;
(2) Training and certification requirements that apply to adult family homes and assisted living facilities on or after January 7, 2012;
(3) Training and certification requirements that apply to enhanced services facilities on or after January 1, 2016; and
(4) Curricula and instructor requirements.
NEW SECTION
WAC 388-112A-0030 Who do the training requirements apply to?
The training requirements in this chapter apply to:
(1) Adult family home providers, applicants, resident managers, entity representatives, long-term care workers, and volunteers;
(2) Assisted living facility administrators or administrator designees, long-term care workers, and volunteers; and
(3) Enhanced services facility applicants, administrators or administrator designees, long-term care workers, and volunteers.
NEW SECTION
WAC 388-112A-0040 When did the seventy-hour long-term care worker basic training requirements go into effect?
(1) The seventy-hour long-term care worker basic training requirements in this chapter for long-term care workers in adult family homes and assisted living facilities and their administrators or administrator designees went into effect January 7, 2012.
(2) The long-term care worker basic training requirements in effect by their employer at the time on or before January 6, 2012 apply to individuals who:
(a) Were hired on or before January 6, 2012; and
(b) Completed basic training within the required time frames.
(3) The seventy-hour long-term care worker basic training requirements for long-term care workers, administrators or administrator designees, and applicants in enhanced services facilities went into effect on January 1, 2016.
NEW SECTION
WAC 388-112A-0050 What are the training and certification requirements for volunteers and long-term care workers in adult family homes, adult family home providers, and adult family home applicants?
(1) The following chart provides a summary of the training and certification requirements for volunteers and long-term care workers in adult family homes and adult family home providers:
(2) The following chart provides a summary of the training and certification requirements for adult family home applicants prior to licensure and adult family home resident managers prior to assuming the duties of the position:
(3) The remainder of this chapter describes the training and certification requirements in more detail.
(4) The following training requirements are not listed in the charts in subsection (1) and (2) of this section but are required under this chapter:
(a) First aid and CPR under WAC 388-112A-0720;
(b) Nurse delegation under WAC 388-112A-0500 and 388-112A-0560; and
(c) Adult family home (AFH) administrator training under WAC 388-112A-0810.
NEW SECTION
WAC 388-112A-0060 What are the training and certification requirements for volunteers and long-term care workers in assisted living facilities and assisted living facility administrators?
(1) The following chart provides a summary of the training and certification requirements for volunteers and long-term care workers in assisted living facilities and assisted living administrators or administrator designees:
(2) The remainder of this chapter describes the training and certification requirements in more detail.
(3) The following training requirements are not listed in the charts in subsections (1) of this section but are required under this chapter:
(a) First aid and CPR under WAC 388-112A-0720;
(b) Nurse delegation under WAC 388-112A-0500 and 388-112A-0560;
(c) Assisted living facility (ALF) administrator training under WAC 388-78A-2521.
NEW SECTION
WAC 388-112A-0070 What are the training and certification requirements for applicants, administrators or their designees, volunteers, and long-term care workers in enhanced services facilities?
(1) The following chart provides a summary of the training and certification requirements for applicants, administrators or their designees, volunteers, and long-term care workers in enhanced services facilities:
(2) The remainder of this chapter and chapter 388-107 WAC describes the training and certification requirements in more detail.
(3) The following training requirements are not listed in the chart in subsection (1) of this section but are required under this chapter:
(a) First aid and CPR under WAC 388-112A-0720; and
(b) Enhanced services facility (ESF) administrator training under WAC 388-112A-0800.
NEW SECTION
WAC 388-112A-0080 Who is required to complete the seventy-hour long-term care worker basic training and by when?
The following individuals must complete the seventy-hour long-term care worker basic training unless exempt as described in WAC 388-112A-0090:
Adult family homes.
(1) Adult family home applicants must complete the seventy-hour long-term care worker basic training and become certified before the adult family home is licensed.
(2) Adult family home entity representatives and resident managers before they assume the duties of their position in the adult family home.
(3) Long-term care workers in adult family homes within one hundred twenty days of date of hire. Long-term care workers must not provide personal care without direct supervision until they have completed the seventy-hour long-term care worker basic training.
Assisted living facilities.
(4) Assisted living facility administrators or their designees within one hundred twenty days of date of hire.
(5) Long-term care workers in assisted living facilities within one hundred twenty days of their date of hire. Long-term care workers must not provide personal care without direct supervision until they have completed the seventy-hour long-term care worker basic training.
Enhanced services facilities.
(6) Enhanced services facility applicants must complete the seventy-hour long-term care worker basic training and become certified before the enhanced services facility is licensed.
(7) Enhanced services facility administrators or their designees must complete the seventy-hour long-term care worker basic training within one hundred twenty days of date of hire.
(8) Long-term care workers in enhanced services facilities must complete the seventy-hour long-term care worker basic training within one hundred twenty days of their date of hire. Long-term care workers must not provide personal care without direct supervision until they have completed the seventy-hour long-term care worker basic training.
(9) For certification requirements for individuals in subsections (2) through (8) in this section refer to WAC 388-112A-0105.
NEW SECTION
WAC 388-112A-0090 Which long-term care workers are exempt from the seventy-hour long-term care worker basic training requirement?
The following long-term care workers are exempt from the seventy-hour long-term care worker basic training requirement:
(1) An applicant for an adult family home license on or before January 6, 2012 who met the basic training requirements in effect at the time of application;
(2) A person employed as a long-term care worker on January 6, 2012 who completed the basic training requirements in effect on the date of his or her hire;
(3) A person employed as a long-term care worker on January 6, 2012 who completed within one hundred twenty days of hire the basic training requirements in effect on the date of his or her hire;
(4) A person previously employed as a long-term care worker who completed the basic training requirements in effect on the date of his or her hire and was employed as a long-term care worker at some point between January 1, 2011 and January 6, 2012;
(5) Washington state department of health registered nurses, licensed practical nurses, and advanced registered nurse practitioners licensed under chapter 18.79 RCW;
(6) Washington state department of health nursing assistants certified under chapter 18.88A RCW and persons in an approved training program for certified nursing assistants under chapter 18.88A RCW provided that they complete the training program within one hundred twenty days of the date of hire and the department of health has issued them their nursing assistant certified credential within two hundred days of the date of hire;
(7) A home health aide who was employed by a medicare certified home health agency within the year before the home health aide was hired as a long-term care worker and has met the requirements of 42 C.F.R. Sec. 484.36; and
(8) An individual with special education training with an endorsement granted by the Washington state superintendent of public instruction as described in RCW 28A.300.010.
NEW SECTION
WAC 388-112A-0095 What actions may the department take if a provider does not comply with the requirements of this chapter?
(1) If a provider knowingly employs an individual who has not satisfied the seventy-hour long-term care worker basic training or certification requirements under this chapter, the department must take one or more of the following enforcement actions under:
(a) RCW 18.20.190(2), for assisted living facility providers;
(b) RCW 70.128.160(2), for adult family home providers;
(c) RCW 70.97.110, for enhanced services facilities.
(2) Except as required under subsection (1) of this section, if a provider fails to comply with any requirements under this chapter, the department may take one or more of the following enforcement actions under:
(a) RCW 18.20.190(2), for assisted living facility providers;
(b) RCW 70.128.160(2), for adult family home providers;
(c) RCW 70.97.110, for enhanced services facilities.
NEW SECTION
WAC 388-112A-0100 Is the department authorized by RCW 74.39A.086 to take enforcement action for noncompliance related to the seventy-hour long-term care worker basic training and home care aide certification requirements?
The department is authorized under RCW 74.39A.086 to take enforcement action for noncompliance related to training and certification requirements.
NEW SECTION
WAC 388-112A-0105 Who is required to obtain home care aide certification and by when?
Unless exempt under WAC 246-980-070, the following individuals must be certified by the department of health as a home care aide within the required timeframes:
(1) All long-term care workers, within two hundred days of the date of hire;
(2) If a long-term care worker is limited English proficient and the department of health has issued a provisional certification, within two hundred sixty days of the date of hire;
(3) Adult family home applicants, before licensure;
(4) Adult family home entity representatives and resident managers, before assuming the duties of the position;
(5) Assisted living facility administrators or their designees within two hundred calendar days of the date of hire.
(6) Enhanced services facility applicants, before licensure; and
(7) Enhanced services facility administrators or their designees within two hundred days of the date of hire.
NEW SECTION
WAC 388-112A-0110 May a home employ a long-term care worker who has not completed the seventy-hour long-term care worker basic training or certification requirements?
(1) If an individual previously worked as a long-term care worker, but did not complete the training or certification requirements under RCW 18.88B.041, 74.39A.074, 74.39A.076, and this chapter, an adult family home, enhanced services facility, or assisted living facility must not employ the individual to work as a long-term care worker until the individual has completed the required training or certification unless the date of hire has been reset as described under subsection (2) of this section.
(2) The original date of hire may be reset once for each home care aide applicant after a minimum of one year has passed since the initial date of hire.
(3) Individuals who meet the criteria in subsection (2) of this section are allowed a new one hundred twenty days to complete the orientation, safety, and seventy-hour long-term care worker basic trainings and a new two hundred days to become certified as a home care aide, if required by WAC 246-980-020.
(4) Individuals who meet the criteria in subsection (2) of this section must submit a new application and fee to the department of health.
NEW SECTION
WAC 388-112A-0115 How do we determine a long-term care worker's date of hire?
(1) The department determines a long-term care worker's date of hire under RCW 18.88B.021(1) by one of the following, whichever occurs first:
(a) The initial service begin date when hired as an individual provider;
(b) The date of hire when the individual was paid to provide personal care by a home care agency; or
(c) The date of hire when the individual was paid to provide personal care by a home licensed by the state.
(2) The date of hire is specific to each long-term care worker. It does not change when a long-term care worker changes clients or employers unless the long-term care worker meets the criteria in WAC 388-112A-0110.
(3) This section does not apply to background check requirements under this chapter.
NEW SECTION
WAC 388-112A-0120 What documentation is required for a long-term care worker to apply for the home care aide certification or recertification?
(1) Successful completion of seventy-hour long-term care worker basic training, the two hours of orientation, and the three hours of safety training (referred to collectively as the seventy-five hours of training) must be documented on a DSHS seventy-five hour training certificate by an approved training entity verifying that a total of seventy-five hours of approved training have occurred.
(2) An approved training entity issuing and signing a DSHS seventy-five hour training certificate must verify that the long-term care worker has the certificates required documenting two hours of DSHS-approved orientation, three hours of DSHS-approved safety training, and the seventy-hour long-term care worker basic training, as described in this chapter. When applying to the department of health for home care aide certification, the long-term care worker may only submit a seventy-five hour training certificate that has been issued by the department or the training partnership.
(3) For home care aide recertification, successful completion of twelve hours of DSHS approved continuing education training must be documented on a certificate(s) or transcript(s) issued by a department approved training entity.
(4) The long-term care worker, certified home care aide, and employer must retain any twelve hour training certificates or transcripts for as long as the long-term care worker is employed.
SECTION II—ORIENTATION AND SAFETY TRAINING
NEW SECTION
WAC 388-112A-0200 What is orientation training, who should complete it, and when should it be completed?
There are two types of orientation training: Facility orientation training and long-term care worker orientation training.
(1) Facility orientation. Individuals who are exempt from certification as described in RCW 18.88B.041 and volunteers are required to complete facility orientation training before having routine interaction with residents. This training provides basic introductory information appropriate to the residential care setting and population served. The department does not approve this specific orientation program, materials, or trainers. No test is required for this orientation.
(2) Long-term care worker orientation. Individuals required to complete the seventy-hour long-term care worker basic training must complete long-term care worker orientation, which is two hours of training regarding the long-term care worker's role and applicable terms of employment as described in WAC 388-112A-0210.
(a) All long-term care workers who are not exempt from certification as described in RCW 18.88B.041 hired on or after January 7, 2012, must complete two hours of long-term care worker orientation training before providing care to residents.
(b) Long-term care worker orientation training must be provided by qualified instructors that meet the requirements in WAC 388-112A-1260.
(c) The department must approve long-term care worker orientation curricula and instructors.
(d) There is no test for long-term care worker orientation.
NEW SECTION
WAC 388-112A-0210 What content must be included in facility and long-term care worker orientation?
(1) For those individuals identified in WAC 388-112A-0200(1) who must compete facility orientation training:
(a) Orientation training may include the use of videotapes, audiotapes, and other media if the person overseeing the orientation is available to answer questions or concerns for the person(s) receiving the orientation. Facility orientation must include introductory information in the following areas:
(i) The care setting;
(ii) The characteristics and special needs of the population served;
(iii) Fire and life safety, including:
(A) Emergency communication (including phone system if one exists);
(B) Evacuation planning (including fire alarms and fire extinguishers where they exist);
(C) Ways to handle resident injuries and falls or other accidents;
(D) Potential risks to residents or staff (for instance, aggressive resident behaviors and how to handle them); and
(E) The location of home policies and procedures;
(iv) Communication skills and information, including:
(A) Methods for supporting effective communication among the resident/guardian, staff, and family members;
(B) Use of verbal and nonverbal communication;
(C) Review of written communications and documentation required for the job, including the resident's service plan;
(D) Expectations about communication with other home staff; and
(E) Who to contact about problems and concerns;
(v) Universal precautions and infection control, including:
(A) Proper hand washing techniques;
(B) Protection from exposure to blood and other body fluids;
(C) Appropriate disposal of contaminated/hazardous articles;
(D) Reporting exposure to contaminated articles, blood, or other body fluids; and
(E) What staff should do if they are ill;
(vi) Resident rights, including:
(A) The resident's right to confidentiality of information about the resident;
(B) The resident's right to participate in making decisions about the resident's care and to refuse care;
(C) Staff's duty to protect and promote the rights of each resident and assist the resident to exercise his or her rights;
(D) How staff should report concerns they may have about a resident's decision on his or her care and who they should report these concerns to;
(E) Staff's duty to report any suspected abuse, abandonment, neglect, or exploitation of a resident;
(F) Advocates that are available to help residents (such as long-term care ombudsmen and organizations); and
(G) Complaint lines, hot lines, and resident grievance procedures such as, but not limited to:
(i) The DSHS complaint hotline at 1-800-562-6078;
(ii) The Washington state long-term care ombudsman program;
(iii) The Washington state department of health and local public health departments;
(iv) The local police;
(v) Facility grievance procedure; and
(b) In adult family homes, safe food handling information must be provided to all staff, prior to handling food for residents.
(2) For long-term care worker orientation required of those individuals identified in WAC 388-112A-0200(2), long-term care worker orientation is a two hour training that must include introductory information in the following areas:
(a) The care setting and the characteristics and special needs of the population served;
(b) Basic job responsibilities and performance expectations;
(c) The care plan or negotiated service agreement, including what it is and how to use it;
(d) The care team;
(e) Process, policies, and procedures for observation, documentation, and reporting;
(f) Resident rights protected by law, including the right to confidentiality and the right to participate in care decisions or to refuse care and how the long-term care worker will protect and promote these rights;
(g) Mandatory reporter law and worker responsibilities as required under chapter 74.34 RCW; and
(h) Communication methods and techniques that may be used while working with a resident or guardian and other care team members.
(3) One hour of completed classroom instruction or other form of training (such as a video or online course) in long-term care orientation training equals one hour of training. The training entity must establish a way for the long-term care worker to ask the instructor questions.
Reviser's note: The typographical errors in the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040. NEW SECTION
WAC 388-112A-0220 What is safety training, who must complete it, and when should it be completed?
(1) Safety training is part of the long-term care worker requirements. It is a three hour training that must meet the requirements of WAC 388-112A-0230 and include basic safety precautions, emergency procedures, and infection control.
(2) The following individuals must complete safety training:
(a) All long-term care workers who are not exempt from certification as described in RCW 18.88B.041 hired after January 7, 2012, must complete three hours of safety training. This safety training must be provided by qualified instructors that meet the requirements in WAC 388-112A-1260.
(3) The department must approve safety training curricula and instructors.
(4) There is no test for safety training.
NEW SECTION
WAC 388-112A-0230 What content must be included in safety training?
(1) Safety training must consist of introductory information in the following areas:
(a) Safety planning and accident prevention, including but not limited to:
(i) Proper body mechanics;
(ii) Fall prevention;
(iii) Fire safety;
(iv) In-home hazards;
(v) Long-term care worker safety; and
(vi) Emergency and disaster preparedness.
(b) Standard precautions and infection control, including but not limited to:
(i) Proper hand washing;
(ii) When to wear gloves and how to correctly put them on and take them off;
(iii) Basic methods to stop the spread of infection;
(iv) Protection from exposure to blood and other body fluids;
(v) Appropriate disposal of contaminated and hazardous articles;
(vi) Reporting exposure to contaminated articles; and
(vii) What to do when the worker or the resident is sick or injured, including who to report this to.
(c) Basic emergency procedures, including but not limited to:
(i) Evacuation preparedness;
(ii) When and where to call for help in an emergency;
(iii) What to do when a resident is falling or falls;
(iv) Location of any advance directives if available; and
(v) Basic fire emergency procedures.
(2) One hour of completed classroom instruction or other form of training (such as video or online course) equals one hour of training. The training entity must establish a way for the long-term care worker to ask the instructor questions.
(3) In adult family homes, safe food handling information must be provided to all staff, prior to handling food for residents.
NEW SECTION
WAC 388-112A-0240 What documentation is required for facility orientation training?
(1) The adult family home, enhanced services facility, and assisted living facility must maintain documentation that facility orientation training has been completed as required by this chapter. The training and documentation must be issued by the home or service provider familiar with the facility and must include:
(a) The name of the student;
(b) The title of the training;
(c) The number of hours of the training;
(d) The signature of the instructor providing facility orientation training;
(e) The student's date of hire; and
(f) The date(s) of facility orientation.
(2) The documentation required under this section must be kept in a manner consistent with chapter 388-76 WAC for adult family homes, chapter 388-107 WAC for enhanced services facilities, and chapter 388-78A WAC for assisted living facilities.
SECTION III—BASIC TRAINING
NEW SECTION
WAC 388-112A-0300 What is the seventy-hour long-term care worker basic training?
(1) The seventy-hour long-term care worker basic training is in addition to orientation and safety training. It is seventy-hours and includes:
(a) The core competencies and skills that long-term care workers need in order to provide personal care services effectively and safely;
(b) Practice and demonstration of skills; and
(c) Population specific competencies.
(2) DSHS must approve the seventy-hour long-term care worker basic training curricula.
(3) On-the-job training may be applied to the seventy-hour long-term care worker basic training for an amount that must be approved by the department;
(4) The DSHS developed revised fundamentals of caregiving (RFOC) or another department approved training may be used to teach the seventy-hour long-term care worker basic training but it must include enhancements. Additional student materials are required to ensure the enhancements are well planned and documented for students. Materials must be submitted for approval and approved per WAC 388-112A-1020. Examples of enhancements include, but are not limited to:
(a) More time for workers to practice skills including:
(i) The mechanics of completing the skill correctly;
(ii) Resident centered communication and problem solving associated with performing the skill;
(iii) The different levels of care required for each skill including independent, supervision, limited, extensive, and total;
(iv) Working with assistive devices associated with a skill;
(v) Helpful tips or best practices in working through common resident challenges associated with a skill; and
(vi) Disease specific concerns or challenges associated with a skill.
(b) Augmenting or adding additional materials, student activities, videos, or guest speakers that:
(i) More deeply reinforce and fortify the learning outcomes required for basic training;
(ii) Ensure each student integrates and retains the knowledge and skills needed to provide quality basic personal care; and
(iii) Prepares workers for the certification testing environment and process.
(c) Enhancements are not materials or activities that are one or more of the following:
(i) Are out of the scope of practice for a long-term care worker such as content clearly written for registered nurses;
(ii) Are identical to, or a direct replacement of, those already included in the RFOC;
(iii) Fail to reinforce Washington state laws associated with resident rights and resident directed care;
(iv) Long-term care workers are not paid to provide;
(v) Are written above a high school reading level.
(5) The delivery mode of the seventy-hour long-term care worker basic training may be either in-person instruction or a hybrid of online and in-person modules. One hour of completed classroom instruction or other form of training (such as a video or online course) equals one hour of training.
(a) Online modules must be an instructor led class, such as a webinar or an interactive online class that provides the student with access to the instructor and adheres to the DSHS online class standards posted on DSHS's website.
(b) The in-person portion of hybrid modules must be no less than twelve hours of the total basic training hours and include in-person instruction on the personal care assistance tasks supporting activities of daily living, commonly referred to as skills training.
(6) The long-term care worker must be able to ask the instructor questions during the training.
(7) There is no challenge test for the seventy-hour long-term care worker basic training.
NEW SECTION
WAC 388-112A-0310 What topics must be taught in the core competencies of the seventy-hour long-term care worker basic training for long-term care workers?
The core competencies of the seventy-hour long-term care worker basic training for long-term care workers must include all of the competencies described in WAC 388-112A-0320 and the following topics:
(1) Communication skills;
(2) Long-term care worker self-care;
(3) Problem solving;
(4) Resident rights and maintaining dignity;
(5) Abuse, abandonment, neglect, financial exploitation, and mandatory reporting;
(6) Resident directed care;
(7) Cultural sensitivity;
(8) Body mechanics;
(9) Fall prevention;
(10) Skin and body care;
(11) Long-term care worker roles and boundaries;
(12) Supporting activities of daily living;
(13) Food preparation and handling;
(14) Medication assistance;
(15) Infection control, blood-borne pathogens, HIV/AIDS; and
(16) Grief and loss.
NEW SECTION
WAC 388-112A-0320 What are the core competencies and learning objectives for the seventy-hour long-term care worker basic training?
The seventy-hour long-term care worker basic training includes core competencies that describe the behavior and skills that a long-term care worker must exhibit when working with residents and the learning objectives associated with each competency as follows:
(1) Regarding communication, communicate effectively and in a respectful and appropriate manner with residents, family members, and care team members:
(a) Recognize how verbal and nonverbal cues impact communication with the resident and care team;
(b) Engage and respect the resident through verbal and nonverbal communication;
(c) Listen attentively and determine that the resident, when able, understands what has been communicated;
(d) Recognize and acknowledge resident's communication including indicators of pain, confusion, or misunderstanding;
(e) Utilize communication strategies to deal with difficult situations; and
(f) Recognize common barriers to effective communication and identify how to eliminate them.
(2) Regarding long-term care worker self-care:
(a) Identify behaviors, practices, and resources to reduce stress and avoid burnout;
(b) Recognize common barriers to self-care and ways to overcome them; and
(c) Recognize aspects of a long-term care worker's job that can lead to stress and burnout, common signs and symptoms of stress and burnout, and the importance of taking action to practice self-care to avoid burnout.
(3) Regarding the competency of effective problem solving, use effective problem solving skills:
(a) Explain why it is necessary to understand and utilize a problem solving method;
(b) Implement a problem solving process/method; and
(c) Identify obstacles to effective problem solving and ways to overcome them.
(4) Regarding the competency of resident rights and dignity, take appropriate action to promote and protect a resident's legal and human rights as protected by federal and Washington state laws, including:
(a) Protect a resident's confidentiality including what is considered confidential information, who a long-term care worker is allowed or not allowed to give confidential information to, and how to respond if a noncare team member asks for confidential information;
(b) Promote a resident's dignity and privacy and encourage and support a resident's maximum independence when providing care;
(c) Maintain a restraint-free environment, including physical, chemical, and environmental restraints and use common, safe alternatives to restraint use; and
(d) Protect and promote the resident's right to live free of abuse, neglect, abandonment, and financial exploitation.
(5) Regarding the competency of recognizing indicators of abuse and understanding the mandatory reporting requirements, recognize the signs of abuse and report suspected abuse, abandonment, neglect, and financial exploitation:
(a) Describe long-term care workers' responsibilities as a mandatory reporter as described in RCW 74.34.020 through 74.34.053; and
(b) Identify common indications of abuse, abandonment, neglect, and financial exploitation.
(6) Regarding the competency of resident directed care, take appropriate action when following a resident's direction regarding his or her care:
(a) Describe a worker's role in resident directed care including determining, understanding, and supporting a resident's choices;
(b) Describe the importance and impact of resident directed care on a resident's independence, self-determination, and quality of life;
(c) Identify effective problem solving strategies that help balance a resident's choice with personal safety; and
(d) Report concerns when a resident refuses care or makes choices that present a possible safety concern.
(7) Regarding the competency of cultural sensitivity, provide culturally appropriate care:
(a) Describe how cultural background, lifestyle practices, and traditions can impact care; and
(b) Use methods to determine and ensure that these are respected and considered when providing care.
(8) Regarding the competency of body mechanics, utilize current best practices and evidence-based methods of proper body mechanics while performing tasks as outlined in the service plan.
(9) Regarding the competency of fall prevention:
(a) Identify fall risk factors and take action to reduce fall risks for a resident; and
(b) Take proper steps to assist a resident who is falling or has fallen.
(10) Regarding the competency of skin and body care, use of personal care practices that promote and maintain skin integrity:
(a) Explain the importance of observing a resident's skin, when to observe it and what to look for, including common signs and symptoms of skin breakdown;
(b) Identify risk factors of skin breakdown;
(c) Observe skin at pressure point locations and report any concerns;
(d) Describe what a pressure ulcer is, what it looks like, and what action to take if a resident appears to be developing or develops a pressure ulcer;
(e) Describe current best practices that protect and maintain a resident's skin integrity including position changes when sitting or lying for extended periods, and proper positioning and transfer techniques;
(f) Implement current best practices that promote healthy skin including hygiene, nutrition, hydration, and mobility; and
(g) Identify when to report skin changes and who to report them to.
(11) Regarding the competency on long-term care worker roles and boundaries, adhere to basic job standards, expectations, and requirements and maintain professional boundaries:
(a) Identify when, how, and why to obtain information from appropriate sources about a resident's condition or disease for which they are receiving services and describe how to use this information to provide appropriate, individualized care;
(b) Describe a resident's baseline functioning level using information provided in the service plan and explain why it is important to know a resident's baseline;
(c) Identify changes in a resident's physical, mental, and emotional state through observation;
(d) Report changes from baseline and concerns to the appropriate care team member(s);
(e) Identify basic job standards and requirements (such as coming to work on time) and describe how maintaining these standards are critical to a resident's safety and well-being;
(f) Explain the purpose of a service plan and describe how it is created, used, and modified;
(g) Use a resident's service plan to direct a worker's job tasks and any resident directed care tasks;
(h) Identify what is required of a long-term care worker, as described in WAC 388-112A-0550, prior to performing a nurse-delegated task;
(i) Describe the role of a care team and a long-term care worker's role in the care team;
(j) Describe professional boundaries and the importance of maintaining them; and
(k) Identify signs of unhealthy professional boundaries, barriers to keeping clear professional boundaries, and ways to avoid or eliminate them.
(12) Regarding the competency on supporting activities of daily living, perform required personal care tasks to the level of assistance needed and according to current best practices and evidence-based guidelines:
(a) Demonstrate, in the presence of a qualified instructor, all critical steps required for personal care tasks including but not limited to:
(i) Helping a resident walk;
(ii) Transferring a resident from a bed to a wheelchair;
(iii) Turning and repositioning a resident in bed;
(iv) Providing oral care;
(v) Cleaning and storing dentures;
(vi) Shaving a face;
(vii) Providing fingernail care;
(viii) Providing foot care;
(ix) Providing a bed bath;
(x) Assisting a resident with a weak arm to dress;
(xi) Putting knee-high elastic stockings on a resident;
(xii) Providing passive range of motion for one shoulder;
(xiii) Providing passive range of motion for one knee and ankle;
(xiv) Assisting a resident to eat;
(xv) Assisting with peri-care;
(xvi) Assisting with the use of a bedpan;
(xvii) Assisting with catheter care;
(xviii) Assisting with condom catheter care; and
(xix) Providing medication assistance;
(b) In the process of performing the personal care tasks, use proper body mechanics, listen attentively, speak clearly and respectfully while explaining what the long-term care worker is doing, incorporate resident preferences, maintain privacy and dignity, support the resident's level of ability, and assure his or her comfort and safety;
(c) Appropriately utilize assistive device(s) specified on the service plan;
(d) Describe any safety concerns related to each task and how to address the concerns;
(e) Demonstrate an understanding of bowel and bladder functioning, including factors that promote healthy bowel and bladder functioning, and the signs, symptoms, and common causes of abnormal bowel and bladder function; and
(f) Identify the importance of knowing a resident's bowel and bladder functioning baseline and when to report changes.
(13) Regarding the core competency on food preparation and handling, plan and prepare meals using a basic knowledge of nutrition and hydration, incorporating any diet restrictions or modifications, and prevent food borne illness by preparing and handling food in a safe manner:
(a) Describe how nutrition and hydration can impact a resident's health;
(b) Plan, shop, and prepare meals for a resident according to the guidelines of good nutrition and hydration, incorporating any dietary requirements and restrictions per the service plan and resident preferences;
(c) Describe common signs of poor nutrition and hydration, when to report concerns, and who to report concerns to;
(d) Understand that diet modification is required for certain health conditions, including dysphagia, and describe how to identify diet modifications required for a resident;
(e) Recognize when a resident's food choices vary from specifications on the care plan and describe when to report concerns and who to report them to;
(f) Describe what causes food borne illness, the risks associated with food borne illness, and examples of potentially hazardous foods;
(g) Describe appropriate food handling practices, including:
(i) Avoiding cross contamination from one food to another;
(ii) Safe storage requirements for cooling of leftover foods, including:
(A) Depth;
(B) Types of containers and temperatures;
(C) The need to maintain food at proper temperatures to limit bacterial growth; and
(D) What are the safe food storage and holding temperatures for both cold and hot foods;
(iii) Best practices for thawing and reheating food; and
(iv) Using clean gloves (if possible) and clean utensils when preparing food;
(h) Describe the importance and correct procedure for cleaning and disinfecting food contact surfaces; and
(i) Describe why a long-term care worker with certain types of illnesses and symptoms must not prepare food.
(14) Regarding the competency of medication assistance, appropriately assist with medications:
(a) Identify what a long-term care worker is allowed and not allowed to do when assisting with medications as described in chapter 246-888 WAC;
(b) Define terms related to medication assistance including prescription drugs, over the counter medications, and as needed (PRN) medications, medication side effects, and drug interactions;
(c) Identify common symptoms of medication side effects, when to report concerns, and who to report them to;
(d) Store medications according to safe practices and the label instructions;
(e) Describe, in the proper sequence, each of the five rights of medication assistance; and
(f) Identify what to do for medication-related concerns, including describing ways to work with a resident who refuses to take medications, identifying when to report when a resident refuses medication or there are other medication-related concerns and who to report these concerns to, and identifying what is considered a medication error, when to report a medication error, and who to report it to.
(15) Regarding the competency of infection control and blood borne pathogens including HIV/AIDS, implement best practices to prevent and control the spread of infections:
(a) Identify commonly occurring infections, ways that infections are spread, and symptoms of infections;
(b) Describe the purpose, benefit, and proper implementation of standard precautions in infection control;
(c) Implement current best practices for controlling the spread of infection, including the use of hand washing and gloves;
(d) Demonstrate proper hand washing and putting on and taking off gloves;
(e) Identify immunizations that are recommended for adults to reduce the spread of virus and bacteria;
(f) Describe laundry and housekeeping measures that help in controlling the spread of infection;
(g) Describe proper use of cleaning agents that destroy microorganisms on surfaces;
(h) Describe what blood-borne (BB) pathogens are and how they are transmitted;
(i) Identify the major BB pathogens, diseases, and high-risk behaviors for BB diseases;
(j) Identify measures to take to prevent BB diseases;
(k) Describe what to do if exposed to BB pathogens and how to report an exposure;
(l) Describe how HIV works in the body;
(m) Explain that testing and counseling for HIV/AIDS is available;
(n) Describe the common symptoms of HIV/AIDS;
(o) Explain the legal and ethical issues related to HIV including required reporting, confidentiality, and nondiscrimination; and
(p) Explain the importance of emotional issues and support for residents and long-term care workers.
(16) Regarding the competency on grief and loss, support yourself and the resident in the grieving process:
(a) Define grief and loss;
(b) Describe common losses a resident and long-term care worker may experience;
(c) Identify common symptoms associated with grief and loss;
(d) Describe why self-care is important during the grieving process; and
(e) Identify beneficial ways and resources to work through feelings of grief and loss.
(17) Long-term care workers who complete a DSHS approved basic training meet the training requirements for adult family homes in RCW 70.128.250.
(18) Long-term care workers who complete a DSHS approved basic training meet the four hours of AIDS education as required by the department of health in WAC 246-980-040.
(19) Regarding the competency on identifying indicators of hearing loss, which may be part of the basic training or population specific hours:
(a) Identify common symptoms associated with hearing loss; and
(b) Identify what to do for hearing loss related concerns, including describing ways to communicate with a resident who is experiencing hearing loss and identifying when and to whom to report when a resident's hearing ability changes.
NEW SECTION
WAC 388-112A-0330 What is on-the-job training?
(1) Effective July 1, 2012, on-the-job training is a method of training where the long-term care worker successfully demonstrates in the seventy-hour long-term care worker basic training, the core competencies in personal care and infection control skills while working with a resident on the job, instead of in a practice training setting.
(2) A qualified instructor as defined in WAC 388-112A-1240 provides on-the-job training and directly observes, coaches, and rein-forces skills training for up to two long-term care workers at a time. The qualified instructor who provides the on-the-job training:
(a) Need not be the same instructor who taught the core competency training; and
(b) May be the immediate supervisor of the long-term care worker who receives the on-the-job training.
(3) The person who oversees on-the-job training must:
(a) Submit DSHS required forms and become an approved instructor for the core competency of basic training;
(b) Verify on a department approved skills checklist the long-term care worker's successful completion of the demonstrated skills; and
(c) Not relinquish his or her duties to trainee caregivers when acting as a trainer.
(4) The department must approve the number of on-the-job hours included in the seventy-hour long-term care worker basic training.
NEW SECTION
WAC 388-112A-0340 What is the population specific component of the seventy-hour long-term care worker basic training and what required training may be used as population specific training?
(1) Population specific basic training is training on topics unique to the care needs of the population that the home or provider serves. Topics may include but are not limited to:
(a) Dementia;
(b) Mental health;
(c) Developmental disabilities;
(d) Young adults with physical disabilities; and
(e) Aging and older adults.
(2) Population specific classes, as required under WAC 388-112A-0400, may include but are not limited to:
(a) DSHS developed or approved specialty training, such as:
(i) Dementia specialty training;
(ii) Mental health specialty training; and
(iii) Developmental disabilities specialty training.
(b) DSHS developed or approved curriculum on population specific topics, such as:
(i) Traumatic brain injury, surviving and thriving; and
(ii) Navigating challenging behaviors; and
(c) For long-term care workers in assisted living facilities and adult family homes, nurse delegation core training and nurse delegation specialized diabetes training may be used to meet all or some of the population specific component of the seventy-hour long-term care worker basic training.
NEW SECTION
WAC 388-112A-0350 What documentation is required to show completion of the seventy-hour long-term care worker basic training and five hour orientation and safety training?
(1) Long-term care worker basic training must be documented by a department certificate of successful completion of seventy-five hours of training that is issued by the instructor or training entity and includes:
(a) The name of the student;
(b) The name of the training;
(c) The number of hours of the training;
(d) The name and department number of the home or training entity giving the training;
(e) The name and signature of the instructor who has an identification number (I-code) to be authorized to sign the certificate, who provided one of the following classes:
(i) Core basic training;
(ii) Population specific training; or
(iii) Specialty training;
(f) The name and identification number (I-code) of the instructor for core competencies and the home or training entity giving the training; and
(g) The completion date of training.
(2) The student must be given an original certificate for proof of completion of the training that the student must retain for his or her records. The provider, and if applicable, the training entity must keep a copy of the certificate as described in WAC 388-76-10198 for adult family homes and as described in WAC 388-78A-2450 for assisted living facilities.
NEW SECTION
WAC 388-112A-0370 What are the requirements for using basic training to meet the specialty training requirements?
When basic training is used to meet the specialty training requirements:
(1) The curriculum for specialty training must include the department developed competencies and learning objectives as described in WAC 388-112A-0430, 388-112A-0440, or 388-112A-0450. Homes or providers may enhance the specialty training component by adding additional competencies, learning objectives, content, or activities. If the department approves the enhancements and an increased number of training hours, the worker's training hours will apply to the seventy-hour training requirement.
(2) Long-term care workers must pass the department competency test described in WAC 388-112A-0910 to meet the applicable licensing requirements for adult family homes, enhanced services facilities, and assisted living facilities for all specialty training.
SECTION IV—SPECIALTY TRAINING
NEW SECTION
WAC 388-112A-0400 What is specialty training and who is required to take it?
(1) Specialty training refers to approved curricula that meets the requirements of RCW 18.20.270 and 70.128.230 to provide basic core knowledge and skills to effectively and safely provide care to residents living with mental illness, dementia, or developmental disabilities.
(2) Specialty training classes are different for each population served and are not interchangeable. Specialty training curriculum must be DSHS developed, as described in WAC 388-112A-0010(3), or DSHS approved.
(a) In order for DSHS to approve a curriculum as a specialty training class, the class must use the competencies and learning objectives in WAC 388-112A-0430, 388-112A-0440, or 388-112A-0450.
(i) Training entities that currently use classes approved as alternative curriculum for specialty training must update and submit their curricula for approval prior to June 30, 2018.
(ii) After July 1, 2018, training entities must not use classes approved as alternative curriculum for specialty training that are not using the competencies and learning objectives in WAC 388-112A-0430, 388-112A-0440, or 388-112A-0450 to meet the specialty training requirement.
(b) Curricula approved as specialty training may be integrated with basic training if the complete content of each training is included.
(3) Assisted living facility administrators or their designees, enhanced services facility administrators or their designees, adult family home applicants or providers, resident managers, and entity representatives who are affiliated with homes that service residents who have special needs, including developmental disabilities, dementia, or mental health, must take one or more of the following specialty training curricula:
(a) Developmental disabilities specialty training as described in WAC 388-112A-0420;
(b) Dementia specialty training as described in WAC 388-112A-0440;
(c) Mental health specialty training as described in WAC 388-112A-0450.
(4) All long-term care workers including those exempt from basic training who work in an assisted living facility, enhanced services facility, or adult family home who serve residents with the special needs described in subsection (3) of this section, must take a class approved as specialty training. The specialty training applies to the type of residents served by the home as follows:
(a) Developmental disabilities specialty training as described in WAC 388-112A-0420.
(b) Dementia specialty training as described in WAC 388-112A-0440; and
(c) Mental health specialty training as described in WAC 388-112A-0450.
(5) Specialty training may be used to meet the requirements for the basic training population specific component if completed within one hundred twenty days of the date of hire.
(6) For long-term care workers who have completed the seventy-five hour training and do not have a specialty training certificate that indicates completion and competency testing, the long-term care worker must complete specialty training when employed by the adult family home, enhanced services facility, or assisted living facility that serves residents with special needs.
NEW SECTION
WAC 388-112A-0410 What specialty training is required if a resident has more than one special need?
(1) If a resident has needs in more than one of the special needs areas, the adult family home, enhanced services facility, or assisted living facility must determine which of the specialty training classes will most appropriately address the overall needs of the resident and ensure that the appropriate specialty training class is completed as required.
(2) If additional training beyond the specialty training class is needed to meet all of the resident's needs, the adult family home, enhanced services facility, or assisted living facility must ensure that additional training is completed.
NEW SECTION
WAC 388-112A-0420 What topics must developmental disabilities specialty training include?
(1) Developmental disabilities specialty training must include all of the competencies and learning objectives described in WAC 388-112A-0430 for the following topics:
(a) Overview of developmental disabilities;
(b) Values of service delivery;
(c) Effective communication;
(d) Introduction to interactive planning;
(e) Understanding behavior;
(f) Crisis prevention and intervention; and
(g) Overview of legal issues and resident rights.
(2) For adult family homes, the developmental disabilities administration (DDA) will provide in-home technical assistance to the adult family home upon admission of the first resident eligible for services from DDA and, thereafter, as determined necessary by DSHS.
NEW SECTION
WAC 388-112A-0430 What are the competencies and learning objectives for the long-term care worker developmental disability specialty training?
The following developmental disabilities specialty competencies describe the behavior and skills a long-term care worker must exhibit when working with residents and include learning objectives associated with each competency:
(1) Regarding the competency on an overview of developmental disabilities, draw upon a basic understanding of developmental disabilities and demonstrate awareness of the unique needs of residents with developmental disabilities:
(a) Define developmental disability and describe intellectual disability, cerebral palsy, epilepsy, and autism;
(b) Identify common myths and misconceptions about developmental disabilities;
(c) Describe the negative effects of using labels such as "retarded" or "handicapped" to represent people and positive alternatives; and
(d) Differentiate between developmental disabilities and mental illness.
(2) Regarding the competency on values of service delivery, promote and support a resident's self-determination:
(a) Identify the principle of normalization and its significance to the work of long-term care workers;
(b) Explain how understanding each resident's needs leads to better services and supports, which lead to better outcomes for the resident;
(c) Describe each of the residential services guidelines and identify how the values represented in the guidelines are important in the lives of people with developmental disabilities;
(d) Describe the principle of self-determination; and
(e) Identify positive outcomes for residents with developmental disabilities when they are connected to the community they live in.
(3) Regarding the competency on communication, provide culturally compassionate and individualized care by utilizing a basic understanding of a resident or resident's history, experience, and cultural beliefs:
(a) List the key elements of effective communication;
(b) Describe the impact communication has on the lives of residents with developmental disabilities;
(c) Explain the impact a long-term care worker's behavior can have on eliciting communication;
(d) Explain the impact of a resident's physical environment on his or her ability to communicate;
(e) Describe methods of communication, other than verbal, that long-term care workers might use when supporting residents with developmental disabilities; and
(f) List tips for communication with residents with developmental disabilities.
(4) Regarding the competency on interactive planning, using person-centered and interactive planning when working with residents with developmental disabilities:
(a) Identify the benefits of using a person-centered planning process rather than the traditional planning methods used to develop supports for people with developmental disabilities;
(b) Identify key elements involved in interactive planning;
(c) Identify ways to include people with developmental disabilities and their families in the planning process; and
(d) Identify the required planning document for the setting and list ways to have a positive impact on the plan.
(5) Regarding the competency on challenging behaviors, use a problem solving approach and positive support principles when dealing with challenging behaviors:
(a) Identify the essential components of the concept of positive behavioral supports;
(b) Define the "ABCs" and describe how to use that process to discover the function of behavior;
(c) Explain why it is critical to understand the function of behavior before developing a support plan;
(d) Define reinforcement and identify ways to utilize it as a tool to increase a resident's ability to be successful;
(e) Identify the problems with using punishment to manage behavior;
(f) Identify behavior management techniques that are not allowed under DSHS policies and applicable laws;
(g) Identify factors that can positively and negatively influence the behavior of residents with developmental disabilities; and
(h) List steps to be taken when crisis or danger to people is immediate.
(6) Regarding the competency on crisis prevention, support a resident experiencing a crisis and get assistance when needed:
(a) Identify behaviors in people with developmental disabilities that might constitute "normal stress;"
(b) Define "crisis;"
(c) Differentiate the behaviors a resident who is in crisis exhibits from mental illness;
(d) Identify the principles of crisis prevention and intervention;
(e) Identify what types of situations require outside assistance and at what point it becomes necessary; and
(f) Name several ways to provide support to a resident experiencing a crisis.
(7) Regarding the competency on legal rights, promote and protect the legal and resident rights of residents with developmental disabilities:
(a) Explain how the rights of residents with disabilities compare to those of the general population;
(b) List the rights of residents living in adult family homes and assisted living facilities and the laws that support those rights;
(c) Describe how long-term care workers can help residents to exercise their rights;
(d) List ways a caregiver or long-term care worker must safeguard each resident's confidentiality;
(e) Describe the three types of guardianship a resident with developmental disabilities might be subject to and why;
(f) List less restrictive alternatives to guardianship;
(g) Describe the responsibilities, powers, and limitations of a guardian; and
(h) Describe the relationship between long-term care workers and guardians/families.
NEW SECTION
WAC 388-112A-0440 What must dementia specialty training include?
Curricula developed and approved as dementia specialty training must include all of the knowledge, skills, topics, competencies, and learning objectives described in this section.
(1) Understanding dementia.
(a) Introduction to dementia. The caregiver will review common signs, symptoms, and types of dementia and identify the difference between dementia and conditions that might look like dementia.
(i) What is dementia: symptoms, causes, parts of the brain, types of dementia; and
(ii) What is not dementia: forgetfulness, depression, delirium, urinary tract infection, mild cognitive impairment.
(b) Hallucinations and delusions. The caregiver will identify common hallucinations and delusions a person with dementia may exhibit and identify physical, emotional, and environmental causes of hallucinations and delusions.
(i) What is baseline;
(ii) Hallucinations: visual, auditory, causes; and
(iii) Delusions: what are delusions, other causes.
(c) Setting the tone. The caregiver will distinguish between positive and negative interactions and ways to enhance quality of life for the individual.
(i) The role and characteristics of the caregiver: empathy, dependability, patience, strength, flexibility, creativity;
(ii) Self-care: reducing personal stress, setting goals, communicating effectively, asking for help, exercise, nutrition;
(iii) Learning from emotions;
(iv) Support;
(v) Environmental influences on the tone;
(vi) Enhancing the environment; and
(vii) Schedule planning.
(d) Working with families. The caregiver will recognize common emotions family members experience with a loved one who has dementia, identify some difficulties family members may experience or express about their loved one's care, and provide resources for families.
(i) Understanding the family unit;
(ii) Working with and supporting family members and friends; and
(iii) Building trust.
(2) Living with dementia.
(a) Sexuality and intimacy. The caregiver will identify safe and unsafe expressions of sexuality and steps to take in the best interest of the individual.
(i) Sexuality and intimacy;
(ii) Sexualized behavior;
(iii) Do no harm;
(iv) Attitudes;
(v) Lesbian, gay, bisexual, transgender, questioning (LGBTQ);
(vi) Changes: reduced interest, increased interest, sexual aggression, inhibitions, coping and frustrations;
(vii) Client rights;
(viii) Consent;
(ix) Abuse;
(x) Talking to families about sex;
(xi) Caregiver responsibility; and
(xii) Reporting nonconsensual sexual contact.
(b) Medications, treatments, and therapies. The caregiver will identify possible medication side effects, ways to respond to side effects, and recognize nondrug therapies to alleviate some symptoms of dementia.
(i) Conventional medicine: general dementia medication, other drugs used with people who have dementia;
(ii) Medication side effects and reporting side effects;
(iii) Chemical restraints;
(iv) Medication refusal; and
(v) Nondrug therapies: natural medicine, cannabis, holistic therapies, nutrition.
(3) Activities of daily living (ADL). The caregiver will identify ways to assist with activities of daily living such as bathing, dressing, eating, oral care, and toileting while focusing on the individual's strengths.
(a) Helping with activities of daily living;
(b) Self-directed and staff-directed activities;
(c) Creating an environment to support activities;
(d) Assisting with challenging ADLs;
(e) Assisting with bathing;
(f) Assisting with dressing;
(g) Assisting with eating;
(h) Assisting with oral care; and
(i) Assisting with toileting.
(4) Fostering communication and understanding.
(a) Communicating with people who have dementia. The caregiver will be able to demonstrate an ability to recognize communication styles and ways to communicate effectively.
(i) Verbal and nonverbal communication;
(ii) Progression of dementia and communication impact;
(iii) Early, middle, and late phase dementia; and
(iv) Approach: nonverbal gestures, giving and receiving information, listening and interpreting information, communicating respect, open-ended questions, reason, logic and time, asking not telling, saying less, gentle deception.
(b) Trauma informed care. The caregiver will recognize that past traumas can affect current thinking, behaviors, and actions, and will identify strategies to provide trauma informed care.
(i) Coping mechanisms;
(ii) Impact of culture;
(iii) Trauma informed care;
(iv) Principles of trauma informed care: safety, trustworthiness, choice, collaboration, empowerment; and
(v) Strategies for care.
(5) Challenging behaviors.
(a) Approaching challenging behaviors. The caregiver will demonstrate the sequence of steps to approach challenging behaviors.
(i) Strategy for approaching behaviors: Stop, identify, take action.
(A) Stop, identify, take action;
(B) Calming techniques;
(C) Expressing a need or desire;
(D) Physical, environmental, and emotional triggers;
(E) Minimizing or eliminating the trigger;
(F) Approaching a client; and
(ii) Document and report.
(b) Tips for dealing with specific challenging behaviors. The caregiver will demonstrate an understanding of navigating challenging situations.
(i) Anger;
(ii) Combative during personal care;
(iii) Cries and tearfulness;
(iv) Disrobes in public;
(v) Eats nonedible substances/objects;
(vi) Hallucinations and delusions;
(vii) Inappropriate toileting/menses activity;
(viii) Injures self;
(ix) Intimidates/threatens;
(x) Mood swings;
(xi) Repetitive anxious complaints or questions;
(xii) Repetitive physical movements and pacing;
(xiii) Resistive to care with words and gestures;
(xiv) Rummages through or takes belongings of others;
(xv) Seeks vulnerable sexual partner;
(xvi) Sexual acting out;
(xvii) Spitting;
(xviii) Unrealistic fears or suspicions;
(xix) Unsafe smoking;
(xx) Up at night while others are sleeping and requires interventions;
(xxi) Verbally abusive; and
(xxii) Wanders and is exit seeking.
NEW SECTION
WAC 388-112A-0450 What must mental health specialty training include?
Curricula approved as mental health specialty training must include all of the knowledge, skills, topics, competencies and learning objectives described in this section.
(1) Introduction to mental disorders. The caregiver will review definitions, common signs, and symptoms and identify types of mental illness.
(a) Understanding mental disorders;
(b) Stigma and mental disorders;
(c) Myths and facts;
(d) Differentiating forms of mental disorders; and
(e) Mental health conditions:
(i) Attention deficit hyperactivity disorder;
(ii) Anxiety disorder;
(iii) Autism;
(iv) Bipolar disorder;
(v) Borderline personality disorder;
(vi) Depression;
(vii) Dissociative disorder;
(viii) Eating disorders;
(ix) Obsessive-compulsive disorder;
(x) Posttraumatic stress disorder;
(xi) Schizoaffective disorder;
(xii) Schizophrenia; and
(xiii) Related conditions including but not limited to:
(A) Anosognosia;
(B) Dual diagnosis;
(C) Psychosis;
(D) Risk of suicide;
(E) Self-harm;
(F) Sleep disorders; and
(G) Substance abuse.
(2) Compassionate and trauma-informed caregiving for mental health. The caregiver will recognize that culture, generation, religion, and past trauma experiences can affect current thinking, behaviors, and actions, and will identify strategies to provide informed care and support resilience.
(a) Impact of culture and ethnicity;
(b) Impact of generation;
(c) Impact of religion;
(d) Trauma and mental disorders;
(e) Trauma informed care;
(f) Trauma informed approach; and
(g) Resilience.
(3) Supports for wellness. The caregiver will identify possible medication side effects, ways to respond to side effects, and recognize individualized nondrug therapies to alleviate symptoms of mental illness.
(a) Baseline;
(b) What good mental health looks like;
(c) Person centered care planning; and
(d) Medication, treatments, and therapies.
(i) Conventional medicine:
(A) Antipsychotic;
(B) Antimania;
(C) Anticonvulsants;
(D) Antianxiety; and
(E) Other drugs used with people who have mental disorders;
(ii) Medication side effects and reporting side effects;
(iii) Chemical restraints;
(iv) Medication refusal; and
(v) Nondrug therapies:
(A) Natural medicine;
(B) Cannabis;
(C) Holistic therapies; and
(D) Nutrition.
(4) Getting help and self-care. The caregiver will recognize the importance of caregiver wellness and identify strategies to prevent secondary trauma and burnout.
(a) Caregiver mental wellness;
(b) Secondary trauma;
(c) Strategies to cope with caregiver burnout; and
(d) Seeking outside help.
(5) Respectful communication. Communication dynamics. The care-giver will demonstrate an ability to recognize communication styles and ways to communicate effectively.
(a) Communication and privacy;
(b) Listening;
(c) Empathy;
(d) Nonverbal vs verbal communication;
(e) Seeking clarification;
(f) Communication and triggering challenging behaviors; and
(g) Behaviors impacting communication.
(6) Boundaries. The caregiver will demonstrate an understanding of creating healthy professional boundaries.
(a) Importance of boundaries for good mental health;
(b) Personal and professional boundaries;
(c) Setting boundaries; and
(d) Assertiveness.
(7) Creative approaches to challenging behaviors. The caregiver will demonstrate the sequence of steps to approach challenging behaviors.
(a) Approach: Stop, identify, take action;
(b) Set limits and providing consistency; and
(c) Specific behaviors and tips on how to respond:
(i) Anger;
(ii) Combative during personal care;
(iii) Cries and tearfulness;
(iv) Disrobes in public;
(v) Eats nonedible substances/objects;
(vi) Hallucinations and delusions;
(vii) Inappropriate toileting/menses activity;
(viii) Injures self;
(ix) Intimidates/threatens;
(x) Mood swings;
(xi) Repetitive anxious complaints or questions;
(xii) Repetitive physical movements and pacing;
(xiii) Resistive to care with words and gestures;
(xiv) Rummages through or takes belongings of others;
(xv) Seeks vulnerable sexual partner;
(xvi) Sexual acting out;
(xvii) Spitting;
(xviii) Unrealistic fears or suspicions;
(xix) Unsafe smoking;
(xx) Up at night while others are sleeping and requires interventions;
(xxi) Verbally abusive; and
(xxii) Wanders and is exit seeking.
(8) Crisis management. The caregiver will identify potential stressors to prevent crisis and demonstrate steps for de-escalation.
(a) What is crisis;
(b) Averting crisis;
(c) Decompensation;
(d) Aggression and violence; and
(e) When a crisis occurs.
(9) Suicide prevention. The caregiver will identify suicide facts, recognize warning signs, and communicate about suicide.
(a) History;
(b) Risk facts;
(c) Indicators;
(d) Asking questions;
(e) Talking about suicide;
(f) Resources;
(g) Hazards;
(h) Stigma;
(i) History of the caregiver;
(j) Medically assisted suicide; and
(k) Grief support.
NEW SECTION
WAC 388-112A-0460 Who must complete competency testing for specialty training?
The following individuals must pass the DSHS competency test as provided under this chapter for successful completion of the specialty training class:
(1) All adult family home applicants or providers, resident managers or designees, entity representatives, and long-term care workers;
(2) All assisted living facility administrators or designees, and long-term care workers; and
(3) All enhanced services facility administrators or designees, and long-term care workers.
NEW SECTION
WAC 388-112A-0470 Is there a challenge test for specialty training classes?
(1) Individuals may take the DSHS challenge test instead of the required specialty training class. A person who does not pass a challenge test on the first attempt must attend the specialty training class.
(2) A challenge test is not permitted when specialty training is taken to meet the population specific component of the seventy-hour long-term care worker basic training under WAC 388-112A-0340.
NEW SECTION
WAC 388-112A-0480 What documentation is required for successful completion of specialty training?
(1) Specialty training must be documented by a department certificate of successful completion, awarded by the instructor or training entity that includes:
(a) The name of the student;
(b) The name of the specialty training;
(c) The number of training hours;
(d) The name and department number of the home or training entity;
(e) The instructor's signature; and
(f) The date of completion.
(2) The training entity must give the student an original certificate. The employer must keep a copy of the certificate on file.
NEW SECTION
WAC 388-112A-0490 When must facility applicants, resident managers, administrators and other types of entity representatives complete specialty training?
Adult family homes.
(1) Adult family home applicants, providers, entity representatives, and resident managers must complete specialty training or developmental disability caregiver training and demonstrate competency before the home is licensed or before a new entity representative or resident manager assumes the duties of the position in order to admit or serve residents who have special needs related to mental illness, dementia, or a developmental disability.
(2) If a resident develops special needs while living in a home without a specialty designation, the provider, entity representative, and resident manager have one hundred twenty days to complete specialty training or developmental disability caregiver training and demonstrate competency.
Assisted living facilities.
(3) If an assisted living facility serves one or more residents with special needs, the assisted living facility administrator or his or her designee must complete specialty training or developmental disability caregiver training and demonstrate competency within one hundred twenty days of date of hire.
(4) If a resident develops special needs while living in an assisted living facility, the assisted living facility administrator or his or her designee has one hundred twenty days to complete specialty training and demonstrate competency.
Enhanced services facilities.
(5) Enhanced services facilities applicants, providers, entity representatives, and resident managers must complete dementia and mental health specialty training and demonstrate competency before the home is licensed or before a new entity representative or resident manager assumes the duties of the position in order to admit or serve residents who have special needs related to mental illness, dementia, or a developmental disability.
(6) If a resident develops special needs while living in a home without a specialty designation, the provider, entity representative, and resident manager have one hundred twenty days to complete developmental disability specialty training and demonstrate competency.
NEW SECTION
WAC 388-112A-0495 What are the facility long-term care workers' specialty training deadlines and what is the requirement for supervision until the training is completed?
Adult family homes.
(1) If an adult family home serves one or more residents with special needs, long-term care workers must complete and demonstrate competency in specialty training within one hundred twenty days of hire.
(2) During the period to complete the specialty training the long-term care worker must not provide personal care to a resident with special needs without direct supervision until that long-term care worker demonstrates competency in specialty training.
(3) The long-term care worker may have indirect supervision if the long-term care worker is one or more of the following:
(a) The long-term care worker is a nursing assistant certified (NA-C) under chapter 18.88A RCW;
(b) The long-term care worker is a certified home care aide (HCA) under chapter 18.88B RCW;
(c) The long-term care worker is a licensed practical nurse (LPN) under chapter 18.79 RCW;
(d) The long-term care worker is a registered nurse (RN) under chapter 18.79 RCW;
(e) The long-term care worker meets the exemption criteria described in WAC 388-112A-0090.
Assisted living facilities.
(4) If an assisted living facility serves one or more residents with special needs, long-term care workers must complete and demonstrate competency in specialty training within one hundred twenty days of hire.
(5) During the period to complete the specialty training, the long-term care worker must not provide personal care to a resident with special needs without indirect supervision until that long-term care worker demonstrates competency in specialty training.
Enhanced services facilities.
(6) Enhanced services facilities are facilities that serves one or more residents with special needs, and long-term care workers must complete and demonstrate competency in mental health and dementia specialty training prior to providing client services.
(7) Long-term care workers are not required to complete specialty training if the adult family home or assisted living facility has no residents with a special need where the specialty training is required.
SECTION V—NURSE DELEGATION CORE TRAINING
NEW SECTION
WAC 388-112A-0500 What is nurse delegation core training?
(1) Nurse delegation core training is required before certified or registered nursing assistants or certified home care aides may be delegated a nursing task.
(2) DSHS approves instructors for nurse delegation core training.
NEW SECTION
WAC 388-112A-0510 What knowledge and skills must nurse delegation core training include?
Only the DSHS developed curriculum for nurse delegation entitled, "nurse delegation for nursing assistants & home care aides," meets the training requirement for nurse delegation core training.
NEW SECTION
WAC 388-112A-0520 Is competency testing required for nurse delegation core training?
Passing the DSHS competency test is required for successful completion of nurse delegation core training, as provided under WAC 388-112A-0900 through 388-112A-0950.
NEW SECTION
WAC 388-112A-0530 Is there a challenge test for nurse delegation core training?
There is no challenge test for nurse delegation core training.
NEW SECTION
WAC 388-112A-0540 What documentation is required for successful completion of nurse delegation core training?
(1) Nurse delegation core training must be documented by a department certificate of successful completion of training, issued by the instructor or training entity, that includes:
(a) The name of the trainee;
(b) The name of the training;
(c) The name and department number of the training entity giving the training;
(d) The instructor's name and signature; and
(e) The date(s) of training.
(2) The training entity must give the student an original certificate. Adult family homes and assisted living facilities must keep a copy of the certificate on file.
NEW SECTION
WAC 388-112A-0550 Who is required to complete nurse delegation core training and nurse delegation specialized diabetes training and by when?
(1) Before performing any delegated nursing task, long-term care workers in adult family homes and assisted living facilities must:
(a) Successfully complete the DSHS designated nurse delegation core training, "nurse delegation for nursing assistants & home care aides";
(b) Be one or more of the following:
(i) Certified home care aide under chapter 18.88B RCW;
(ii) Nursing assistant certified under chapter 18.88A RCW;
(iii) If the long-term care worker is exempt from the home care aide certification under WAC 246-980-070, the long-term care worker must be a nursing assistant registered and complete the core competencies of basic training, unless they already completed the twenty-eight hours of revised fundamentals of care or a department approved alternative;
(iv) If nurse delegation is needed to implement a care plan or negotiated service agreement earlier than home care aide certification can be obtained, the long-term care worker must become a nursing assistant registered and complete core competencies (the core basic training) of the seventy-hour long-term care worker basic training.
(2) Before long-term care workers in adult family homes and assisted living facilities may perform the task of insulin injections, the long-term care workers must:
(a) Meet the requirements in subsections (1)(a) and (b) of this section; and
(b) Successfully complete the DSHS designated specialized diabetes nurse delegation training.
NEW SECTION
WAC 388-112A-0560 What is specialized diabetes nurse delegation training?
Specialized diabetes nurse delegation training is the required training for certified or registered nursing assistants or certified home care aides, who will be delegated the task of insulin injections. DSHS approves the instructors for specialized diabetes nurse delegation training.
NEW SECTION
WAC 388-112A-0570 What knowledge and skills must specialized diabetes nurse delegation training include?
Specialized diabetes nurse delegation training consists of three modules on diabetes, insulin, and injections. Only the curriculum developed by DSHS, "nurse delegation for nursing assistants: special focus on diabetes," may be used for the specialized diabetes nurse delegation training.
NEW SECTION
WAC 388-112A-0575 Is competency testing required for the specialized diabetes nurse delegation training?
Passing the DSHS competency test is required for successful completion of the specialized diabetes nurse delegation training, as provided under WAC 388-112A-0900 through 388-112A-0950.
NEW SECTION
WAC 388-112A-0580 Is there a challenge test for specialized diabetes nurse delegation training?
There is no challenge test for specialized diabetes nurse delegation training.
NEW SECTION
WAC 388-112A-0585 What documentation is required for successful completion of specialized diabetes nurse delegation training?
(1) Specialized diabetes nurse delegation training must be documented by a department certificate of successful completion of training, issued by the instructor or training entity, that includes the following:
(a) The name of the trainee;
(b) The name of the training;
(c) The name and department number of the training entity giving the training;
(d) The instructor's name and signature; and
(e) The date(s) of the training.
(2) The instructor or training entity must give the trainee an original certificate. Adult family homes and assisted living facilities must keep a copy of the certificate on file.
NEW SECTION
WAC 388-112A-0590 May nurse delegation core and specialized diabetes training occur in the same year as the seventy-hour long-term care worker basic training?
(1) Nurse delegation core and specialized diabetes training may occur in the same year as basic training if required to be able to perform delegated tasks. The training hours may apply to the population specific component of the seventy-hour long-term care worker basic training.
(2) Long-term care workers in enhanced services facilities are not permitted to perform nurse delegated tasks.
SECTION VI—CONTINUING EDUCATION
NEW SECTION
WAC 388-112A-0600 What is continuing education and what topics may be covered in continuing education?
(1) Continuing education is annual training designed to promote professional development and increase a caregiver's knowledge, expertise, and skills. DSHS must approve continuing education curricula and instructors. The same continuing education course must not be repeated for credit unless it is a new or more advanced training on the same topic. However, long-term care workers may repeat up to five credit hours per year on the following topics:
(a) Blood borne pathogens and infection control;
(b) CPR training;
(c) First aid training;
(d) Food handling training;
(e) Health insurance portability and accountability act (HIPAA);
(f) Medication assistance;
(g) Disaster preparedness;
(h) Aging sensitivity;
(i) Resident rights as it relates to caregiving issues in chapter 70.129 RCW;
(j) Resident safety;
(k) Abuse and neglect identification and mandatory reporting; and
(l) Topics where the assisted living facility, enhanced services facility, or adult family home can demonstrate a need for retraining.
(2) Continuing education must be on a topic relevant to the care setting, care needs of residents, or long-term care worker career development. In addition to the topics listed in subsection (1) of this section, topics or course may include:
(a) Personal care services;
(b) Mental illness;
(c) Dementia;
(d) Developmental disabilities;
(e) Depression;
(f) Communication skills;
(g) Positive resident behavior support;
(h) Developing or improving resident centered activities;
(i) Dealing with wandering or aggressive resident behaviors;
(j) De-escalating challenging behaviors; and
(k) Medical conditions.
(3) Nurse delegation core and nurse delegation specialized diabetes training hours when not applied to basic training hours may count towards continuing education.
(4) Specialty training, except if completed through a challenge test, may be used to meet continuing education requirements.
(5) When hours from a class approved as specialty training are counted toward basic training requirements, the hours must not be counted toward continuing education.
(6) Residential care administrator training under WAC 388-112A-0800 may be used to meet the continuing education requirements described in WAC 388-112A-0610 during the year it was completed.
(7) Successful completion of a department of health approved home care aide certified alternative bridge program may be applied up to twelve hours of continuing education in the year it was completed.
NEW SECTION
WAC 388-112A-0610 Who is required to complete continuing education training each year, how many hours of continuing education are required, and when must they be completed?
(1) Adult family homes.
(a) Certified home care aides must complete twelve hours of continuing education by their birthday each year after obtaining certification as required by the Washington department of health as described in RCW 74.39A.341.
(b) If exempt from certification as described in RCW 18.88B.041, long-term care workers must complete twelve hours of continuing education by their birthday each year.
(i) Unless voluntarily certified as a home care aide under chapter 18.88B RCW, the continuing education does not apply to registered nurses and licensed practical nurses licensed under chapter 18.79 RCW.
(ii) Continuing education requirements under subsection (1)(b) of this section do not apply to certified nursing assistants and persons with special education training and an endorsement granted by the superintendent of public instruction, as described in RCW 28A.300.010.
(c) For long-term care workers that are certified as a home care aide or nursing assistant, if the first renewal period is less than a full year from the initial date of certification, no continuing education will be due for the first renewal period.
(d) Continuing education must include one half hour per year on safe food handling in adult family homes as described in RCW 70.128.250 when the long-term worker does not maintain a food handler's permit.
(2) Assisted living facilities.
(a) Certified home care aides must complete twelve hours of continuing education by their birthday each year after obtaining certification as required by the Washington department of health as described in RCW 74.39A.341.
(b) Long-term care workers exempt from certification under RCW 18.88B.041 must complete twelve hours of continuing education by their birthday each year.
(c) For long-term care workers that are certified as a home care aide or nursing assistant, if the first renewal period is less than a full year from the initial date of certification, no continuing education will be due for the first renewal period.
(i) Unless voluntarily certified as a home care aide under chapter 18.88B RCW, the continuing education does not apply to registered nurses and licensed practical nurses licensed under chapter 18.79 RCW.
(ii) Continuing education requirements under subsection (2)(b) of this section apply to certified nursing assistants and persons with special education training and an endorsement granted by the superintendent of public instruction, as described in RCW 28A.300.010.
(iii) Assisted living facility administrators or the administrator designees must complete twelve hours of continuing education by their birthday each year.
(3) Enhanced services facilities.
(a) Certified home care aides must complete twelve hours of continuing education by their birthday each year after obtaining certification as required by the Washington department of health as described in RCW 74.39A.341.
(b) Long-term care workers exempt from certification under RCW 18.88B.041 must complete twelve hours of continuing education by their birthday each year for each year they worked.
(c) For long-term care workers that are certified as a home care aide or nursing assistant, if the first renewal period is less than a full year from the initial date of certification, no continuing education will be due for the first renewal period.
(i) Unless voluntarily certified as a home care aide under chapter 18.88B RCW, the continuing education does not apply to registered nurses and licensed practical nurses licensed under chapter 18.79 RCW.
(ii) Continuing education requirements under subsection (3)(b) of this section do apply to certified nursing assistants and persons with special education training and an endorsement granted by the superintendent of public instruction, as described in RCW 28A.300.010.
(iii) Enhanced services facility administrators or the administrator designees must complete twelve hours of continuing education by their birthday each year.
(d) Enhanced services facility certified home care aide staff and nursing assistant certified staff must have ten of their twelve hours of annual continuing education cover relevant education regarding the population served in the enhanced services facility as provided in WAC 388-107-0660.
(e) In addition to the annual continuing education requirements for individual staff, the enhanced services facility must provide three hours of staff education per quarter relevant to the needs of the population served.
(4) A long-term care worker who does not complete continuing education as required in subsections (1) through (3) of this section or RCW 74.39A.341 must not be paid to provide care until they complete the required continuing education.
(5) One hour of completed classroom instruction or other form of training (such as an online course) equals one hour of continuing education. For online courses, the training entity must establish a way for the long-term care worker to ask the instructor questions.
NEW SECTION
WAC 388-112A-0620 What are the documentation requirements for continuing education?
(1) The adult family home, enhanced services facility, or assisted living facility must maintain written documentation of department approved continuing education in the form of a certificate or transcript that contains the following information:
(a) The name of the student;
(b) The title of the training;
(c) The number of hours of the training;
(d) The assigned curriculum approval code;
(e) The instructor's name and signature;
(f) The name and identification number of the home or training entity giving the training; and
(g) The date(s) of the training.
(2) The instructor or training program must give the student an original certificate or other documentation of continuing education. The adult family home, enhanced services facility, or assisted living facility must keep a copy of the certificate or transcript on file as described in WAC 388-76-10198 for adult family homes, WAC 388-107-0630 for enhanced services facilities, and WAC 388-78A-2450 for assisted living facilities.
SECTION VII—CPR AND FIRST AID TRAINING
NEW SECTION
WAC 388-112A-0700 What is CPR training?
Cardiopulmonary resuscitation (CPR) training is training provided by an authorized CPR instructor. Trainees must successfully complete the written and skills demonstration tests.
NEW SECTION
WAC 388-112A-0710 What is CPR/first aid training?
CPR/first aid training is training that meets the guidelines established by the Occupational Safety and Health Administration (OSHA). Under OSHA guidelines, training must include hands on skills development through the use of mannequins or trainee partners.
NEW SECTION
WAC 388-112A-0720 What are the CPR and first aid training requirements?
(1) Adult family homes.
(a) Adult family home applicants, providers, entity representatives, and resident managers must have and maintain a valid CPR and first aid card or certificate before they obtain a license.
(b) Licensed nurses who work in adult family homes must have and maintain a valid CPR card or certificate within thirty days of their date of hire. If the licensed nurse is an adult family home provider or resident manager, they must obtain the valid CPR card or certificate prior to providing care for residents.
(c) Adult family home long-term care workers must obtain and maintain a valid CPR and first aid card or certificate as follows:
(i) Within thirty days of beginning to provide care for residents if directly supervised by a fully qualified long-term care worker with a valid first aid and CPR card or certificate; or
(ii) Before providing care for residents, if not directly supervised by a fully qualified long-term care worker with a valid first aid and CPR card or certificate.
(d) The form of the first aid or CPR card or certificate may be electronic or printed.
(2) Assisted living facilities.
(a) Assisted living facility administrators who provide direct care and long-term care workers must have and maintain a valid CPR and first aid card or certificate within thirty days of their date of hire.
(b) Licensed nurses working in assisted living facility must have and maintain a valid CPR card or certificate within thirty days of their date of hire.
(c) The form of the first aid or CPR card or certificate may be electronic or printed.
(3) Enhanced services facilities.
(a) Enhanced services facility administrators and long-term care workers who provide direct care must have and maintain a valid CPR and first aid card or certificate within thirty days of their date of hire.
(b) Licensed nurses working in an enhanced services facility must have and maintain a valid CPR card or certificate within thirty days of their date of hire.
(c) The form of the first aid or CPR card or certificate may be electronic or printed.
SECTION VIII—RESIDENTIAL CARE ADMINISTRATOR TRAINING
NEW SECTION
WAC 388-112A-0800 What is residential care administrator training?
(1) Residential care administrator training is specific training on the administration of the care and services required to obtain a license or manage a facility. The training covers the facility specific Washington state statutes and administrative rules related to the operation of a long-term care facility.
(2) Adult family home (AFH) administrator training.
(a) AFH administrator training is a minimum of fifty-four hours of training on topics related to the management and licensing requirements of adult family homes described in chapter 388-76 WAC.
(b) DSHS must approve AFH administrator training curricula, instructors, and training programs in a community college setting.
(3) Assisted living facility (ALF) administrator training.
(a) ALF administrator training curricula must be based on the requirements described in chapter 388-78A WAC.
(b) DSHS will work with stakeholders to develop, update, and approve ALF administrator training curricula, instructors, and training programs.
(4) Enhanced services facility (ESF) administrator training.
(a) An ESF administrator must complete:
(i) All training as required under this chapter and chapter 388-107 WAC; and
(ii) When available, ESF administrator training developed by the department.
(b) DSHS must approve ESF administrator training, instructors, and training programs.
NEW SECTION
WAC 388-112A-0810 Who must take the adult family home administrator training?
New applicants for an adult family home (AFH) license must successfully complete the DSHS developed adult family home administrator training from colleges contracted with the department.
NEW SECTION
WAC 388-112A-0820 What knowledge and skills must adult family home administrator training include?
At a minimum, adult family home (AFH) administrator training must include fifty-four hours of class time and all of the following subjects:
(1) Business planning and marketing;
(2) Fiscal planning and management;
(3) Human resource planning;
(4) Identifying resident health issues;
(5) Person centered planning;
(6) Negotiated care planning;
(7) Emergency and disaster planning;
(8) Nutrition and food service;
(9) Working with people who are elderly, chronically mentally ill, or developmentally disabled;
(10) The licensing process;
(11) Social and recreational activities;
(12) Resident rights;
(13) Legal issues;
(14) Physical maintenance and fire safety; and
(15) Housekeeping.
NEW SECTION
WAC 388-112A-0830 Is competency testing required for adult family home administrator training?
Competency testing is required for adult family home administrator training.
NEW SECTION
WAC 388-112A-0840 What documentation is required for adult family home administrator training?
(1) Adult family home administrator training must be documented by a department certificate of successful completion of training, issued by the instructor or training entity. The certificate must include the following:
(a) The trainee's name;
(b) The name of the training;
(c) The name and department number of the training entity giving the training;
(d) The instructor's name and signature; and
(e) The date(s) of training.
(2) The instructor or training program must give the trainee an original certificate. The adult family home must maintain a copy of the certificate in its files.
SECTION IX—COMPETENCY TESTING
NEW SECTION
WAC 388-112A-0900 What is competency testing?
(1) Competency testing, including challenge testing, is evaluating a trainee to determine if they can demonstrate the required level of skill, knowledge, and behavior with respect to the identified learning outcomes of a particular course.
(2) Competency and challenge tests are DSHS developed.
(3) DSHS distributes the competency and challenge tests to the training entities when the entities are approved for the applicable course.
NEW SECTION
WAC 388-112A-0910 What components must competency testing include?
(1) Competency testing must include the following components:
(a) Skills demonstration except as provided in (b) of this sub-section on the ability to perform and implement specific caregiving approaches and activities as appropriate for the training;
(b) Adult family home administrator training does not include a skills demonstration and student's progress and knowledge will be measured by assigned projects, quizzes, a final exam, and other means of measuring competency;
(c) Written evaluation to show the level of comprehension and knowledge of the training's learning objectives; and
(d) A scoring guide for the tester with clearly stated criteria and minimum proficiency standards.
(2) Instructors who conduct competency testing must have experience or training in assessing competencies.
NEW SECTION
WAC 388-112A-0920 What training must include the DSHS developed competency test?
The following trainings must include the DSHS developed competency test:
(1) Dementia specialty training;
(2) Mental health specialty training;
(3) Developmental disabilities specialty training;
(4) Nurse delegation core training;
(5) Nurse delegation specialized diabetes training; and
(6) Adult family home administrator training.
NEW SECTION
WAC 388-112A-0930 How must competency test administration be standardized?
To standardize competency test administration, testing must include the following components:
(1) The person teaching the course must administer or supervise the administration of all testing; and
(2) The tester must follow DSHS guidelines for:
(a) The maximum length of time allowed for testing;
(b) The amount and nature of instruction given to students before beginning a test;
(c) The amount of assistance to students allowed during testing;
(d) The accommodation guidelines for students with disabilities; and
(e) Accessibility guidelines for students with limited English proficiency.
NEW SECTION
WAC 388-112A-0940 What form of identification must students provide before they take a competency or challenge test?
Students must provide photo identification before they take a competency or challenge test for basic, specialty, adult family home administrator, and nurse delegation training.
NEW SECTION
WAC 388-112A-0950 How many times may a competency test be taken?
(1) A competency test that is part of a course may be taken twice. If the test is failed a second time, the person must retake the course before any additional tests are administered.
(2) If a challenge test is available for a course, it may be taken only once. If the test is failed, the person must take the classroom course.
SECTION X—CURRICULUM APPROVAL
NEW SECTION
WAC 388-112A-1000 Which trainings require department approval of the curriculum and instructor?
(1) Except for facility orientation training under WAC 388-112A-0200(1), the department must preapprove the curriculum, including delivery mode, and instructors for all training required under this chapter.
(2) The following trainings must use only DSHS curriculum:
(a) Nurse delegation core and specialized diabetes nurse delegation training;
(b) Adult family home administrator training; and
(c) Developmental disabilities specialty training.
(3) The department's approval will be based on curriculum review as described in WAC 388-112A-1010.
(4) The department will approve adult family home, enhanced services facilities, and assisted living facility training programs and instructors for orientation and safety training under WAC 388-112A-0200(2) and 388-112A-0220 when the home is licensed. The facility training program may make changes to its training program as described in WAC 388-112A-1210.
NEW SECTION
WAC 388-112A-1010 What is the curriculum approval process for orientation, safety training, basic training, population specific training, specialty training, residential care administrator training, and continuing education?
In order to obtain the department's approval of the curriculum for orientation, safety training, basic training, population specific training, specialty training, residential care administrator training, and continuing education:
(1) Submit the required training application forms and any other materials required for specific curriculum to the department.
(2) After review of the curriculum, DSHS will send a written response to the submitter, indicating approval or disapproval of the curriculum.
(3) If the curriculum is not approved, the reason(s) for denial will be given and the submitter will be told what portion(s) of the training must be changed and resubmitted for review for the curriculum to be approved.
(4) The submitter may then make the requested changes and resubmit the curriculum for review.
(5) If after working with the department, the reasons why the curriculum was not approved cannot be resolved, the submitter may seek a review of the nonapproval decision from the assistant secretary of aging and long-term support administration (ALTSA). The assistant secretary's review decision will be DSHS's final decision. No other administrative review is available to the submitter.
NEW SECTION
WAC 388-112A-1020 What must be submitted to DSHS for curriculum approval?
(1) If a training entity modifies a department developed curriculum in any manner, the training entity must submit the curriculum to the department for approval.
(2) For orientation and safety training:
(a) Submit an outline of what will be covered in each training offered, like a table of contents or a class syllabus, that shows where the required introductory topics listed in WAC 388-112A-0210 for orientation and WAC 388-112A-0230 for safety training are covered in the training.
(b) Department required orientation and safety training application forms must be submitted to the department at least forty-five days before the training is expected to be offered.
(c) Training cannot be offered before the department approves the curriculum and instructor.
(3) For continuing education:
(a) Continuing education curriculum delivery models must only include instructor led, online instructor led (such as a webinar), or online interactive self-paced learning with access to an instructor.
(b) Online classes must adhere to the DSHS online class standards in effect at the time of approval. These online standards are posted on the department's website.
(c) For continuing education classes, submit on a department developed form a summary of the class that includes the topic, a brief description of what the training will cover, a course outline, the number of training hours, and a description of how the training is relevant to the care setting, care needs of residents, or long-term care worker career development.
(d) For online training courses, submit the information requested in (c) of this subsection and a description of how the instructor or training will assess that the students have integrated the information being taught.
(e) Department required continuing education training application forms must be submitted at least forty-five days in advance of the training. The department must approve the curriculum and instructor before the training may be offered.
(4) For core basic training:
(a) If the instructor or training entity uses the DSHS developed revised fundamentals of caregiving learner's guide with enhancements, they must submit the DSHS form with all required information.
(b) If the instructor or training entity does not use a DSHS developed revised fundamentals of caregiving learner's guide with enhancements to teach the seventy-hour long-term care worker basic training, they must submit to DSHS the following for approval:
(i) A completed DSHS curriculum checklist indicating where all of the competencies and learning objectives described in this chapter are located in the long-term care worker materials from the proposed curriculum for that course;
(ii) Any materials long-term care workers will receive, such as a textbook, long-term care worker manual, learning activities, audio-visual materials, handouts, and books;
(iii) The table of contents or curriculum outline, including the allotted time for each section;
(iv) Demonstration skills checklists for the personal care tasks described in WAC 388-112A-0320 (12)(a) and (b) and infection control skills such as hand washing and putting on and taking off gloves;
(v) The teacher's guide or manual that includes for each section of the curriculum:
(A) The goals and objectives;
(B) Method of teaching, including learning activities that incorporate adult learning principles;
(C) Methods used to determine whether each long-term care worker understands the materials covered and can demonstrate all skills;
(D) A list of the sources or references that were used to develop the curriculum and if the primary source or reference is not a published citation, the instructor must provide detail on how the content is evidence based;
(E) Description of how the curriculum was designed to accommodate long-term care workers with either limited English proficiency, learning disabilities, or both; and
(F) Description and proof of how input was obtained from consumer and long-term care worker representatives in the development of the curriculum.
(c) Curriculum submitted for the core competency section of basic training, called core basic training, as described in WAC 388-112A-0320, must include how much time students will have to practice skills and how instructors will evaluate and ensure each long-term care worker can proficiently complete each skill.
(d) Entities that submit curriculum for the population specific component of the seventy-hour long-term care worker basic training must submit their own list of competencies and learning objectives used to develop the population specific basic training curriculum.
(5) For specialty training:
(a) For specialty training that is not the DSHS developed curriculum or another department approved specialty training curriculum, submit the required specialty training application form and any additional learning objectives added to the competency and learning objectives checklist, the enhancements that have been added, and additional student materials or handouts.
(b) To be approved, an alternative curriculum must at a minimum include:
(i) All the DSHS published learning outcomes and competencies for the course;
(ii) Printed student materials that support the curriculum, a teacher's guide or manual, and learning resource materials such as learning activities, audio-visual materials, handouts, and books;
(iii) The recommended sequence and delivery of the material;
(iv) The teaching methods or approaches that will be used for different sections of the course, including for each lesson:
(A) Learning activities that incorporate adult learning principles and address the learning readiness of the student population;
(B) Practice of skills to increase competency;
(C) Feedback to the student on knowledge and skills;
(D) An emphasis on facilitation by the teacher; and
(E) An integration of knowledge and skills from previous lessons to build skills;
(v) A list of the sources or references, if any, used to develop the curriculum;
(vi) Methods of teaching and student evaluation for students with either limited English proficiency, learning disabilities, or both;
(vii) A plan for updating material; and
(6) Substantial changes to a previous approved curriculum must be approved before they are used.
SECTION XI—HOME-BASED TRAINING
NEW SECTION
WAC 388-112A-1100 What are the requirements for an assisted living facility, enhanced services facility, or adult family home to conduct orientation, safety, basic, on-the-job, continuing education, or specialty training?
(1) An assisted living facility, enhanced services facility, or adult family home provider may conduct orientation, safety, basic, on-the-job, continuing education, and specialty trainings if the provider:
(a) Verifies, documents using the department's attestation process, keeps on file, and makes available to the department upon re-quest that all instructors meet the minimum instructor qualifications in WAC 388-112A-1230 through 388-112A-1295 for the course they plan to teach;
(b) Teaches using a complete DSHS developed or approved curriculum;
(c) Notifies DSHS in writing of the provider's intent to conduct staff training prior to providing the provider's first training and when changing training plans, including:
(i) The provider's name;
(ii) Name of training(s) the provider will conduct;
(iii) Name of approved curriculum the provider will use;
(iv) Name of lead instructor and instructor's past employment in assisted living facility or adult family homes; and
(v) Whether the provider will train only the provider's staff or also other providers and if the provider will train staff outside the home or corporation, the instructor must become a DSHS contracted community instructor;
(d) Ensures that DSHS competency tests are administered as required under this chapter and referenced in department instructor guides and instructor policies distributed at the time of course approval;
(e) Provides a certificate or transcript of completion of training to all staff that successfully complete the entire course;
(f) Keeps electronic or paper copies of long-term care worker certificates on file for six years and gives the original certificate to the student;
(g) Reports training data to DSHS when requested by the department;
(2) The department may conduct a random audit at any time to review training and instructor qualifications.
NEW SECTION
WAC 388-112A-1110 When may DSHS prohibit a home from conducting its own training?
(1) DSHS may prohibit a home from providing its own seventy-hour long-term care worker basic, specialty, or continuing education training when any one of the following occurs:
(a) DSHS determines that the training fails to meet the standards under this chapter;
(b) The home fails to notify DSHS of a change in curriculum prior to teaching the curriculum;
(c) The home provides false or misleading information to long-term care workers or the public concerning the courses offered or conducted;
(d) The home's instructor fails to meet the applicable qualifications described under this chapter;
(e) The home's instructor has been a licensee, assisted living facility administrator, enhanced services facility administrator, or adult family home resident manager, of any home subject to temporary management, revocation or summary suspension of the home's license, stop placement of admissions order, condition on the license related to resident care, or civil fine of five thousand dollars or more, while the instructor was the licensee, administrator, or resident manager;
(f) The home has been operated under temporary management or has been subject to a revocation or suspension of the home license, stop placement of admissions order, condition on the license related to resident care, or civil fine of five thousand dollars or more, within the previous eighteen months.
(2) Nothing in this section shall be construed to limit the authority of DSHS under this chapter to require the immediate enforcement, pending any appeal, of a condition on the home license prohibiting the home from conducting its own training programs.
SECTION XII—INSTRUCTOR APPROVAL
NEW SECTION
WAC 388-112A-1200 What are the training entity's responsibilities?
The training entity is responsible for:
(1) Coordinating and teaching classes;
(2) Assuring that the curriculum used is taught as designed;
(3) Selecting qualified guest speakers where applicable;
(4) Establishing a method whereby the long-term care worker can ask the instructor questions;
(5) Administering or overseeing the administration of DSHS competency and challenge tests;
(6) Maintaining training records electronically or on paper including long-term care worker certificates and attendance records for a minimum of six years;
(7) Reporting training data to DSHS when requested by the department; and
(8) Issuing or reissuing training certificates to long-term care workers.
NEW SECTION
WAC 388-112A-1210 Must training entities and their instructors be approved by DSHS?
Training entities and their instructors must be approved by DSHS as follows:
(1) For DSHS contracted training entities:
(a) DSHS must approve or approve and contract with a training entity and its instructor(s) to conduct orientation, safety training, basic training, population specific training, residential care administrator training, specialty training, nurse delegation core and specialized diabetes training, on-the-job training, and continuing education.
(b) DSHS may select training entities using any applicable contracting procedures. Contractors must meet the minimum qualifications for instructors under this chapter and any additional qualifications established through the contracting procedure.
(2) Homes that conduct their own training using the training curricula developed by DSHS or another curriculum approved by DSHS must ensure, through an attestation process, that their instructors meet the minimum qualifications for instructors under this chapter.
NEW SECTION
WAC 388-112A-1220 May DSHS deny or terminate a contract or rescind approval of an instructor or training entity?
(1) DSHS may deny a person or organization seeking a contract with or approval by DSHS to conduct orientation, continuing education, or safety, basic, population specific, adult family home administrator, specialty, nurse delegation core, or specialized diabetes training. No administrative remedies are available to dispute DSHS's decision not to contract with or approve a person or organization, except as may be provided through the contracting process.
(2) DSHS may terminate an existing training contract in accordance with the terms of the contract. The contractor's administrative remedies are limited to those specified in the contract.
(3) DSHS may terminate an existing training approval of a person or entity to conduct orientation, continuing education, or safety, basic, population specific, residential care administrator, specialty, nurse delegation core, or diabetes training.
NEW SECTION
WAC 388-112A-1230 What is a guest speaker and what are the minimum qualifications to be a guest speaker?
(1) A guest speaker is a person selected by an approved instructor to teach a specific topic. A guest speaker:
(a) May only teach a specific subject in which they has expertise and their background and experience demonstrates expertise on the topic they will teach.
(b) May not teach the entire course;
(c) Must not supplant the primary teaching responsibilities of the primary instructor; and
(d) Must cover the DSHS competencies and learning objectives for the topic the guest speaker is teaching.
(2) The approved instructor:
(a) Must select a guest speaker based on his or her knowledge and experience in the specific topic;
(b) Maintain documentation of the guest speaker's qualifications and experience;
(c) Supervise and monitor the guest speaker's performance; and
(d) Is responsible for insuring the required content is taught.
(3) DSHS does not approve guest speakers.
NEW SECTION
WAC 388-112A-1240 What are the minimum qualifications for an instructor for core basic, population specific, on-the-job, residential care administrator, nurse delegation core, and specialized diabetes trainings?
An instructor for core basic, population specific, on-the-job, residential care administrator, nurse delegation core, and nurse delegation specialized diabetes trainings must meet the following minimum qualifications:
(1) Twenty-one years of age;
(2) Has not had a professional health care, adult family home, assisted living facility, or social services license or certification revoked in Washington state; and
(3) Meets one or more of the following education or work experience requirements upon initial approval or hire:
(a) Is a registered nurse with work experience within the last five years with the elderly or persons with disabilities requiring long-term care in a community setting;
(b) Has an associate degree or higher degree in the field of health or human services and six months professional or caregiving experience within the last five years in a community based setting or an adult family home, enhanced services facility, assisted living facility, supported living through the developmental disabilities administration (DDA), or home care setting;
(c) Has a high school diploma or equivalent and one year of professional or caregiving experience within the last five years in an adult family home, enhanced services facility, assisted living, supported living through DDA, or home care setting;
(4) Meets one or more of the following teaching experience requirements:
(a) One hundred hours of experience teaching adults in an appropriate setting on topics directly related to basic training or basic training topics that may be offered as continuing education;
(b) Forty hours of teaching basic training while being mentored by an instructor who is approved to teach basic training;
(c) Instructors with adult family homes, enhanced services facilities, and assisted living facilities that do not meet the criteria in (a) or (b) of this subsection, must have and attest to the following experience in their application:
(i) Forty hours of informal teaching experiences unrelated to basic training topics such as guest lecturing, team teaching, and volunteer teaching with parks, local high schools, 4-H groups, English as a second language (ESL) groups, senior organizations, and religious organizations;
(ii) Three adult learning techniques that the instructor will implement in his or her long-term care worker training; and
(iii) Three ways the instructor plans on improving his or her instructional facilitation and the method the instructor will use to measure improvement such as submitting the continuous improvement plan feedback from the DSHS adult education class;
(5) Except for instructors for nurse delegation core and diabetes training, completion of a class on adult education that meets the requirements of WAC 388-112A-1297;
(6) The instructor must be experienced in caregiving practices and capable of demonstrating competency with respect to teaching the course content or units taught;
(7) Instructors who will administer tests must have experience or training in assessment and competency testing;
(8) Community instructors for nurse delegation core and diabetes training must have a current Washington registered nurse (RN) license in good standing without practice restrictions;
(9) Facility instructors must be approved and contracted by the department as a community instructor in order to be approved to teach the following classes:
(a) Nurse delegation core;
(b) Nurse delegation diabetes training; or
(c) DSHS adult education training curriculum.
NEW SECTION
WAC 388-112A-1250 What are the minimum qualifications for community instructors for adult education training using DSHS curriculum?
(1) The minimum qualifications for community instructors of adult education training using DSHS curriculum, in addition to the general qualifications in WAC 388-112A-1240 (1) and (2), include:
(a) The instructor must be experienced in adult education practices and capable of demonstrating competency in the entire course content;
(b) Education:
(i) Has a bachelor's degree or is a registered nurse with at least one year of education in seminars, conferences, continuing education, or in college classes in subjects directly related to adult education, such as, but not limited to English as a second language (ESL), adult basic education, and adult secondary education (one year of education equals twenty-four semester credits in a semester system, thirty-six quarter credits in a quarter system, or at least eighty hours of seminars, conferences, and continuing education); and
(ii) Successful completion of the DSHS adult education training curriculum prior to beginning to train others;
(c) Meets one or more of the following teaching experience requirements:
(i) Two years experience teaching long-term care workers; or
(ii) Two hundred hours experience teaching adult education or closely related subjects;
(d) Successful completion of the DSHS instructor qualification/demonstration process; and
(e) Instructor approved and contracted by the department as a community instructor.
(2) Instructors that administer tests must have experience or training in assessment and competency testing.
NEW SECTION
WAC 388-112A-1260 What are the minimum qualifications for an instructor for orientation, safety training, and continuing education?
(1) An instructor for orientation and safety training, must be a registered nurse or other person with specific knowledge, training, and work experience relevant to the topics required in orientation and safety training. Facility training programs and their orientation and safety training instructors will be approved at the time of the facility licensing as provided in WAC 388-112A-1000(4).
(2) An instructor for continuing education must be a registered nurse or other person that is proficient in the content they cover in the course or have specific knowledge, training, or experience in the provision of direct, personal care, or other relevant services to the elderly or persons with disabilities requiring long-term care.
NEW SECTION
WAC 388-112A-1270 What are the minimum qualifications for community instructors for mental health specialty training?
(1) The minimum qualifications for community instructors for mental health specialty training, in addition to the general qualifications in WAC 388-112A-1240 (1) and (2), include:
(a) The instructor must be experienced in mental health caregiving practices and capable of demonstrating competency in the entire course content;
(b) Education:
(i) Bachelor's degree, registered nurse, or mental health specialist, with at least one year of education in seminars, conferences, continuing education, or accredited college classes, in subjects directly related to mental health, including, but not limited to, psychology (one year of education equals twenty-four credits in a semester system, thirty-six credits in a quarter system, or at least eighty hours of seminars, conferences, and continuing education); and
(ii) Successful completion of the mental health specialty training class before the instructor trains others;
(c) Work experience: Two years full-time equivalent direct work experience with people who have a mental illness; and
(d) Teaching experience:
(i) Two hundred hours experience teaching long-term care related subjects;
(ii) Successful completion of an adult education class that meets the requirements of WAC 388-112A-1297;
(iii) Successful completion of the DSHS instructor qualification/demonstration process; and
(iv) The instructor has been approved and contracted by the department as a community instructor;
(e) Instructors who will administer tests must have experience or training in assessment and competency testing; and
(2) Five years of full-time equivalent direct work experience with people who have a mental illness may substitute for either:
(a) The credential described in subsection (1)(b)(i) of this section; or
(b) The one year of education in college classes or eighty hours in seminars, conferences, continuing education described in subsection (1)(b)(ii).
(3) If your status is an approved instructor for mental health specialty training, you may instruct a new mental health specialty training curriculum after submitting to the department a copy of a certificate of completion for that curriculum and a copy of a certificate of completion of an adult education class that meets the requirements of WAC 388-112A-1297.
NEW SECTION
WAC 388-112A-1280 What are the minimum qualifications for facility training program instructors for mental health specialty training?
(1) The minimum qualifications for facility instructors to teach mental health specialty training is to meet the requirements in WAC 388-112A-1240. The facility instructor must submit an application attesting to those qualifications and submit copies of certificates of completion for the mental health specialty training curriculum they would like to teach and a copy of a certificate of completion of an adult education class that meets the requirements of WAC 388-112A-1297.
(a) Facility instructors must be approved prior to teaching the class.
(b) A qualified instructor under this subsection may teach specialty training to long-term care workers employed at other homes licensed by the same licensee.
(2) If your status is an approved instructor for mental health specialty training, you may instruct a new mental health specialty training curriculum after submitting to the department a copy of a certificate of completion for that curriculum and a copy of a certificate of completion of an adult education class that meets the requirements of WAC 388-112A-1297.
NEW SECTION
WAC 388-112A-1285 What are the minimum qualifications for community instructors for dementia specialty training?
(1) The minimum qualifications for instructors for dementia specialty, in addition to the general qualifications defined in WAC 388-112A-1240 (1) and (2) include:
(a) The instructor must be experienced in dementia caregiving practices and capable of demonstrating competency in the entire course content;
(b) Education:
(i) Bachelor's degree, registered nurse, or mental health specialist, with at least one year of education in seminars, conferences, continuing education or college classes, in dementia or subjects directly related to dementia, such as, but not limited to, psychology (one year of education equals twenty-four credits in a semester system, thirty-six credits in a quarter system, or at least eighty hours of seminars, conferences, or continuing education); and
(ii) Successful completion of the dementia specialty training, prior to beginning to train others;
(c) Work experience: Two years full-time equivalent direct work experience with people who have dementia;
(d) Teaching experience:
(i) Two hundred hours experience teaching long-term care related subjects;
(ii) Successful completion of an adult education class that meets the requirements of WAC 388-112A-1297;
(iii) Successful completion of the DSHS instructor qualification/demonstration process; and
(iv) The instructor has been approved and contracted by the department as a community instructor;
(e) Instructors who will administer tests must have experience or training in assessment and competency testing.
(2) Five years of full-time equivalent direct work experience with people who have dementia may substitute for either:
(a) The credential (bachelor's degree, registered nurse, or mental health specialist) described in subsection (1)(b)(i) of this section; or
(b) The one year of education in college classes or eighty hours in seminars, conferences, continuing education described in subsection (1)(b)(ii) of this section.
(3) If your status is an approved instructor for dementia specialty training, you may instruct a new dementia specialty training curriculum after submitting to the department a copy of a certificate of completion for that curriculum and a copy of a certificate of completion of an adult education class that meets the requirements of WAC 388-112A-1297.
NEW SECTION
WAC 388-112A-1290 What are the minimum qualifications for facility training program instructors for dementia specialty training?
(1) The minimum qualifications for facility instructors to teach dementia specialty training is to meet the requirements in WAC 388-112A-1240. The facility instructor must submit an application attesting to those qualifications and submit copies of certificates of completion for the dementia specialty training curriculum they would like to teach and a copy of a certificate of completion of an adult education class that meets the requirements of WAC 388-112A-1297.
(a) Facility instructors must be approved prior to teaching the class.
(b) A qualified instructor under this section may teach specialty training to long-term care workers employed at other home(s) licensed by the same licensee.
(2) If your status is an approved instructor for dementia specialty training, you may instruct a new dementia specialty training curriculum after submitting to the department a copy of a certificate of completion for that curriculum and a copy of a certificate of completion of an adult education class that meets the requirements of WAC 388-112A-1297.
NEW SECTION
WAC 388-112A-1295 What are the minimum qualifications for instructors for developmental disabilities specialty training?
(1) Instructors for developmental disabilities specialty training must meet the minimum qualifications in WAC 388-112A-1240 (1) and (2) and the following minimum qualifications:
(a) The instructor must be experienced in developmental disabilities caregiving practices and capable of demonstrating competency in the entire course content;
(b) Education and work experience:
(i) Bachelor's degree with at least two years of full-time work experience in the field of disabilities; or
(ii) High school diploma or equivalent, with four years full-time work experience in the field of developmental disabilities, including two years full-time direct work experience with people who have a developmental disability;
(c) Successful completion of the developmental disabilities specialty training under WAC 388-112A-0420;
(d) Teaching experience:
(i) Two hundred hours of teaching experience;
(ii) Successful completion of an adult education class that meets the requirements of WAC 388-112A-1297; and
(iii) Successful completion of the DSHS instructor qualification/demonstration process; and
(e) Has been approved and contracted by the department as a community instructor.
(2) Instructors who will administer tests must have experience in assessment and competency testing.
(3) Developmental disabilities specialty training may be taught by an assisted living facility administrator or designee, enhanced services facility administrator or designee, adult family home provider or designee, or corporate trainer, who has successfully completed the following:
(a) Developmental disabilities specialty training under WAC 388-112A-0420;
(b) DSHS instructor qualification/demonstration process; and
(c) Adult education class that meets the requirements of WAC 388-112A-1297.
(4) A qualified instructor under this section may teach developmental disabilities specialty training to long-term care workers employed at other homes licensed by the same licensee.
NEW SECTION
WAC 388-112A-1297 What must be included in an adult education class and which instructors must complete it?
(1) A class on adult education must include content, student practice, and evaluation of student skills by the instructor in:
(a) Adult education theory and practice principles;
(b) Instructor facilitation techniques;
(c) Facilitating learning activities for adults;
(d) Administering competency testing and assessment; and
(e) Working with adults with special training needs like limited English proficiency, learning disabilities, or both.
(2) Instructors who request approval to teach core basic, population specific, on-the-job, residential care administrator, and specialty trainings must complete the DSHS adult education class or an adult education class that meets the criteria in subsection (1) of this section and provide a copy of the certificate of completion.
SECTION XIII—PHYSICAL RESOURCES AND STANDARD PRACTICES FOR TRAINING
NEW SECTION
WAC 388-112A-1300 What physical resources are required for classroom training and testing?
(1) The training entity must provide accessible classroom facilities to students and provide adequate space for learning activities, comfort, lighting, lack of disturbance, and tools for effective teaching and learning such as white boards and flip charts. The training entity must maintain appropriate supplies and equipment for teaching and practice of caregiving skills in the class being taught.
(2) The training entity must provide testing sites with adequate space for testing, comfort, lighting, and lack of disturbance appropriate for the written or skills test being conducted. The training entity must maintain appropriate supplies and equipment necessary for the particular test.
NEW SECTION
WAC 388-112A-1310 The training entity must maintain standard training practices for classroom training and testing.
The training entity must maintain the following training standards for classroom training and testing:
(1) Training must not exceed eight hours within one day;
(2) Training provided in short time segments must include an entire unit, skill, or concept;
(3) Training must include regular breaks; and
(4) Long-term care workers attending a classroom training must not be expected to leave the class to attend to job duties, except in an emergency.
REPEALER
The following sections of the Washington Administrative Code are repealed:
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