BILL REQ. #:  H-1384.1 

Read first time 02/10/2003.   Referred to Committee on Health Care.

     AN ACT Relating to fairness and protection in boarding homes and adult family homes; amending RCW 18.20.020, 18.20.050, 18.20.110, 18.20.115, 18.20.120, 18.20.125, 18.20.185, 18.20.190, 18.20.195, 70.128.060, 70.128.080, 70.128.090, 70.128.160, 74.39A.009, 74.39A.050, 74.39A.060, and 74.39A.080; reenacting and amending RCW 18.20.010 and 70.128.010; and prescribing penalties.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1   RCW 18.20.010 and 2000 c 171 s 3 and 2000 c 121 s 1 are each reenacted and amended to read as follows:
     The purpose of this chapter is to provide for the development, establishment, and enforcement of standards for the maintenance and operation of boarding homes, which, in the light of advancing knowledge, will promote safe and adequate care of the individuals therein. It is further the intent of the legislature that boarding homes be available to meet the needs of those for whom they care by recognizing the capabilities of individuals to direct their self-medication or to use supervised self-medication techniques when ordered and approved by a physician licensed under chapter 18.57 or 18.71 RCW or a podiatric physician and surgeon licensed under chapter 18.22 RCW.
     The legislature finds that many residents of community-based long-term care facilities are vulnerable and their health and well-being are dependent on their caregivers. The quality, skills, and knowledge of their caregivers are often the key to good care. The legislature finds that the need for well-trained caregivers is growing as the state's population ages and residents' needs increase. The legislature intends that current training standards be enhanced.
     The legislature declares that the state of Washington has a compelling interest in protecting and promoting the health, safety, and well-being of the vulnerable adults residing in boarding homes. The legislature recognizes that boarding homes are a vital part of the state's long-term care system and offer a valued and desirable setting for care and services. It is the intent of the legislature that residents and the public be assured through trainings, technical assistance, and appropriate oversight and enforcement by the department that boarding homes are safe, well-regulated facilities providing a high quality of life and care to residents.

Sec. 2   RCW 18.20.020 and 2000 c 47 s 1 are each amended to read as follows:
     ((As used in this chapter:)) The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Aged person" means a person of the age sixty-five years or more, or a person of less than sixty-five years who by reason of infirmity requires domiciliary care.
     (2) "Boarding home" means any home or other institution, however named, which is advertised, announced, or maintained for the express or implied purpose of providing board and domiciliary care to seven or more aged persons not related by blood or marriage to the operator. However, a boarding home that is licensed to provide board and domiciliary care to three to six persons on July 1, 2000, may maintain its boarding home license as long as it is continually licensed as a boarding home. "Boarding home" shall not include facilities certified as group training homes pursuant to RCW 71A.22.040, nor any home, institution or section thereof which is otherwise licensed and regulated under the provisions of state law providing specifically for the licensing and regulation of such home, institution or section thereof. Nor shall it include any independent senior housing, independent living units in continuing care retirement communities, or other similar living situations including those subsidized by the department of housing and urban development. However, independent living units that are located within the boarding home premises may be subject to inspection, as set forth in rule by the department, if the department determines that conditions or activities from the unit or units may detrimentally impact the health, safety, or well-being of residents in the boarding home.
     (3) "Person" means any individual, firm, partnership, corporation, company, association, or joint stock association, and the legal successor thereof.
     (4) "Secretary" means the secretary of social and health services.
     (5) "Department" means the state department of social and health services.
     (6) "Harm" means a physical, mental, or emotional injury or damage to a resident, including from neglect or a violation of a resident's rights. Examples of harm include, but are not limited to: Shallow bruising, lacerations, or other injuries that can be treated with first aid; dehydration not requiring professional intervention; yelling or ridicule of a resident that is not repeated or part of a pattern; leaving a resident unassisted on the toilet for an unnecessary, prolonged period of time; leaving a resident to lie in urine or feces; failing to assist a resident needing help with eating; transferring a resident within the facility without prior notice; or failing to include a resident or the resident's representative in care planning. Incidents that cause harm may, if repeated or prolonged, result in substantial harm.
     (7) "Substantial harm" means harm that causes significant physical, mental, or emotional suffering to a resident, or is a significant violation of a resident's rights. Examples of substantial harm include, but are not limited to: Deep bruising; laceration requiring sutures; fracture; burn; dehydration or malnutrition requiring the intervention of a licensed health care professional; retaliation against a resident for filing a complaint with the department or the ombudsman, such as by withholding or reducing needed care, threatening to discharge the resident, or threatening to cut off communication with family or friends; bruising in areas not generally exposed to trauma, such as the head, neck, inner thigh, and anal area; any sexual assault or suspected sexual assault; any pattern of or repeated assault or injury between the same residents or involving the same resident; or any injury requiring close assessment or monitoring by a licensed health care professional.
     (8) "Serious violation" means a violation cited by the department of this chapter, the rules adopted under this chapter, or other applicable law, that causes substantial harm to a resident.
     (9) "Uncorrected violation" means the department has cited the boarding home for a violation of this chapter, the rules adopted under this chapter, or other applicable law, and the violation is not corrected at the time the department makes an on-site revisit, inspection, or investigation to determine whether the violation has been corrected.
     (10) "Recurring problem" means the department has cited the boarding home three times within a three-year period for the same or substantially the same violation of this chapter, the rules adopted under this chapter, or other applicable law.

Sec. 3   RCW 18.20.050 and 2001 c 193 s 10 are each amended to read as follows:
     Upon receipt of an application for license, if the applicant and the boarding home facilities meet the requirements established under this chapter, the department shall issue a license. If there is a failure to comply with the provisions of this chapter or the standards and rules adopted pursuant thereto, the department may in its discretion issue to an applicant for a license, or for the renewal of a license, a provisional license which will permit the operation of the boarding home for a period to be determined by the department, but not to exceed twelve months, which provisional license shall not be subject to renewal. At the time of the application for or renewal of a license or provisional license the licensee shall pay a license fee as established by the department under RCW 43.20B.110. All licenses issued under the provisions of this chapter shall expire on a date to be set by the department, but no license issued pursuant to this chapter shall exceed twelve months in duration. However, when the annual license renewal date of a previously licensed boarding home is set by the department on a date less than twelve months prior to the expiration date of a license in effect at the time of reissuance, the license fee shall be prorated on a monthly basis and a credit be allowed at the first renewal of a license for any period of one month or more covered by the previous license. All applications for renewal of a license shall be made not later than thirty days prior to the date of expiration of the license. Each license shall be issued only for the premises and persons named in the application, and no license shall be transferable or assignable. Licenses shall be posted in a conspicuous place on the licensed premises.
     A licensee who receives notification of the department's initiation of a denial, suspension, nonrenewal, or revocation of a boarding home license may, in lieu of appealing the department's action, surrender or relinquish the license. The department shall not issue a new license to or contract with the licensee, for the purposes of providing care to vulnerable adults or children, for a period of twenty years following the surrendering or relinquishment of the former license. The licensing record shall indicate that the licensee relinquished or surrendered the license, without admitting the violations, after receiving notice of the department's initiation of a denial, suspension, nonrenewal, or revocation of a license.
     The department shall establish, by rule, the circumstances requiring a change in licensee, which include, but are not limited to, a change in ownership or control of the boarding home or licensee, a change in the licensee's form of legal organization, such as from sole proprietorship to partnership or corporation, and a dissolution or merger of the licensed entity with another legal organization. The new licensee is subject to the provisions of this chapter, the rules adopted under this chapter, and other applicable law. In order to ensure that the safety of residents is not compromised by a change in licensee, the new licensee is responsible for correction of all violations that may exist at the time of the new license, including compliance with any plan of correction in effect immediately prior to the change in licensee. If any person affiliated with the new licensee was affiliated with a prior licensee at the same boarding home, then the prior licensee's compliance and enforcement record becomes part of the new licensee's record at the boarding home. A person is considered affiliated with a licensee if the person is an applicant for the boarding home license, or is listed on the license application as a partner, officer, director, managerial employee, or owner of five percent or more of the applying entity.

Sec. 4   RCW 18.20.110 and 2000 c 47 s 4 are each amended to read as follows:
     The department shall make or cause to be made at least a yearly inspection and investigation of all boarding homes. Every inspection shall focus primarily on actual or potential resident outcomes, and may include an inspection of every part of the premises and an examination of all records (other than financial records, which may be examined to the extent relevant to verifying the ability to adequately care for residents), methods of administration, the general and special dietary, and the stores and methods of supply. Following such an inspection or inspections, written notice of any violation of this law or the rules adopted hereunder shall be given to the applicant or licensee and the department. The department may prescribe by rule that any licensee or applicant desiring to make specified types of alterations or additions to its facilities or to construct new facilities shall, before commencing such alteration, addition, or new construction, submit plans and specifications therefor to the agencies responsible for plan reviews for preliminary inspection and approval or recommendations with respect to compliance with the rules and standards herein authorized.

Sec. 5   RCW 18.20.115 and 2001 c 85 s 1 are each amended to read as follows:
     The department shall, within available funding for this purpose, develop and make available to boarding homes and residents a quality improvement ((consultation)) information program using the following principles:
     (1) The system shall be resident-centered and promote privacy, independence, dignity, choice, and a home or home-like environment for residents consistent with chapter 70.129 RCW.
     (2) The goal of the system is continuous quality improvement of the boarding home's care and services, with the focus on resident satisfaction and positive outcomes for residents. The quality improvement ((consultation)) information program shall be offered to boarding homes and resident councils or similar groups of residents, on a voluntary basis. Based on requests for the services of the quality improvement ((consultation)) information program, the department may establish a process for prioritizing service availability.
     (3) Boarding homes should be supported in their efforts to improve quality and address problems, as identified by the licensee, initially through training, ((consultation)) information, and technical assistance. At a minimum, the department may, within available funding, at the request of the boarding home, conduct on-site visits and provide information over the telephone ((consultations)).
     (4) To facilitate collaboration and trust between the boarding homes and the department's quality improvement ((consultation)) information program staff, the ((consultation)) information program staff shall not simultaneously serve as department licensors, complaint investigators, or participate in any enforcement-related decisions, within the region in which they perform ((consultation)) information activities; except such staff may investigate on an emergency basis, complaints anywhere in the state when the complaint indicates high risk to resident health or safety. Any records or information gained as a result of their work under the quality improvement ((consultation)) information program shall not be disclosed to or shared with nonmanagerial department licensing or complaint investigation staff, unless necessary to carry out duties described under chapter 74.34 RCW. The emphasis should be on problem prevention. Nothing in this section shall limit or interfere with the ((consultant's)) information staff's mandated reporting duties under chapter 74.34 RCW.
     (5) The department shall develop with input from interested stakeholders a component of the quality improvement information program to be responsive to requests for information from boarding home resident councils and similar groups, and to provide the department with an opportunity to hear the general concerns and questions residents and their representatives may have. The department information may address such topics as how to better participate in the care planning process, aging in place principles, and summaries of licensing standards and regulations. The quality improvement information program shall not replace the complaint investigation or licensing inspection processes. The resident component of the quality improvement information program shall be funded from a reasonable portion of the funding available for the overall program and may be offered initially on a pilot program basis.
     (6) The department shall promote the development of a training system that is practical and relevant to the needs of residents and staff. To improve access to training, especially for rural communities, the training system may include, but is not limited to, the use of satellite technology distance learning that is coordinated through community colleges or other appropriate organizations.

Sec. 6   RCW 18.20.120 and 2000 c 47 s 5 are each amended to read as follows:
     All information received by the department through filed reports, inspections, or as otherwise authorized under this chapter ((shall not be disclosed publicly in any manner as to identify individuals or boarding homes, except at the specific request of a member of the public and disclosure is consistent with RCW 42.17.260(1))), or used by the department in connection with this chapter, is a public record and is subject to disclosure except as prohibited by RCW 42.17.260(1).

Sec. 7   RCW 18.20.125 and 2001 c 85 s 2 are each amended to read as follows:
     (1) Monitoring ((should)) of boarding homes through license inspections and complaint investigations shall be outcome based and responsive to ((resident)) the concerns and complaints ((and)) of residents, their family members, advocates, facility staff, and others. The department's monitoring shall be based on a clear set of health, quality of care, and safety standards that are easily understandable and have been made available to ((facilities. This includes that)) boarding homes, residents, and other interested parties. When conducting ((licensing)) license inspections, the department shall interview an appropriate percentage of residents, family members, and advocates in addition to interviewing appropriate staff. During license inspections, the department shall provide both the boarding home and residents and their representatives the opportunity to provide additional or clarifying information about concerns. The process should be as even-handed and open as possible, with due regard for confidentiality requirements. The department shall adopt rules setting forth the monitoring and enforcement processes for license inspections and complaint investigations.
     (2) ((Prompt and specific enforcement remedies shall also be implemented without delay, consistent with RCW 18.20.190, for facilities found to have delivered care or failed to deliver care resulting in problems that are serious, recurring, or uncorrected, or that create a hazard that is causing or likely to cause death or serious harm to one or more residents. These enforcement remedies may also include, when appropriate, reasonable conditions on a license. In the selection of remedies, the safety, health, and well-being of residents shall be of paramount importance.
     (3))) When the department finds in any inspection or investigation that the boarding home has failed or refused to comply with the requirements of this chapter, the rules adopted under this chapter, or other applicable law, the department shall issue a written citation and require the boarding home to correct the violation or violations. The department may provide technical assistance and information to the boarding home, residents, and their representatives. Consistent with this chapter, the department may impose enforcement actions provided for in RCW 18.20.190, and shall impose enforcement actions when required by this chapter. The facility's plan of correction shall not be considered an enforcement action. In the selection of remedies by the department, the safety, health, and well-being of residents shall be of paramount importance. The department shall take appropriate steps to verify correction of violations, as set forth in RCW 18.20.190.
     (3) Boarding homes cited by the department in any inspection or investigation for a serious violation, uncorrected violation, or recurring problem shall be sanctioned with one or more of the enforcement actions set forth in RCW 18.20.190. Enforcement actions required under this subsection shall be imposed promptly and corrective action implemented without delay.
     (4) To the extent funding is available, the licensee, administrator, and their staff should be screened through background checks in a uniform and timely manner to ensure that they do not have a criminal history that would disqualify them from working with vulnerable adults. Employees may be provisionally hired pending the results of the background check if they have been given three positive references.
     (((4))) (5) No licensee, administrator, or staff, or prospective licensee, administrator, or staff, with a stipulated finding of fact, conclusion of law, and agreed order, or finding of fact, conclusion of law, or final order issued by a disciplining authority, a court of law, or entered into the state registry finding him or her guilty of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW shall be employed in the care of and have unsupervised access to vulnerable adults.

Sec. 8   RCW 18.20.185 and 2001 c 193 s 2 are each amended to read as follows:
     (1) The department shall establish and maintain a toll-free telephone number for receiving complaints regarding a facility that the department licenses.
     (2) All facilities that are licensed under this chapter shall post in a place and manner clearly visible to residents and visitors the department's toll-free complaint telephone number and the toll-free number and program description of the long-term care ombudsman as provided by RCW 43.190.050.
     (3) The department shall investigate complaints if the subject of the complaint is within its authority unless the department determines that: (a) The complaint is intended to willfully harass a licensee or employee of the licensee; or (b) there is no reasonable basis for investigation; or (c) corrective action has been taken as determined by the ombudsman or the department.
     (4) The department shall refer complaints to appropriate state agencies, law enforcement agencies, the attorney general, the long-term care ombudsman, or other entities if the department lacks authority to investigate or if its investigation reveals that a follow-up referral to one or more of these entities is appropriate.
     (5) The department shall adopt rules that include the following complaint investigation protocols:
     (a) Upon receipt of a complaint, the department shall make a preliminary review of the complaint, assess the severity of the complaint, and assign an appropriate response time. Complaints involving imminent danger to the health, safety, or well-being of a resident must be responded to within two days. When appropriate, the department shall make an on-site investigation within a reasonable time after receipt of the complaint or otherwise ensure that complaints are responded to.
     (b) The complainant must be: Promptly contacted by the department, unless anonymous or unavailable despite several attempts by the department, and informed of the right to discuss alleged violations with the inspector and to provide other information the complainant believes will assist the inspector; informed of the department's course of action; and informed of the right to receive a written copy of the investigation report.
     (c) In conducting the investigation, the department shall interview the complainant, unless anonymous, and shall use its best efforts to interview the resident or residents allegedly harmed by the violations, and, in addition to facility staff, any available independent sources of relevant information, including if appropriate the family members of the resident. Prior to completing the investigation, the department shall give the complainant the opportunity to provide additional or clarifying information.
     (d) Substantiated complaints involving harm to a resident, if an applicable law or regulation has been violated, shall be subject to one or more of the enforcement actions provided in RCW 18.20.190 (2) and (3). Whenever appropriate, the department ((shall)) may also give ((consultation)) information and technical assistance to the facility, complainant, resident, and other interested parties, subject to confidentiality restrictions.
     (e) ((After a department finding of a violation for which a stop placement has been imposed, the department shall make an on-site revisit of the provider within fifteen working days from the request for revisit, to ensure correction of the violation. For violations that are serious or recurring or uncorrected following a previous citation, and create actual or threatened harm to one or more residents' well-being, including violations of residents' rights, the department shall make an on-site revisit as soon as appropriate to ensure correction of the violation. Verification of correction of all other violations may be made by either a department on-site revisit or by written or photographic documentation found by the department to be credible. This subsection does not prevent the department from enforcing license suspensions or revocations. Nothing in this subsection shall interfere with or diminish the department's authority and duty to ensure that the provider adequately cares for residents, including to make departmental on-site revisits as needed to ensure that the provider protects residents, and to enforce compliance with this chapter.
     (f))) Substantiated complaints of neglect, abuse, financial exploitation, or abandonment of residents, or suspected criminal violations, shall also be referred by the department to the appropriate law enforcement agencies, the attorney general, and appropriate professional disciplining authority.
     (6) The department may provide the substance of the complaint to the licensee before the completion of the investigation by the department unless such disclosure would reveal the identity of a complainant, witness, or resident who chooses to remain anonymous. Neither the substance of the complaint provided to the licensee ((or contractor)) nor any copy of the complaint or related report published, released, or made otherwise available shall disclose, or reasonably lead to the disclosure of, the name, title, or identity of any complainant, or other person mentioned in the complaint, except that the name of the provider and the name or names of any officer, employee, or agent of the department conducting the investigation shall be disclosed after the investigation has been closed and the complaint has been substantiated. The department may disclose the identity of the complainant or any other person mentioned in the complaint if such disclosure is requested in writing by the ((complainant)) person whose identity is to be disclosed. Nothing in this subsection shall be construed to interfere with the obligation of the long-term care ombudsman program to monitor the department's licensing, contract, and complaint investigation files for long-term care facilities.
     (7) The resident has the right to be free of interference, coercion, discrimination, and reprisal from a facility in exercising his or her rights, including the right to voice grievances about treatment furnished or not furnished. A facility licensed under this chapter shall not discriminate or retaliate in any manner against a resident, employee, or any other person on the basis or for the reason that such resident or any other person made a complaint to the department, the attorney general, law enforcement agencies, or the long-term care ombudsman, provided information, or otherwise cooperated with the investigation of such a complaint. Any attempt to discharge a resident against the resident's wishes, or any type of retaliatory treatment of a resident by whom or upon whose behalf a complaint substantiated by the department has been made to the department, the attorney general, law enforcement agencies, or the long-term care ombudsman, within one year of the filing of the complaint, raises a rebuttable presumption that such action was in retaliation for the filing of the complaint. "Retaliatory treatment" means, but is not limited to, monitoring a resident's phone, mail, or visits; involuntary seclusion or isolation; transferring a resident to a different room unless requested or based upon legitimate management reasons; attempted discharge, transfer, or retaliatory treatment of a relative of the resident, if the relative is also a resident at the facility; withholding, reducing, or threatening to withhold or reduce food, services, or treatment unless agreed to by the resident or authorized by a terminally ill resident or his or her representative pursuant to law; or persistently delaying responses to a resident's request for service or assistance. A facility licensed under this chapter shall not willfully interfere with the performance of official duties by a long-term care ombudsman. The department shall sanction and may impose a civil penalty of not more than three thousand dollars for a violation of this subsection. The department shall require the facility to rectify to the extent possible the retaliatory treatment or other violation of this subsection.

Sec. 9   RCW 18.20.190 and 2001 c 193 s 4 are each amended to read as follows:
     (1) When the department finds that the boarding home has failed or refused to comply with the requirements of this chapter, the rules adopted under this chapter, or other applicable law, the department shall issue a written citation and require the boarding home to correct the violation or violations. In addition, the department ((of social and health services)) is authorized to take one or more of the enforcement actions listed in subsections (2) and (3) of this section in any case in which the department finds that a boarding home ((provider)) has:
     (a) Failed or refused to comply with the requirements of this chapter or the rules adopted under this chapter;
     (b) Operated a boarding home without a license or under a revoked license;
     (c) Knowingly, or with reason to know, made a false statement of material fact on his or her application for license or any data attached thereto, or in any matter under investigation by the department; or
     (d) Willfully prevented or interfered with any inspection or investigation by the department.
     (2) When authorized by subsection (1) of this section, and subject to the further criteria in subsection (3) of this section, the department may take one or more of the following enforcement actions:
     (a) Refuse to issue a license;
     (b) Impose reasonable conditions on a license, such as a directed plan of correction within a specified time, training, and limits on the type of clients the ((provider)) boarding home may admit or serve;
     (c) Impose civil penalties of not more than one hundred dollars per day per violation;
     (d) Suspend, revoke, or refuse to renew a license; ((or))
     (e) Suspend admissions to the boarding home by imposing stop placement; or
     (f) Seek an injunction under RCW 18.20.150.
     (3) The department shall adopt by rule criteria for the selection of enforcement actions. The criteria shall include, but not be limited to, the following requirements:
     (a) A reasonable condition on a license may not be the sole enforcement action imposed by the department for a serious violation, or for an uncorrected violation or recurring problem that harmed a resident;
     (b) A civil penalty for a serious violation, or an uncorrected violation or recurring problem that harmed a resident, shall be not less than one thousand dollars; a civil penalty for a violation of RCW 18.20.185(7) may be up to three thousand dollars; and the initial day of a civil penalty for violations involving harm to a resident may be the first day harm occurred;
     (c) A stop placement shall not be imposed unless there is a reasonable probability that harm to more than one resident will occur or reoccur as a result of the violation or violations;
     (d) A summary suspension shall not be imposed unless there is an imminent threat that substantial harm to more than one resident will occur as a result of a violation or violations; and
     (e) The department may revoke, deny, or refuse to renew a license when there is cause to summarily suspend the license; when there is a current violation and the boarding home has a history of significant noncompliance; when there is a very serious current violation, such as significant financial problems resulting in poor care and possible business failure; or for other good cause.
     (4) When the department orders stop placement, the ((facility)) boarding home shall not admit any new resident until the stop placement order is terminated. The department may approve readmission of a resident to the ((facility)) boarding home from a hospital or nursing home during the stop placement. The department shall terminate the stop placement when: (a) The violations necessitating the stop placement have been corrected; and (b) the ((provider)) boarding home exhibits the capacity to maintain correction of the violations previously found deficient. However, if upon the revisit the department finds new violations that the department reasonably believes will result in a new stop placement, the previous stop placement shall remain in effect until the new stop placement is imposed.
     (((4))) (5) The department shall take appropriate steps to verify correction of violations:
     (a) After a department finding of a violation for which a stop placement has been imposed, the department shall make an on-site revisit of the ((provider)) boarding home within fifteen working days from the request for revisit, to ensure correction of the violation. ((For violations that are serious or recurring or uncorrected following a previous citation, and create actual or threatened harm to one or more residents' well-being, including violations of residents' rights))
     (b) After a department citation for a serious violation, or for an uncorrected violation or recurring problem that harmed a resident, the department shall make an on-site revisit to the boarding home as soon as appropriate to ensure correction of the violation or problem. Depending on the extent of the threatened or actual harm to residents, the department's on-site revisit shall occur shortly after issuing the citation or may be initiated more than fifteen working days from notification of correction of the violation.
     (c) Verification of correction of all other violations may be made by either a department on-site revisit or by written or photographic documentation found by the department to be credible.
     (d) This ((subsection)) section does not prevent the department from enforcing license suspensions or revocations. Nothing in this ((subsection)) section shall interfere with or diminish the department's authority and duty to ensure that the ((provider)) boarding home adequately cares for residents, ((including)) to make ((departmental)) on-site revisits as needed to ensure that the ((provider)) boarding home protects residents, and to enforce compliance with this chapter, the rules adopted under this chapter, and other applicable law. The department shall adopt rules setting forth the monitoring and enforcement processes for license inspections and complaint investigations.
     (((5))) (6) RCW 43.20A.205 governs notice of a license denial, revocation, suspension, or modification. Chapter 34.05 RCW applies to department actions under this section, except that orders of the department imposing license suspension, stop placement, or conditions for continuation of a license are effective immediately upon notice and shall continue pending any hearing.

Sec. 10   RCW 18.20.195 and 2001 c 193 s 7 are each amended to read as follows:
     (1) Within available resources, the licensee or its designee has the right to an informal dispute resolution process to dispute any violation found or enforcement remedy imposed by the department during a licensing inspection or complaint investigation. The purpose of the informal dispute resolution process is to provide an opportunity for an exchange of information that may lead to the modification, deletion, or removal of a violation, or parts of a violation, or enforcement remedy imposed by the department. If the dispute concerns a complaint investigation, the complainant has the right to provide the department with additional or clarifying information before the department reaches a decision in the informal dispute resolution process. If the dispute concerns a licensing inspection, the resident council or other representatives of the residents have the right to provide the department with additional or clarifying information before the department reaches a decision in the informal dispute resolution process.
     (2) The informal dispute resolution process provided by the department shall include, but is not necessarily limited to, an opportunity for review by a department employee who did not participate in, or oversee, the determination of the violation or enforcement remedy under dispute. The department shall develop, or further develop, an informal dispute resolution process consistent with this section.
     (3) A request for an informal dispute resolution shall be made to the department within ten working days from the receipt of a written finding of a violation or enforcement remedy. The request shall identify the violation or violations and enforcement remedy or remedies being disputed. The department shall convene a meeting, when possible, within ten working days of receipt of the request for informal dispute resolution, unless by mutual agreement a later date is agreed upon.
     (4) If the department determines that a violation or enforcement remedy should not be cited or imposed, the department shall delete the violation or immediately rescind or modify the enforcement remedy. If the department determines that a violation should have been cited or an enforcement remedy imposed, the department shall add the citation and enforcement remedy. Upon request, the department shall issue a clean copy of the revised report, statement of deficiencies, or notice of enforcement action.
     (5) The request for informal dispute resolution does not delay the effective date of any enforcement remedy imposed by the department, except that civil monetary fines are not payable until the exhaustion of any formal hearing and appeal rights provided under this chapter. The licensee shall submit to the department, within the time period prescribed by the department, a plan of correction to address any undisputed violations, and including any violations that still remain following the informal dispute resolution.

Sec. 11   RCW 70.128.010 and 2001 c 319 s 6 and 2001 c 319 s 2 are each reenacted and amended to read as follows:
     Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
     (1) "Adult family home" means a residential home in which a person or persons provide personal care((,)) or special care((,)) and room((,)) and board to more than one but not more than six adults who are not related by blood or marriage to the person or persons providing the services.
     (2) "Provider" means any person who is licensed or required to be licensed under this chapter to operate an adult family home. For the purposes of this section, "person" means any individual, partnership, corporation, association, or limited liability company.
     (3) "Department" means the department of social and health services.
     (4) "Resident" means an adult in need of personal or special care in an adult family home who is not related to the provider.
     (5) "Adults" means persons who have attained the age of eighteen years.
     (6) "Home" means an adult family home.
     (7) "Imminent danger" means serious physical harm to or death of a resident has occurred, or there is a serious threat to resident life, health, or safety.
     (8) "Special care" means care beyond personal care as defined by the department, in rule.
     (9) "Capacity" means the maximum number of persons in need of personal or special care permitted in an adult family home at a given time. This number shall include related children or adults in the home and who received special care.
     (10) "Resident manager" means a person employed or designated by the provider to manage the adult family home.
     (11) "Harm" means a physical, mental, or emotional injury or damage to a resident, including from neglect or a violation of a resident's rights. Examples of harm include, but are not limited to: Shallow bruising, lacerations, or other injuries that can be treated with first aid; dehydration not requiring professional intervention; yelling or ridicule of a resident that is not repeated or part of a pattern; leaving a resident unassisted on the toilet for an unnecessary, prolonged period of time; leaving a resident to lie in urine or feces; failing to assist a resident needing help with eating; transferring a resident within the facility without prior notice; or failing to include a resident or the resident's representative in care planning. Incidents that cause harm may, if repeated or prolonged, result in substantial harm.
     (12) "Substantial harm" means harm that causes significant physical, mental, or emotional suffering to a resident, or is a significant violation of a resident's rights. Examples of substantial harm include, but are not limited to: Deep bruising; laceration requiring sutures; fracture; burn; dehydration or malnutrition requiring the intervention of a licensed health care professional; retaliation against a resident for filing a complaint with the department or the ombudsman, such as by withholding or reducing needed care, threatening to discharge the resident, or threatening to cut off communication with family or friends; bruising in areas not generally exposed to trauma, such as the head, neck, inner thigh, and anal area; any sexual assault or suspected sexual assault; any pattern of or repeated assault or injury between the same residents or involving the same resident; or any injury requiring close assessment or monitoring by a licensed health care professional.
     (13) "Serious violation" means a violation cited by the department of this chapter, the rules adopted under this chapter, or other applicable law, that causes substantial harm to a resident.
     (14) "Uncorrected violation" means the department has cited the adult family home for a violation of this chapter, the rules adopted under this chapter, or other applicable law, and the violation is not corrected at the time the department makes an on-site revisit, inspection, or investigation to determine whether the violation has been corrected.
     (15) "Recurring problem" means the department has cited the adult family home three times within a three-year period for the same or substantially the same violation of this chapter, the rules adopted under this chapter, or other applicable law.

Sec. 12   RCW 70.128.060 and 2001 c 193 s 9 are each amended to read as follows:
     (1) An application for license shall be made to the department upon forms provided by it and shall contain such information as the department reasonably requires.
     (2) Subject to the provisions of this section, the department shall issue a license to an adult family home if the department finds that the applicant and the home are in compliance with this chapter and the rules adopted under this chapter, unless (a) the applicant or a person affiliated with the applicant has prior violations of this chapter relating to the adult family home subject to the application or any other adult family home, or of any other law regulating residential care facilities within the past five years that resulted in revocation, suspension, or nonrenewal of a license or contract with the department; or (b) the applicant or a person affiliated with the applicant has a history of significant noncompliance with federal, state, or local laws, rules, or regulations relating to the provision of care or services to vulnerable adults or to children. A person is considered affiliated with an applicant if the person is listed on the license application as a partner, officer, director, resident manager, or owner of five percent or more of the applying entity.
     (3) The license fee shall be submitted with the application.
     (4) The department shall serve upon the applicant a copy of the decision granting or denying an application for a license. An applicant shall have the right to contest denial of his or her application for a license as provided in chapter 34.05 RCW by requesting a hearing in writing within twenty-eight days after receipt of the notice of denial.
     (5) The department shall not issue a license to a provider if the department finds that the provider or any partner, officer, director, managerial employee, or owner of five percent or more if the provider has a history of significant noncompliance with federal or state regulations, rules, or laws in providing care or services to vulnerable adults or to children.
     (6) The department shall license an adult family home for the maximum level of care that the adult family home may provide. The department shall define, in rule, license levels based upon the education, training, and caregiving experience of the licensed provider or staff.
     (7) The department shall establish, by rule, standards used to license nonresident providers and multiple facility operators.
     (8) The department shall establish, by rule, for multiple facility operators educational standards substantially equivalent to recognized national certification standards for residential care administrators.
     (9) The license fee shall be set at fifty dollars per year for each home. A fifty dollar processing fee shall also be charged each home when the home is initially licensed.
     (10) A provider who receives notification of the department's initiation of a denial, suspension, nonrenewal, or revocation of an adult family home license may, in lieu of appealing the department's action, surrender or relinquish the license. The department shall not issue a new license to or contract with the provider, for the purposes of providing care to vulnerable adults or children, for a period of twenty years following the surrendering or relinquishment of the former license. The licensing record shall indicate that the provider relinquished or surrendered the license, without admitting the violations, after receiving notice of the department's initiation of a denial, suspension, nonrenewal, or revocation of a license.
     (11) The department shall establish, by rule, the circumstances requiring a change in the licensed provider, which include, but are not limited to, a change in ownership or control of the adult family home or provider, a change in the provider's form of legal organization, such as from sole proprietorship to partnership or corporation, and a dissolution or merger of the licensed entity with another legal organization. The new provider is subject to the provisions of this chapter, the rules adopted under this chapter, and other applicable law. In order to ensure that the safety of residents is not compromised by a change in provider, the new provider is responsible for correction of all violations that may exist at the time of the new license, including compliance with any plan of correction in effect immediately prior to the change in provider. If any person affiliated with the new provider was affiliated with a prior provider at the same adult family home, then the prior provider's compliance and enforcement record becomes part of the new provider's record at the adult family home.

Sec. 13   RCW 70.128.080 and 1995 1st sp.s. c 18 s 23 are each amended to read as follows:
     An adult family home shall have readily available for review by the department, residents, and the public:
     (1) Its license to operate; and
     (2) A copy of each inspection and investigation report received by the home from the department for the past three years.

Sec. 14   RCW 70.128.090 and 2001 c 319 s 7 are each amended to read as follows:
     (1) During inspections of an adult family home, the department shall have access and authority to examine areas and articles in the home used to provide care or support to residents, including residents' records, accounts, and the physical premises, including the buildings, grounds, and equipment. The personal records of the provider are not subject to department inspection nor is the separate bedroom of the provider, not used in direct care of a client, subject to review. The department may inspect all rooms during the initial licensing of the home. However, during a complaint investigation, the department shall have access to the entire premises and all pertinent records when necessary to conduct official business. The department also shall have the authority to interview the provider and residents of an adult family home.
     (2) Whenever an inspection or investigation is conducted, the department shall prepare a written report that summarizes all information obtained ((during the inspection)), and if the home is in violation of this chapter, serve a copy of the inspection or investigation report upon the provider at the same time as a notice of violation. This notice shall be mailed to the provider within ten working days of the completion of the inspection or investigation process. If the home is not in violation of this chapter, a copy of the ((inspection)) report shall be mailed to the provider within ten calendar days of the inspection or investigation of the home. All ((inspection)) reports shall be made available to the public at the department during business hours.
     (3) The provider shall develop corrective measures for any violations found by the department's inspection or investigation. Within available resources, the department shall upon request provide consultation and technical assistance to assist the provider in developing effective corrective measures. The department shall include a statement of the provider's corrective measures in the department's inspection report.

Sec. 15   RCW 70.128.160 and 2001 c 193 s 5 are each amended to read as follows:
     (1) When the department finds in any inspection or investigation that the adult family home has failed or refused to comply with the requirements of this chapter, the rules adopted under this chapter, or other applicable law, the department shall issue a written citation and require the adult family home to correct the violation or violations. All written citations shall become part of the adult family home's compliance and enforcement record. In addition, the department is authorized to take one or more of the enforcement actions listed in subsections (2) and (3) of this section in any case in which the department finds that an adult family home ((provider)) has:
     (a) Failed or refused to comply with the requirements of this chapter or the rules adopted under this chapter;
     (b) Operated an adult family home without a license or under a revoked license;
     (c) Knowingly or with reason to know made a false statement of material fact on his or her application for license or any data attached thereto, or in any matter under investigation by the department; or
     (d) Willfully prevented or interfered with any inspection or investigation by the department.
     (2) When authorized by subsection (1) of this section, and subject to the further criteria in subsection (3) of this section, the department may take one or more of the following actions:
     (a) Refuse to issue a license;
     (b) Impose reasonable conditions on a license, such as correction within a specified time, training, and limits on the type of clients the provider may admit or serve;
     (c) Impose civil penalties of not more than one hundred dollars per day per violation;
     (d) Suspend, revoke, or refuse to renew a license; ((or))
     (e) Suspend admissions to the adult family home by imposing stop placement; or
     (f) Seek an injunction under RCW 70.128.105.
     (3) The department shall adopt by rule criteria for the selection of enforcement actions. The criteria shall include, but not be limited to, the following requirements:
     (a) A reasonable condition on a license may not be the sole enforcement action imposed by the department for a serious violation, or for an uncorrected violation or recurring problem that harmed a resident;
     (b) A civil penalty for a serious violation, or for an uncorrected violation or recurring problem that harmed a resident, shall not be less than one thousand dollars; a civil penalty for a violation of RCW 74.39A.060(7) may be up to three thousand dollars; a civil penalty for a violation of RCW 70.128.150 may be up to one thousand dollars; and the initial day of a civil penalty for violations involving harm to a resident may be the first day harm occurred;
     (c) A stop placement shall not be imposed unless there is a reasonable probability that harm to more than one resident will occur or reoccur as a result of a violation or violations;
     (d) A summary suspension shall not be imposed unless there is an imminent threat that substantial harm to more than one resident will occur as a result of a violation or violations; and
     (e) The department may revoke, deny, or refuse to renew a license when there is cause to summarily suspend the license; when there is a current violation and the adult family home has a history of significant noncompliance; when there is a very serious current violation, such as significant financial problems resulting in poor care and possible business failure; or for other good cause.
     (4) When the department orders stop placement, the ((facility)) adult family home shall not admit any person until the stop placement order is terminated. The department may approve readmission of a resident to the ((facility)) adult family home from a hospital or nursing home during the stop placement. The department shall terminate the stop placement when: (a) The violations necessitating the stop placement have been corrected; and (b) the ((provider)) adult family home exhibits the capacity to maintain correction of the violations previously found deficient. However, if upon the revisit the department finds new violations that the department reasonably believes will result in a new stop placement, the previous stop placement shall remain in effect until the new stop placement is imposed.
     (((4))) (5) The department shall take appropriate steps to verify correction of violations:
     (a) After a department finding of a violation for which a stop placement has been imposed, the department shall make an on-site revisit of the ((provider)) adult family home within fifteen working days from the request for revisit, to ensure correction of the violation. ((For violations that are serious or recurring or uncorrected following a previous citation, and create actual or threatened harm to one or more residents' well-being, including violations of residents' rights))
     (b) After a department citation for a serious violation, or for an uncorrected violation or recurring problem that harmed a resident, the department shall make an on-site revisit to the adult family home as soon as appropriate to ensure correction of the violation or problem. Depending on the extent of the threatened or actual harm to residents, the department's on-site revisit shall occur shortly after issuing the citation or may be initiated more than fifteen working days from notification of correction of the violation.
     (c) Verification of correction of all other violations may be made by either a department on-site revisit or by written or photographic documentation found by the department to be credible.
     (d) This ((subsection)) section does not prevent the department from enforcing license suspensions or revocations. Nothing in this ((subsection)) section shall interfere with or diminish the department's authority and duty to ensure that the ((provider)) adult family home adequately cares for residents, ((including)) to make ((departmental)) on-site revisits as needed to ensure that the ((provider)) adult family home protects residents, and to enforce compliance with this chapter, the rules adopted under this chapter, and other applicable law. The department shall adopt rules setting forth the monitoring and enforcement processes for license inspections and complaint investigations.
     (((5))) (6) Chapter 34.05 RCW applies to department actions under this section, except that orders of the department imposing license suspension, stop placement, or conditions for continuation of a license are effective immediately upon notice and shall continue in effect pending any hearing.

Sec. 16   RCW 74.39A.009 and 1997 c 392 s 103 are each amended to read as follows:
     Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
     (1) "Adult family home" means a home licensed under chapter 70.128 RCW.
     (2) "Adult residential care" means services provided by a boarding home that is licensed under chapter 18.20 RCW and that has a contract with the department under RCW 74.39A.020.
     (3) "Assisted living services" means services provided by a boarding home that has a contract with the department under RCW 74.39A.010 and the resident is housed in a private apartment-like unit.
     (4) "Boarding home" means a facility licensed under chapter 18.20 RCW.
     (5) "Cost-effective care" means care provided in a setting of an individual's choice that is necessary to promote the most appropriate level of physical, mental, and psychosocial well-being consistent with client choice, in an environment that is appropriate to the care and safety needs of the individual, and such care cannot be provided at a lower cost in any other setting. But this in no way precludes an individual from choosing a different residential setting to achieve his or her desired quality of life.
     (6) "Department" means the department of social and health services.
     (7) "Enhanced adult residential care" means services provided by a boarding home that is licensed under chapter 18.20 RCW and that has a contract with the department under RCW 74.39A.010.
     (8) "Functionally disabled person" is synonymous with chronic functionally disabled and means a person who because of a recognized chronic physical or mental condition or disease, including chemical dependency, is impaired to the extent of being dependent upon others for direct care, support, supervision, or monitoring to perform activities of daily living. "Activities of daily living", in this context, means self-care abilities related to personal care such as bathing, eating, using the toilet, dressing, and transfer. Instrumental activities of daily living may also be used to assess a person's functional abilities as they are related to the mental capacity to perform activities in the home and the community such as cooking, shopping, house cleaning, doing laundry, working, and managing personal finances.
     (9) "Home and community services" means adult family homes, in-home services, and other services administered or provided by contract by the department directly or through contract with area agencies on aging or similar services provided by facilities and agencies licensed by the department.
     (10) "Long-term care" is synonymous with chronic care and means care and supports delivered indefinitely, intermittently, or over a sustained time to persons of any age disabled by chronic mental or physical illness, disease, chemical dependency, or a medical condition that is permanent, not reversible or curable, or is long-lasting and severely limits their mental or physical capacity for self-care. The use of this definition is not intended to expand the scope of services, care, or assistance by any individuals, groups, residential care settings, or professions unless otherwise expressed by law.
     (11) "Nursing home" means a facility licensed under chapter 18.51 RCW.
     (12) "Secretary" means the secretary of social and health services.
     (13) "Tribally licensed boarding home" means a boarding home licensed by a federally recognized Indian tribe which home provides services similar to boarding homes licensed under chapter 18.20 RCW.
     (14) "Harm" means a physical, mental, or emotional injury or damage to a resident, including from neglect or a violation of a resident's rights. Examples of harm include, but are not limited to: Shallow bruising, lacerations, or other injuries that can be treated with first aid; dehydration not requiring professional intervention; yelling or ridicule of a resident that is not repeated or part of a pattern; leaving a resident unassisted on the toilet for an unnecessary, prolonged period of time; leaving a resident to lie in urine or feces; failing to assist a resident needing help with eating; transferring a resident within the facility without prior notice; or failing to include a resident or the resident's representative in care planning. Incidents that cause harm may, if repeated or prolonged, result in substantial harm.
     (15) "Substantial harm" means harm that causes significant physical, mental, or emotional suffering to a resident, or is a significant violation of a resident's rights. Examples of substantial harm include, but are not limited to: Deep bruising; laceration requiring sutures; fracture; burn; dehydration or malnutrition requiring the intervention of a licensed health care professional; retaliation against a resident for filing a complaint with the department or the ombudsman, such as by withholding or reducing needed care, threatening to discharge the resident, or threatening to cut off communication with family or friends; bruising in areas not generally exposed to trauma, such as the head, neck, inner thigh, and anal area; any sexual assault or suspected sexual assault; any pattern of or repeated assault or injury between the same residents or involving the same resident; or any injury requiring close assessment or monitoring by a licensed health care professional.
     (16) "Serious violation" means a violation cited by the department of this chapter, the rules adopted under this chapter, or other applicable law, that causes substantial harm to a resident.
     (17) "Uncorrected violation" means the department has cited a provider of home and community services for a violation and the violation is not corrected at the time the department makes an on-site revisit, inspection, or investigation to determine whether the violation has been corrected.
     (18) "Recurring problem" means the department has cited the provider of home and community services three times within a three-year period for the same or substantially the same violation of this chapter, the rules adopted under this chapter, or other applicable law.

Sec. 17   RCW 74.39A.050 and 2000 c 121 s 10 are each amended to read as follows:
     The department's system of monitoring, enforcement, and quality improvement for long-term care services shall use the following principles, consistent with applicable federal laws and regulations:
     (1) The system shall be client-centered and promote privacy, independence, dignity, choice, and a home or home-like environment for residents and consumers consistent with chapter 392, Laws of 1997.
     (2) The goal of the system is continuous quality improvement with the focus on consumer and resident satisfaction and outcomes for consumers and residents. ((This includes that)) When conducting licensing or contract inspections, the department shall interview an appropriate percentage of residents, family members, ((resident)) case managers, and advocates in addition to interviewing providers and staff. During licensing or contract inspections, the department shall provide the provider and residents and their representatives the opportunity to provide additional or clarifying information about their concerns. The process shall be as even-handed as possible, with due regard for confidentiality requirements.
     (3) Providers should be supported in their efforts to improve quality and address identified problems initially through training, consultation, technical assistance, and case management.
     (4) The emphasis should be on problem prevention both in monitoring and in screening potential providers of service.
     (5) Monitoring should be outcome based and responsive to ((consumer)) the concerns and complaints of residents, consumers, and others and be based upon a clear set of health, quality of care, and safety standards that are ((easily)) understandable and have been made available to providers, residents, consumers, and other interested parties.
     (6) ((Prompt and specific enforcement remedies shall also be implemented without delay, pursuant to RCW 74.39A.080, RCW 70.128.160, chapter 18.51 RCW, or chapter 74.42 RCW, for providers found to have delivered care or failed to deliver care resulting in problems that are serious, recurring, or uncorrected, or that create a hazard that is causing or likely to cause death or serious harm to one or more residents. These enforcement remedies may also include, when appropriate, reasonable conditions on a contract or license. In the selection of remedies, the safety, health, and well-being of residents shall be of paramount importance)) When the department finds in any inspection or investigation that a long-term care facility has failed or refused to comply with the requirements of this chapter, the rules adopted under this chapter, the facility's licensing laws, or other applicable laws, the department shall issue a written citation and require the facility to correct the violation or violations. The department may provide technical assistance and information to the facility, residents, and their representatives. Adult family homes, boarding homes, and nursing homes cited by the department for a serious violation, uncorrected violation, or recurring problem shall be sanctioned with one or more of the enforcement actions set forth in RCW 70.128.160, 74.39A.080, chapter 18.51 RCW, or chapter 74.42 RCW. The facility's plan of correction shall not be considered an enforcement action. In the selection of remedies by the department, the safety, health, and well-being of residents shall be of paramount importance.
     (7) To the extent funding is available, all long-term care staff directly responsible for the care, supervision, or treatment of vulnerable persons should be screened through background checks in a uniform and timely manner to ensure that they do not have a criminal history that would disqualify them from working with vulnerable persons. Whenever a state conviction record check is required by state law, persons may be employed or engaged as volunteers or independent contractors on a conditional basis according to law and rules adopted by the department.
     (8) No provider or staff, or prospective provider or staff, with a stipulated finding of fact, conclusion of law, an agreed order, or finding of fact, conclusion of law, or final order issued by a disciplining authority, a court of law, or entered into a state registry finding him or her guilty of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW shall be employed in the care of and have unsupervised access to vulnerable adults.
     (9) The department shall establish, by rule, a state registry which contains identifying information about personal care aides identified under this chapter who have substantiated findings of abuse, neglect, financial exploitation, or abandonment of a vulnerable adult as defined in RCW 74.34.020. The rule must include disclosure, disposition of findings, notification, findings of fact, appeal rights, and fair hearing requirements. The department shall disclose, upon request, substantiated findings of abuse, neglect, financial exploitation, or abandonment to any person so requesting this information.
     (10) The department shall by rule develop training requirements for individual providers and home care agency providers. Effective March 1, 2002, individual providers and home care agency providers must satisfactorily complete department-approved orientation, basic training, and continuing education within the time period specified by the department in rule. The department shall adopt rules by March 1, 2002, for the implementation of this section based on the recommendations of the community long-term care training and education steering committee established in RCW 74.39A.190. The department shall deny payment to an individual provider or a home care provider who does not complete the training requirements within the time limit specified by the department by rule.
     (11) In an effort to improve access to training and education and reduce costs, especially for rural communities, the coordinated system of long-term care training and education must include the use of innovative types of learning strategies such as internet resources, videotapes, and distance learning using satellite technology coordinated through community colleges or other entities, as defined by the department.
     (12) The department shall create an approval system by March 1, 2002, for those seeking to conduct department-approved training. In the rule-making process, the department shall adopt rules based on the recommendations of the community long-term care training and education steering committee established in RCW 74.39A.190.
     (13) The department shall establish, by rule, training, background checks, and other quality assurance requirements for personal aides who provide in-home services funded by medicaid personal care as described in RCW 74.09.520, community options program entry system waiver services as described in RCW 74.39A.030, or chore services as described in RCW 74.39A.110 that are equivalent to requirements for individual providers.
     (14) Under existing funds the department shall establish internally a quality improvement standards committee to monitor the development of standards and to suggest modifications.
     (15) Within existing funds, the department shall design, develop, and implement a long-term care training program that is flexible, relevant, and qualifies towards the requirements for a nursing assistant certificate as established under chapter 18.88A RCW. This subsection does not require completion of the nursing assistant certificate training program by providers or their staff. The long-term care teaching curriculum must consist of a fundamental module, or modules, and a range of other available relevant training modules that provide the caregiver with appropriate options that assist in meeting the resident's care needs. Some of the training modules may include, but are not limited to, specific training on the special care needs of persons with developmental disabilities, dementia, mental illness, and the care needs of the elderly. No less than one training module must be dedicated to workplace violence prevention. The nursing care quality assurance commission shall work together with the department to develop the curriculum modules. The nursing care quality assurance commission shall direct the nursing assistant training programs to accept some or all of the skills and competencies from the curriculum modules towards meeting the requirements for a nursing assistant certificate as defined in chapter 18.88A RCW. A process may be developed to test persons completing modules from a caregiver's class to verify that they have the transferable skills and competencies for entry into a nursing assistant training program. The department may review whether facilities can develop their own related long-term care training programs. The department may develop a review process for determining what previous experience and training may be used to waive some or all of the mandatory training. The department of social and health services and the nursing care quality assurance commission shall work together to develop an implementation plan by December 12, 1998.

Sec. 18   RCW 74.39A.060 and 2001 c 193 s 1 are each amended to read as follows:
     (1) The aging and adult services administration of the department shall establish and maintain a toll-free telephone number for receiving complaints regarding a facility that the administration licenses or with which it contracts for long-term care services.
     (2) All facilities that are licensed by, or that contract with the aging and adult services administration to provide chronic long-term care services shall post in a place and manner clearly visible to residents and visitors the department's toll-free complaint telephone number and the toll-free number and program description of the long-term care ombudsman as provided by RCW 43.190.050.
     (3) The aging and adult services administration shall investigate complaints if the subject of the complaint is within its authority unless the department determines that: (a) The complaint is intended to willfully harass a licensee or employee of the licensee; or (b) there is no reasonable basis for investigation; or (c) corrective action has been taken as determined by the ombudsman or the department.
     (4) The aging and adult services administration shall refer complaints to appropriate state agencies, law enforcement agencies, the attorney general, the long-term care ombudsman, or other entities if the department lacks authority to investigate or if its investigation reveals that a follow-up referral to one or more of these entities is appropriate.
     (5) The department shall adopt rules that include the following complaint investigation protocols:
     (a) Upon receipt of a complaint, the department shall make a preliminary review of the complaint, assess the severity of the complaint, and assign an appropriate response time. Complaints involving imminent danger to the health, safety, or well-being of a resident must be responded to within two days. When appropriate, the department shall make an on-site investigation within a reasonable time after receipt of the complaint or otherwise ensure that complaints are responded to.
     (b) The complainant must be: Promptly contacted by the department, unless anonymous or unavailable despite several attempts by the department, and informed of the right to discuss the alleged violations with the inspector and to provide other information the complainant believes will assist the inspector; informed of the department's course of action; and informed of the right to receive a written copy of the investigation report.
     (c) In conducting the investigation, the department shall interview the complainant, unless anonymous, and shall use its best efforts to interview the vulnerable adult or adults allegedly harmed, and, consistent with the protection of the vulnerable adult shall interview facility staff, any available independent sources of relevant information, including if appropriate the family members of the vulnerable adult. Prior to completing the investigation, the department shall give the complainant the opportunity to provide additional or clarifying information.
     (d) Substantiated complaints involving harm to a resident, if an applicable law or rule has been violated, shall be subject to one or more of the enforcement actions provided in RCW 74.39A.080 or 70.128.160. Whenever appropriate, the department ((shall)) may also give ((consultation)) information and technical assistance to the provider, complainant, resident, or others, consistent with confidentiality requirements.
     (e) The department shall take appropriate steps to verify correction of violations. After a department finding of a violation for which a stop placement has been imposed, the department shall make an on-site revisit of the provider within fifteen working days from the request for revisit, to ensure correction of the violation. ((For violations that are serious or recurring or uncorrected following a previous citation, and create actual or threatened harm to one or more residents' well-being, including violations of residents' rights)) After a department citation for a serious violation, or for an uncorrected violation or recurring problem that harmed a resident or consumer, the department shall make an on-site revisit as soon as appropriate to ensure correction of the violation. Verification of correction of all other violations may be made by either a department on-site revisit or by written or photographic documentation found by the department to be credible. This subsection does not prevent the department from enforcing license or contract suspensions or revocations. Nothing in this subsection shall interfere with or diminish the department's authority and duty to ensure that the provider adequately cares for residents, ((including)) to make ((departmental)) on-site revisits as needed to ensure that the provider protects residents and to enforce compliance with this chapter and other applicable law.
     (f) Substantiated complaints of neglect, abuse, financial exploitation, or abandonment of residents, or suspected criminal violations, shall also be referred by the department to the appropriate law enforcement agencies, the attorney general, and appropriate professional disciplining authority.
     (6) The department may provide the substance of the complaint to the licensee or contractor before the completion of the investigation by the department unless such disclosure would reveal the identity of a complainant, witness, or resident who chooses to remain anonymous. Neither the substance of the complaint provided to the licensee or contractor nor any copy of the complaint or related report published, released, or made otherwise available shall disclose, or reasonably lead to the disclosure of, the name, title, or identity of any complainant, or other person mentioned in the complaint, except that the name of the provider and the name or names of any officer, employee, or agent of the department conducting the investigation shall be disclosed after the investigation has been closed and the complaint has been substantiated. The department may disclose the identity of the complainant or any other person mentioned in the complaint if such disclosure is requested in writing by the ((complainant)) person whose identity is to be disclosed. Nothing in this subsection shall be construed to interfere with the obligation of the long-term care ombudsman program or department staff to monitor the department's licensing, contract, and complaint investigation files for long-term care facilities.
     (7) The resident has the right to be free of interference, coercion, discrimination, and reprisal from a facility in exercising his or her rights, including the right to voice grievances about treatment furnished or not furnished. A facility that provides long-term care services shall not discriminate or retaliate in any manner against a resident, employee, or any other person on the basis or for the reason that such resident or any other person made a complaint to the department, the attorney general, law enforcement agencies, or the long-term care ombudsman, provided information, or otherwise cooperated with the investigation of such a complaint. Any attempt to discharge a resident against the resident's wishes, or any type of retaliatory treatment of a resident by whom or upon whose behalf a complaint substantiated by the department has been made to the department, the attorney general, law enforcement agencies, or the long-term care ombudsman, within one year of the filing of the complaint, raises a rebuttable presumption that such action was in retaliation for the filing of the complaint. "Retaliatory treatment" means, but is not limited to, monitoring a resident's phone, mail, or visits; involuntary seclusion or isolation; transferring a resident to a different room unless requested or based upon legitimate management reasons; attempted discharge, transfer, or retaliatory treatment of a relative of the resident, if the relative is also a resident at the facility; withholding, reducing, or threatening to withhold or reduce food, services, or treatment unless agreed to by the resident authorized by a terminally ill resident or his or her representative pursuant to law; or persistently delaying responses to a resident's request for service or assistance. A facility that provides long-term care services shall not willfully interfere with the performance of official duties by a long-term care ombudsman. The department shall sanction and may impose a civil penalty of not more than three thousand dollars for a violation of this subsection. The department shall require the facility to rectify to the extent possible the retaliatory treatment or other violation of this subsection.

Sec. 19   RCW 74.39A.080 and 2001 c 193 s 3 are each amended to read as follows:
     (1) When the department finds in any inspection or investigation that a facility providing assisted living services, adult residential care services, or enhanced adult residential care services has failed or refused to comply with the requirements of this chapter, the rules adopted under this chapter, or other applicable law, the department shall issue a written citation and require the facility to correct the violation or violations. All written citations shall become part of the facility's compliance and enforcement record. In addition, the department is authorized to take one or more of the enforcement actions listed in subsections (2) and (3) of this section in any case in which the department finds that a ((provider of)) facility providing assisted living services, adult residential care services, or enhanced adult residential care services has:
     (a) Failed or refused to comply with the requirements of this chapter or the rules adopted under this chapter;
     (b) Operated without a license or under a revoked license;
     (c) Knowingly, or with reason to know, made a false statement of material fact on his or her application for license or contract, or any data attached thereto, or in any matter under investigation by the department; or
     (d) Willfully prevented or interfered with any inspection or investigation by the department.
     (2) When authorized by subsection (1) of this section, and subject to the further criteria in subsection (3) of this section, the department may take one or more of the following enforcement actions:
     (a) Refuse to issue a contract;
     (b) Impose reasonable conditions on a contract, such as a directed plan of correction within a specified time, training, and limits on the type of clients the ((provider)) facility may admit or serve;
     (c) Impose civil penalties of not more than one hundred dollars per day per violation;
     (d) Suspend, revoke, or refuse to renew a contract; ((or))
     (e) Suspend admissions to the facility by imposing stop placement on contracted services; or
     (f) Seek an injunction under RCW 18.20.150.
     (3) The department shall adopt by rule criteria for the selection of enforcement actions. The criteria shall include, but not be limited to, the following requirements:
     (a) A reasonable condition on a contract may not be the sole enforcement action imposed by the department for a serious violation, or for an uncorrected violation or recurring problem that harmed a resident;
     (b) A civil penalty for a serious violation, or for an uncorrected violation or recurring problem that harmed a resident, shall not be less than one thousand dollars; a civil penalty for a violation of RCW 74.39A.060(7) may be up to three thousand dollars; and the initial day of a civil penalty for violations involving harm to a resident shall be the first day harm occurred;
     (c) A stop placement shall not be imposed unless there is a reasonable probability that harm to more than one resident will occur or reoccur as a result of a violation or violations;
     (d) A summary suspension shall not be imposed unless there is an imminent threat that substantial harm to more than one resident will occur as a result of a violation or violations; and
     (e) The department may revoke, deny, or refuse to renew a contract when there is cause to summarily suspend the contract; when there is a current violation and the facility has a history of significant noncompliance; when there is a very serious current violation, such as significant financial problems resulting in poor care and possible business failure; or for other good cause.
     (((3))) (4) When the department orders stop placement, the facility shall not admit any person admitted by contract until the stop placement order is terminated. The department may approve readmission of a resident to the facility from a hospital or nursing home during the stop placement. The department shall terminate the stop placement when: (a) The violations necessitating the stop placement have been corrected; and (b) the provider exhibits the capacity to maintain correction of the violations previously found deficient. However, if upon the revisit the department finds new violations that the department reasonably believes will result in a new stop placement, the previous stop placement shall remain in effect until the new stop placement is imposed.
     (5) The department shall take appropriate steps to verify correction of violations:
     (a) After a department finding of a violation for which a stop placement has been imposed, the department shall make an on-site revisit of the ((provider)) facility within fifteen working days from the request for revisit, to ensure correction of the violation. ((For violations that are serious or recurring or uncorrected following a previous citation, and create actual or threatened harm to one or more residents' well-being, including violations of residents' rights,))
     (b) After a department citation for a serious violation, or for an uncorrected violation or recurring problem that harmed a resident, the department shall make an on-site revisit to the facility as soon as appropriate to ensure correction of the violation or problem. Depending on the extent of the threatened or actual harm to residents, the department's on-site revisit shall occur shortly after issuing the citation or may be initiated more than fifteen working days from notification of correction of the violation.
     (c) Verification of correction of all other violations may be made by either a department on-site revisit or by written or photographic documentation found by the department to be credible.
     (d) This ((subsection)) section does not prevent the department from enforcing license suspensions or revocations. Nothing in this ((subsection)) section shall interfere with or diminish the department's authority and duty to ensure that the ((provider)) facility adequately cares for residents, ((including)) to make ((departmental)) on-site revisits as needed to ensure that the ((provider)) facility protects residents, and to enforce compliance with this chapter, the rules adopted under this chapter, and other applicable law. The department shall adopt rules setting forth the monitoring and enforcement processes for license inspections and complaint investigations.
     (((4))) (6) Chapter 34.05 RCW applies to department actions under this section, except that orders of the department imposing contracts suspension, stop placement, or conditions for continuation of a contract are effective immediately upon notice and shall continue pending any hearing.