Original Notice.

Preproposal statement of inquiry was filed as WSR 98-08-084.

Title of Rule: Chapter 388-148 WAC, Licensing requirements for child foster homes, group care programs/facilities and agencies.

Purpose: Clarify the language of the licensing requirements for foster homes, group care programs/facilities and child-placing agencies licensed by Children's Administration, DSHS. The chapter incorporates changes in state and federal law, Children's Administration policy and current practice.

Statutory Authority for Adoption: RCW 74.15.030.

Statute Being Implemented: RCW 74.15.030.

Summary: Change in the format and organization adds to clarity. The major changes have to do with strengthening health and safety requirements regarding exposure to second-hand smoke, water hazards, psychotropic medications, securing a child's belongings; increasing staffing during sleeping hours in group care facilities, raising the age of child care staff; changing language to comply with changes in federal legislation.

Reasons Supporting Proposal: Overall clarity, elimination of duplicative and out-of-date regulations, and effectiveness of the rules affecting foster homes, group care facilities and child-placing agencies will be achieved.

Name of Agency Personnel Responsible for Drafting and Implementation: Jean L. Croisant, P.O. Box 45710, Olympia, WA 98504-5710, (360) 902-7992; and Enforcement: Division of Licensed Resources, Office of Foster Care Licensing, Children's Administration, Department of Social and Health Services.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: The purpose of the chapter is to define the minimum general and specific licensing requirements for foster homes, staffed residential homes, group facilities and child-placing agencies. Foster homes and group care facilities must be regulated to ensure that children experience safe and healthy care while in out-of-home placement.

The anticipated effect will be the overall clarification of the requirements licensing foster homes, group care facilities and child-placing agencies. The more clearly written question and answer format will improve understanding of the rules and consistency of interpretation of the WAC chapter. It is anticipated there will be greater compliance with the rules, more effective monitoring, and fewer corrective action plans needed as a result of the changes.

Proposal Changes the Following Existing Rules: Some of the changes are as follows:

	Clarifying the use of psychotropic drugs.
	Aligning the chapter with federal laws under the Multiethnic Placement Act of 1994 and the Interethnic Adoption Provisions Act of 1996.
	Clarifying the difference between licensing and certification.
	Requiring a child's belongings to be secured for up to thirty days when a child leaves a home or facility, which allows time for the child's personal belongings to be moved to the new placement.
	Addition of the "awake staff" in group care settings where there are more than six children in care; or the focus of the program is behavioral in nature rather than transitional living or when the child's behavior is a risk.
	Expansion of the behavior management policy to include requiring training prior to the use of any physical restraint.
	Prohibiting smoking in any home or facility caring for children and in motor vehicles while transporting children.
	Clarification of capacity for foster homes allowing licensing for up to six foster children with the approval of the department.
	Have the same qualifications for the director, on-site program manager, and child care staff for all group care programs.
	Raising the minimum age of the licensee from eighteen to twenty-one years old.
	Raising the age of child care staff from eighteen to twenty-one years old, unless the person is nineteen or twenty and participation in an internship program with an accredited college or university.
	Reducing the capacity for respite care to comply with the general foster home licensed capacity.

No small business economic impact statement has been prepared under chapter 19.85 RCW. Children's Administration gathered information in the small businesses in each region. A telephone survey was completed on those identified regarding changes in the rules. It was determined from the survey results that their costs would be minor. Therefore, only minor costs will be imposed on small businesses affected by these changes.

The preparation of a comprehensive small business economic impact statement is not required.

RCW 34.05.328 applies to this rule adoption. The proposed rule changes for chapter 388-148 WAC, Licensing requirements for foster homes, group care programs/facilities and agencies, are "significant legislative rules" as defined in RCW 34.05.325 and therefore require a cost benefit analysis (CBA). A copy of the CBA may be requested by contacting Jean L. Croisant, at the Division of Program and Policy Development, Children's Administration, P.O. Box 45710, Olympia, WA 98504-5710, (360) 902-7992, or loje300@dshs.wa.gov.

Hearing Location: The public hearing will be conducted through Department of Information Services videoconference, on August 9, 2001, at 10:00 a.m.; DIS - Interactive Technologies, Yesterday's Village, The 15 West Yakima Avenue Building, 15 West Yakima Avenue, Suite 220, Yakima, WA 98902, (509) 454-7878; at Educational Service District (ESD) 112, 2500 N.E. 65th Avenue, Vancouver, WA 98661, (360) 750-7500; at 1107 S.W. Grady Way, Suite 112, Renton, WA 98055, (425) 277-7290; at DIS Interactive Technologies, 710 Sleater Kinney Road S.E., Suite Q, Lacey, WA 98504-2445, (360) 407-9487; at 8551 West Gage Boulevard, Suite H, Kennewick, WA 99336, (509) 734-7180; and at 1101 North Argonne, Suite 109, Spokane, WA 99201, (509) 921-2371.

Assistance for Persons with Disabilities: Contact Kelly Cooper, DSHS Rules Coordinator, by August 2, 2001, phone (360) 664-6094, TTY (360) 664-6178, e-mail myercme@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by August 9, 2001.

Date of Intended Adoption: No sooner than August 10, 2001.

May 30, 2001

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

The department is committed to ensuring that the children who receive care experience health, safety, and well-being. We want these children's experiences to be beneficial to them not only in the short run, but also in the long term. Our licensing requirements reflect our commitment to children.

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"Abuse or neglect" means the injury, sexual abuse, sexual exploitation, negligent treatment or mistreatment of a child where the child's health, welfare and safety are harmed.

"Capacity" means the maximum number of children that a home or facility is licensed to care for at a given time.

"Care provider" means any licensed or certified person or organization that provides twenty-four-hour care for children.

"Case manager" means the private agency employee who coordinates the planning efforts of all the persons working on behalf of a child. They are responsible for implementing the child's case plan, assisting in achieving those goals, and assisting with day-to-day problem solving.

"Certification" means:

(1) Department approval of a person, home, or facility that does not legally need to be licensed, but wishes to have evidence that they met the minimum licensing requirements; or

(2) Department licensing of a child-placing agency to certify a foster home and/or a group care program meets licensing requirements.

"Children" or "youth," means individuals who are:

(1) Under eighteen years old, including expectant mothers under eighteen years old; or

(2) Up to twenty-one years of age and enrolled in high school, equivalent course of study, GED, or educational program;

(3) Up to twenty-one years of age with developmental disabilities; or

(4) Up to twenty-one years of age if under the custody of the Washington state juvenile rehabilitation administration.

"Child-placing agency" means an agency licensed to place children for temporary care, continued care or adoption.

"Crisis residential center (CRC)" means an agency under contract with DSHS that provides temporary, protective care to children in a foster home, regular (semi-secure) or secure group setting.

"Compliance agreement" means a written licensing improvement plan to address specific skills, abilities or other issues of a fully licensed home or facility to maintain and/or increase the safety and well-being of children in their care.

"DCFS" means the division of children and family services.

"DDD" means division of developmental disabilities.

"Department" means the department of social and health services (DSHS).

"Developmental disabilities" means the language used by DSHS, division of developmental disabilities as defined in RCW 71A.10.020.

"DLR" means the division of licensed resources.

"Firearms" means guns or weapons, including but not limited to the following: BB guns, pellet guns, air rifles, stun guns, antique guns, bows and arrows, handguns, rifles, and shotguns.

"Foster-adopt" means placement of a child with a foster parent(s) who intends to adopt the child, if possible.

"Foster home or foster family home" means person(s) regularly providing care on a twenty-four-hour basis to one or more children in the person's home.

"Full licensure" means an entity meets the requirements established by the state for licensing or approved as meeting state licensing requirements.

"Group care facility for children" means a location maintained and operated for a group of children on a twenty-four-hour basis.

"Hearing" means the department's administrative review process.

"I" refers to anyone who operates or owns a foster home, staffed residential home, and group facilities, including group homes, child-placing agencies, maternity homes, day treatment centers, and crisis residential centers.

"Infants" means children under one year of age.

"License" means a permit issued by the department affirming that a home or facility meets all the general licensing requirements.

"Licensor" means:

(1) A division of licensed resources (DLR) employee at DSHS who:

(a) Approves licenses or certifications for foster homes and group facilities; and

(b) Monitors homes and facilities to ensure that they continue to meet health and safety requirements.

(2) An employee of a child-placing agency who:

(a) Attests that a foster home and/or group home facility supervised by the child-placing agency meets licensing requirements; and

(b) Monitors the homes and facilities to ensure they continue to meet the licensing standards for the health and safety of the children in care.

(3) The department has the responsibility for final approval of homes and facilities that the child-placing agency certifies as meeting the full licensing standards for children in care.

"Maternity service" means an individual, program or facility providing or arranging for care for:

(1) Expectant mothers before and during pregnancy; and

(2) Mothers and their infants after pregnancy.

These services are provided to mothers who are under eighteen years of age.

"Medically fragile" means the condition of a child who has a chronic illness or severe medical disabilities requiring regular nursing visits, regular medical check-ups, or under a physician's care.

"Multidisciplinary teams (MDT)" means groups formed to assist children who are considered at-risk youth or children in need of services, and their parents.

"Nonambulatory" means not able to walk.

"Nonmobile" refers to children who are not yet walking, are unable to walk, or unable to use a wheelchair or other device to move about freely.

"Out-of-home placement" means a child's placement in a home or facility other than the child's parent, guardian, or legal custodian.

"Premises" means a facility's buildings and adjoining grounds that are managed by a person or agency in charge.

"Probationary license" means a license issued as a disciplinary measure to an individual or agency that has previously been issued a full license but is out of compliance with licensing standards.

"Psychotropic medication" means a type of medicine that is prescribed to affect or alter thought processes, mood, sleep, or behavior. These include anti-psychotic, antidepressants and anti-anxiety medications.

"Relative" means a person who is related to the child as defined in RCW 74.15.020(4)(a)(i), (ii), (iii), and (iv) only.

"Respite" means brief, relief care provided to foster parents with the respite provider fulfilling some or all of the functions of the care-taking responsibilities of the foster parent.

"Secure facilities" means a crisis residential center that has locking doors and windows, or secured perimeters intended to prevent children from leaving without permission.

"Severe developmental disabilities" means significant disabling, physical and/or mental condition(s) that cause a child to need external support for self-direction, self-support and social participation.

"Social service staff" means child placing agency or group care program staff who is an employee of the agency or hired to provide consultation on developing and implementing the child's individual service and treatment plans.

"Staffed residential home" means a licensed home providing twenty-four-hour care for six or fewer children or expectant mothers. The home may employ staff to care for children or expectant mothers. It may or may not be a family residence.

"We" or "our" refers to the department of social and health services, including DLR licensors and DCFS social workers.

"You" refers to anyone who operates a foster home, staffed residential home, and group facilities, including group homes, maternity programs, day treatment programs, crisis residential centers, and child-placing agencies.

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(a) Division of licensed resources (DLR) at DSHS; or

(b) A licensed child-placing agency.

(2) The types of homes or facilities that need a license include:

(a) Foster homes;

(b) Group care programs;

(c) Programs for medically fragile children and children with severe developmental disabilities;

(d) Maternity services;

(e) Day treatment programs;

(f) Crisis residential centers;

(g) Staffed residential homes; and

(h) Child-placing agencies.

Note: Homes and facilities offering maternity services, day treatment, crisis residential centers, services to medically fragile children and/or children with severe developmental disabilities will need to follow the specific program requirements outlined in this chapter as well.

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(a) Physical accommodations in your home or facility;

(b) The number of staff, family members and volunteers available for providing care;

(c) Your skills and the skills of your staff; and

(d) The ages and characteristics of the children you are serving.

(2) Based on the evaluation, the department may license you for the care of fewer children than you normally would serve in your category of care.

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(1) You must demonstrate that you have the understanding, ability, physical health, emotional stability and personality suited to meet the physical, mental, emotional, and social needs of the children under your care.

(2) You must clear our criminal history (chapter 388-06 WAC) and background check prior to having unsupervised access to children.

(3) You must have the ability to furnish the child with a nurturing, respectful, supportive, and responsive environment.

(4) The department may require you to give additional information. We may request this information at any time and it may include, but is not limited to:

(a) Substance and alcohol abuse evaluations and/or documentation of treatment;

(b) Psychiatric evaluations;

(c) Psycho-sexual evaluations; and

(d) Medical evaluations and/or medical records.

(5) Any evaluation requested under WAC 388-148-0035 (4)(a)-(d) will be at the applicant/licensees expense.

(6) the licensor must be given permission to speak with the evaluator/provider prior to and after the evaluation.

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(1) If you have a home or facility that provides care, the care givers must have current training in:

(a) Basic standard first aid; and

(b) Age-appropriate cardiopulmonary resuscitation (CPR).

(2) Approved first aid and CPR training must be in accordance with a nationally recognized standard such as the American Red Cross or American Heart Association.

(3) For any facilities other than foster homes, the person with first aid and CPR training must be on the premises at all times when children are present.

(4) The requirement for CPR training may be waived for persons with a statement from their physician that the training is not advised for medical reasons.

(5) You must keep records in your home or facility showing who has completed current first aid and CPR training.

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(2) You must use infection control requirements and educational material consistent with the approved curriculum Know - HIV/AIDS Prevention Education for Health Care Facility Employees, published by the department of health, office on HIV/AIDS.

(3) The staff of group care programs are required to complete blood borne pathogen training.

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(1) You must send the application form to your licensor at DLR or a child-placing agency.

(2) With the application form, you must send the following information:

(a) Written verification for each applicant of:

(i) A tuberculosis test or x-ray unless you can demonstrate religious reasons prohibiting the test;

(ii) First-aid and cardio-pulmonary resuscitation (CPR) training appropriate to the age of the children in care; and

(iii) HIV/AIDS training including infection control standards.

(b) A completed background check form for each applicant, family member, staff person, board member, intern or volunteer who:

(i) Is at least sixteen years old;

(ii) Is not a foster child; and

(iii) Has unsupervised access to children (see chapter 388-06 WAC).

(c) If you have lived in Washington state less than three years, you must provide us with a completed FBI fingerprint form.

(d) We may require additional information from you including, but not limited to:

(i) Substance and alcohol abuse evaluations and/or documentation of completed treatment;

(ii) Psychiatric evaluations;

(iii) Psycho-sexual evaluations; and

(iv) Medical evaluations and/or medical records.

(3) If you are applying for a license renewal, you must send the application form to your licensor at least ninety days prior to the expiration of your current license.

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(2) You or your relative may apply to a different child-placing agency for a license.

(3) Licensed foster parents who become employed by the department or a child-placing agency must be re-licensed through an agency other than their employer within six months of employment.

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(1) Are exempt from needing a license (per chapter 74.15 RCW);

(2) Meet the licensing requirements; and

(3) Wish to serve department-funded children.

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(2) The department may license a child-placing agency, including a Tribal CPA, to operate foster home and/or group care facilities.

(3) The child-placing agency is only authorized to "certify" or attest to the department that the home or facility meets the licensing requirements.

(4) The licensing and certification requirements are the same and are contained in this chapter.

(5) The department has the final approval for licensing the home or facility that the CPA will be supervising.

(6) The department's representative signs the license of the home or facility.

(7) A home or facility "certified" by a child-placing agency (CPA) and licensed by the department must be supervised by that CPA to have a valid license to care for children.

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(2) Exceptions are approved for non-safety requirements only.

(3) The safety and well-being of the children receiving care must not be compromised.

(4) The request for an exception to the licensing requirements must be in writing.

(5)You must keep a copy of the approved exception to the licensing requirements for your files.

(6) Along with an exception to the licensing requirements, the department may limit or restrict a license issued to you and/or require you to enter into a compliance agreement to ensure the safety and well-being of the children in your care.

(7) You do not have appeal rights if the department denies your request for an exception to our requirements.

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(2) The department must base its decision as to whether a probationary license will be issued on the following:

(a) Intentional or negligent noncompliance with the licensing rules;

(b) A history of noncompliance with the rules;

(c) Current noncompliance with the rules;

(d) Evidence of a good faith effort to comply; and

(e) Any other factors relevant to the specific situation.

(2) A probationary license may be issued for up to six months. At its discretion, the department may extend the probationary license for an additional six months.

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Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-148-0095   When are licenses denied, suspended or revoked?   (1) A license must be denied, suspended or revoked if the department decides that you cannot provide care for children in a way that ensures their safety, health and well-being.

(2) The department must disqualify you for any of the reasons that follow.

(a) You have failed your background check (see chapter 388-06 WAC).

(b) You have been found to have committed child abuse or neglect or you treat, permit or assist in treating children in your care with cruelty, indifference, abuse, neglect, or exploitation, unless the department determines that you do not pose a risk to a child's safety, well-being, and long-term stability.

(c) You or anyone living on the premises had a license denied or revoked from an agency that provided care to children or vulnerable adults.

(d) You try to get a license by deceitful means, such as making false statements or leaving out important information on the application.

(e) You commit, permit or assist in an illegal act on the premises of a home or facility providing care to children.

(f) You are using illegal drugs, or excessively using alcohol and/or prescription drugs.

(g) You knowingly allowed employees or volunteers who made false statements on their applicants to work at your agency.

(h) You repeatedly lack qualified or an adequate number of staff to care for the number and types of children under your care.

(i) You have refused to allow our authorized staff and inspectors to have requested information or access to your facility, child and program files, and/or your staff and clients.

(j) You are unable to manage the property, fiscal responsibilities, or staff in your agency.

(k) You have failed to comply with the federal and state laws for any Native American children that you have under care.

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(a) Having more children than the license allows;

(b) Having children with ages different than the license allows;

(c) Failing to provide a safe, healthy and nurturing environment for children under your care;

(d) Failing to comply with any of our other licensing requirements; or

(e) Failing to meet the health and safety requirements to receive a certificate of compliance as required by the department of health and/or office of the state Fire Marshall.

(2) The department must suspend your license to provide care to children, if we receive a notice from the division of child support that you are not in compliance with a support order.

Note: The governing authority is RCW 43.20A.205 and 74.20A.320)

(3) The suspension of your license for noncompliance of a support order would be effective the date you receive a notice that we received the certificate of noncompliance from the division of child support.

(4) Your license would remain suspended until you provide proof that you are in compliance with the child support order.

(5) You would not have a right to an administrative hearing based on a suspension of your license due to noncompliance of a child support order.

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(1) You may request a department administrative hearing to disagree with the department's decision to modify, suspend, revoke or deny your license.

(2) You must request a department administrative hearing within twenty-eight days of receiving a certified letter with the department's decision (see chapter 34.05 RCW).

(3) You must send a letter to the office of administrative hearings, P.O. Box 42489, Olympia, Washington 98504-2489, 1-800-583-8271 requesting an administrative hearing. The letter must have the following attachments:

(a) A specific statement of your reasons for disagreeing with the department decision and any laws that relate to your reasons; and

(b) A copy of the certified letter from the department that you are disputing.

(4) The administrative hearing will take place before an employee of the office of administrative hearings.

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(2) The procedure for requesting, or responding to, a petition for review with the board of appeals is in WAC 388-02-0560 through 388-02-0635.

(3) If either party asks for a review, the decision of the board of appeals review judge will be the department's final decision.

(4) If you disagree with the decision of the board of appeals, you may file a petition in superior court and ask for judicial review. The procedure for judicial review is in RCW 34.05.510 to 34.05.598.

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(a) Any reasonable cause to believe that a child has suffered child abuse or neglect;

(b) Any violations of the licensing or certification requirements;

(c) Death of a child;

(d) Any child's suicide attempt that results in injury requiring medical treatment or hospitalization;

(e) Any use of physical restraint that is alleged improper or excessive;

(f) Sexual contact between two or more children that is not considered typical play between pre-school age children;

(g) Any disclosures of sexual or physical abuse by a child in care;

(h) Physical assaults between two or more children that result in injury requiring off-site medical treatment or hospitalization;

(i) Unexpected health problems that require off-site medical treatment;

(j) Any medication that is given incorrectly and requires off-site medical treatment;

(k) Serious property damage that is a safety hazard and is not immediately corrected; or

(l) Any emergent medical care.

(2) You or your staff must report immediately or in no instance later then forty-eight hours, any of the following incidents to the child's social worker:

(a) Suicidal/homicidal ideas, gestures, or attempts that do not require professional medical treatment;

(b) Unexpected health problems that do not require professional medical treatment;

(c) Any incident of medication incorrectly administered;

(d) Physical assaults between two or more children that result in injury but did not require professional medical treatment;

(e) Runaways; and

(f) Use of physical restraints for routine behavior management.

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(2) You must keep records about children and their families in a secure place. At the end of the child's placement, reports written by others about the child or the child's family must be returned to department staff.

(3) During a placement in your foster home, your records must be kept at your home and contain, at a minimum, the following information:

(a) The child's name, birth date, and legal status;

(b) Name and telephone number of the social worker for each child in care;

(c) Names, address and telephone numbers of parents or persons to be contacted in case of emergency;

(d) Information on specific cultural needs of the child;

(e) Medical history including any medical problems, name of doctor, type of medical coverage and provider;

(f) Mental health history and any current mental health and behavioral issues, including medical and psychological reports when available;

(g) Other pertinent information related to the child's health;

(h) Record of immunizations. Receiving and interim care homes and facilities do not need to keep records of immunizations for children in their care less than thirty days. Crisis residential centers do not need to keep records of immunizations for children in their care;

(i) Child's school records, report cards, school pictures, and individual education plans (IEP);

(j) Special instructions including supervision requirements and suggestions for managing problem behavior;

(k) Inventory of personal belongings at the time of placement; and

(l) The child's visitation plan.

(4) During a child's placement in a staffed residential home or a group care program, your records must be kept at your site and contain, at a minimum, the following information in addition to the information in subsection (3)(a) through (k) of this section:

(a) Written consent from the child placing agency, if any, for providing medical care and emergency surgery (unless that care is authorized by a court order);

(b) Names, addresses, and telephone numbers of persons authorized to take the child under care out of the facility;

(c) A copy of the court order or voluntary placement agreement that gives approval to place the child;

(d) Case plans, such as children's administration's "individual service and safety plan;" and

(e) Daily logs of therapy treatment received by children with the signature of the person making the entry in the log.

(5) If you operate a group care program, staffed residential home, or child-placing agency and have client files with information not returned to the department, you must keep them for six years following the termination or expiration of any contract you have with the department.

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(a) Friends,

(b) Relatives,

(c) Neighbors.

(2) You may discuss information about the child, the child's family and the case plan only with:

(a) A representative of the department, including staff from DCFS and DLR; department of health and the office of the state fire marshal;

(b) A child-placing agency case manager assigned to the child;

(c) The child's assigned guardian ad litem or court-appointed special advocate; or

(d) Others designated by the child's social worker.

(3) You may check with your child's social worker for guidance about sharing information with the child's teacher, counselor or doctor, respite care provider or any other professional.

(4) Child-placing agencies and the department must share with the child's care provider any information about the child and child's family related to the case plan.

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(a) Changes in your location or designated space, including address;

(b) Changes in your phone number;

(c) Changes in the maximum number, age ranges, and sex of children you wish to serve;

(d) Changes in the structure of your facility or premises from events causing damage, such as a fire, or from remodeling;

(e) Addition of any new staff person, employee, intern, contractor, or volunteer, who might have contact with the children in care; or

(f) Changes in household composition, such as:

(i) A marriage, separation or divorce;

(ii) Incapacity or serious illness of a foster parent or member of the household;

(iii) The death of anyone in the household;

(iv) A change in employment status or significant change in income; or

(v) A change in who resides in the household or is on the premises for more than fourteen days.

(2) A license is valid only for the person or organization named on the license at a specific address. If you operate a group facility or child-placing agency, you must also report any of the following changes to your licensor:

(a) A change of your agency's executive director or any staff changes;

(b) The death, retirement, or incapacity of the person who holds the license;

(c) A change in the name of a licensed corporation, or the name by which your facility is commonly known; or

(d) Changes in an agency's articles of incorporation and bylaws.

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Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-148-0140   What personnel policies must I have?   You must follow the personnel requirements listed below, at any home or facility we license.

(1) Each employee, intern, contractor, or volunteer who has unsupervised access to children must have completed an application for employment and signed a form enabling us to do a background check (chapter 388-06 WAC).

(2) Misrepresentation by the prospective employee, interns, or volunteer will be grounds for termination or denial of employment or volunteer service.

(3) If you have five or more staff, volunteers, or interns you must have written policies covering qualifications, training, and duties for employees, interns, and volunteers.

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(2) If you operate any other kind of home, facility, or agency you must post your license where the public can easily view it.

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(2) We may require you to provide proof that you have met local ordinances.

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(1) Maintain your buildings, premises, and equipment in a clean and sanitary condition, free of hazards, and in good repair;

(2) Provide handrails for steps, stairways, and ramps; if required by the department;

(3) Have emergency lighting devices available and in operational condition;

(4) Furnish your home or facility appropriately, based on the age and activities of the children under care.

(5) Have washable, water-resistant floors in your home or facility bathrooms, kitchens, and any other rooms exposed to moisture. The department may approve washable, short-pile carpeting that is kept clean and sanitary for your home or facility's kitchens.

(6) All homes and facilities must provide tamper proof or tamper resistant electrical outlets or blank covers installed in areas accessible to children under the age of six or other persons with limited mental capacity or who might be endangered by access to them.

(7) Have easy access to rooms occupied by children in case an emergency arises. Some examples are bedrooms, toilet rooms, shower rooms, and bathrooms.

(8) Except for foster homes, have posted a written disaster plan for emergencies such as fire and earthquakes.

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(2) Your home or facility must be located on a well-drained site, free from hazardous conditions. The safety of the children in care is paramount. You must discuss with the licensor any potential hazardous conditions, considering the children's ages, behaviors, and abilities.

(3) A supervision plan must be written for the children in care if it is decided that hazardous conditions are present. Some examples of hazards are natural or man-made water hazards such as lakes or streams, steep banks, ravines, and busy streets.

(4) Your home or facility must be accessible to emergency vehicles.

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(2) You must daily empty and clean any portable wading pool that children use.

(3) Children under twelve must be in continuous visual or auditory range at all times when they are swimming, wading, or boating by an adult with current age appropriate first aid and CPR.

(4) You must ensure age and developmentally appropriate supervision of any child that uses hot tubs, swimming pools, spas, and around natural bodies of water.

(5) You must lock hot tub and spa areas when they are not in use.

(6) You must place a fence designed to discourage climbing and have a locking gate around a pool. The pool must be inaccessible to children when not in use.

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(2) The department, at its discretion, may limit the type and number of common household pets, exotic pets, animals, birds, insects, reptiles or fish accessible to children if the department determines there are risks to the children in care.

(3) You must ensure that common household pets, exotic pets, animals, birds, insects, reptiles, and fish are free from disease and cared for in a safe and sanitary manner.

(4) Common household pets, exotic pets, animals, birds, insects, reptiles, and fish must be cared for in compliance with state regulations and/or local ordinances.

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(2) Any other facility must not have alcohol on the premises. The staff of these facilities may not consume alcohol on the premises or during breaks.

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(2) You may permit adults to smoke outdoors away from children.

(3) Nothing in this section is meant to interfere with traditional or spiritual Native American ceremonies involving the use of tobacco.

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(2) If you are licensed as a foster home, firearms, ammunition, and other weapons must be kept in locked container, gun cabinet, gun safe, or another storage area made of strong, unbreakable material when not in use.

(a) If the storage cabinet has a glass or another breakable front, the guns must be secured with a locked cable or chain placed through the trigger guards.

(b) Ammunition must be stored in a place that is separate from weapons or locked in a gun safe.

(c) Weapons and ammunition must be accessible only to authorized persons.

(3) You may allow a child to use a firearm use only if:

(a) The child's social worker approves;

(b) Competent adults are supervising use; and

(c) The youth has completed an approved gun safety or hunter safety course.

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(a) Cleaning supplies;

(b) Toxic or poisonous substances;

(c) Aerosols; and

(d) Items with warning labels.

(2) When containers are filled with toxic substances from a stock supply, you must label containers filled from a stock supply.

(3) Toxic substances must be stored separately from food items.

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(2) The following first aid supplies must be kept on hand:

(a) Barrier gloves and one-way resuscitation mask;

(b) Bandages;

(c) Scissors and tweezers;

(d) Ace bandage;

(e) Gauze; and

(f) Thermometer.

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(2) Pet and human medications must be stored in separate places.

(3) You must store external medications separately from internal medications.

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(1) The vehicle must be kept in a safe operating condition.

(2) The driver must have a valid driver's license.

(3) There must be at least one adult other than the driver in a vehicle when:

(a) There are more than five preschool-aged children in the vehicle;

(b) Staff-to-child ratio guidelines or your contract require a second staff person; or

(c) The child's specific needs require a second adult person.

(4) The driver or owner of the vehicle must be covered under an automobile liability and insurance policy.

(5) Your vehicles must be equipped with, seat belts, car seats and booster seats, and/or other appropriate safety devices for all passengers as required by law.

(6) The number of passengers must not exceed the vehicle's seat belts.

(7) Buses approved by the state patrol are not required to have seat belts.

(8) All persons in the vehicle must use seat belts or approved child passenger restraint systems, as appropriate for age, whenever the vehicle is in motion.

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(2) Foster homes and staffed residential homes only need inspections by fire marshals or local fire department if either:

(a) Licensors request the inspections; or

(b) City ordinances require these inspections.

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(1) Exit doors and rescue windows must be easily opened to the fully open position from the inside without requiring a key or special instructions.

(2) Locks on outside exit doors must automatically unlock when the doorknob is turned from the inside.

(3) Except in foster homes, night latches, dead bolts, security chains, manually operated edge or surface-mounted flush bolts and surface bolts must not be used.

(4) Each home and facility must have at least one swinging exit door that is pivoted or hinged on the side.

(5) Other exit doors in your home or facility may be sliding doors.

(6) Each home or facility must have two exits, located at opposite ends of the building or one on each floor. The requirement for one of the two exits may be deleted if:

(a) A residential sprinkler system (complying with the state fire Marshall standards) is provided throughout the entire building; and

(b) The remaining exit is a door.

(7) Every occupied area must have access to at least one exit that does not pass through rooms or spaces that can be locked or blocked from the opposite side.

(8) Obstacles must not be placed in corridors, aisles, doorways, exit doors, stairways, ramps, or rescue windows.

(9) Barriers to exiting must be restricted to gates or other approved devices that are easily opened and do not delay exiting.

(10) Stoves or heaters must not block escape or exit routes.

(11) Flammable, combustible, or poisonous material must be stored away from exits and away from areas that are accessible to children under care.

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(1) Every room used by children under care must have easy entry and exit, including one of these features:

(a) Two separate doors; or

(b) One door leading to an exit; and

(c) A window that opens to the outside and is large enough for emergency escape or rescue.

(2) No space may be lived-in by the children in care that is accessible only by a ladder, folding stairs, or a trap door.

(3) Every bathroom door lock must be designed to permit the opening of the locked door from the outside.

(4) Every closet door latch must designed to be opened from the inside.

(5) Open-flame devices and fireplaces, heating and cooking appliances, and products capable of igniting clothing must not be left unattended or used incorrectly.

(6) Fireplaces, wood stoves and other heating systems that have a surface hot enough to cause a burn must have a barrier to prevent access by children.

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(2) If a sleeping or napping room has a ceiling height that is at least twenty-four inches higher than its adjoining hallway, you must install a smoke detector in both the hallway and the sleeping or napping room.

(3) In foster homes, if questions arise concerning fire danger, the local fire protection authority must be consulted.

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(1) You must have readily available at least one approved 2A10BC-rated or larger all purpose (ABC) fire extinguisher.

Note: Approved 2A10BC-rated means a fire extinguisher with an Underwriters' Laboratory label on the nameplate classifying the extinguisher as 2A10BC-rated. These extinguishers are usually multi-purpose, five-pound dry chemical units.

(2) Approved fire extinguisher(s) must be located in the area of the normal path of exiting. The maximum travel distance to an extinguisher from any place on the premises must not exceed seventy-five feet. When the travel distance exceeds seventy-five feet, additional extinguisher(s) are required.

(3) Fire extinguishers must be ready for use at all times.

(4) Fire extinguishers must be kept on a shelf or mounted in a bracket so that the top of the extinguisher is not more than five feet above the floor.

(5) Fire extinguishers must receive yearly maintenance certification by a licensed firm specializing in this work. Maintenance means a thorough check of the extinguisher for:

(a) Mechanical parts;

(b) Extinguishing agent; and

(c) Expelling means.

(6) Exception: New fire extinguishers do not need to receive an additional certification test during the first year.

(7) If local fire authorities require installation of a different type or size of fire extinguisher, those requirements apply instead of the departments, as long as at least the minimum size is maintained.

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(2) If a fire ladder is needed to escape from an upper story window, it must be stored in a location that is easily accessible.

(3) For foster homes and staffed residential homes, a local fire department official may be consulted to determine if a fire ladder is needed to ensure adequate safety.

(4) For group care programs, this determination is made by the state fire marshal representative.

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(2) You must ensure that the plan includes:

(a) Action to take by the person discovering a fire;

(b) Methods for sounding an alarm on the premises;

(c) Action to take for evacuating the building that ensures responsibility for the children; and

(d) Action to take while waiting for the fire department.

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(1) An adult must be on the same floor or within easy hearing distance and accessibility to where children under six years of age are sleeping.

(2) You must use only bedrooms that have unrestricted direct access to hallways, corridors, living rooms, day rooms, or other such common use areas.

(3) You must not use hallways, kitchens, living rooms, dining rooms, and unfinished basements as bedrooms.

(4) For facilities licensed after December 31, 1986, bedrooms must have both:

(a) Adequate ceiling height for the safety and comfort of the occupants. Normally, this would be seven and a half feet; and

(b) A window of not less than one-tenth of the required floor space that can open into the outside, allowing natural light into the bedroom and permitting emergency access or exit.

(5) For any children six years of age and over, you must furnish separate sleeping quarters for each gender.

(6) Children in care must not share the same bed.

(7) In group care facilities, single occupancy bedrooms must provide at least fifty square feet of floor space.

(8) In foster homes, single occupancy bedrooms must provide adequate floor space for the safety and comfort of the child. Normally, this would be at least fifty square feet of floor space, not including closets.

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(2) There must be no more than four persons to a bedroom.

(3) Multiple occupancy bedrooms must provide adequate floor space for safety and comfort of the children. Normally this would be at least fifty square feet of floor space per occupant, not including closets.

(4) When a mother and her infant sleep in the same room, the room must contain at least eighty square feet of usable floor space.

(5) You must allow only one mother and her newborn infant(s) to occupy a bedroom.

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(2) For each child in care, you must provide a bed at least thirty inches wide with a clean and comfortable mattress in good condition, pillow, sheets, blankets, and pillowcases. Each child's pillow must be covered with waterproof material or be washable.

(3) Bedding must be clean.

(4) You must provide waterproof mattress covers or moisture resistant mattresses, if needed.

(5) You must provide an infant with a crib that ensures the safety of the infant and complies with chapter 70.111 RCW, Infant Crib Safety Act.

(6) Cribs must have no more than two and three-eighths inches space between vertical slats when used for infants under six months of age.

(7) Cribs, infant beds, bassinets, and playpens must:

(a) Have clean, firm, snug fitting mattresses covered with waterproof material that is easily sanitized; and

(b) Be made of wood, metal, or approved plastic with secure latching devices

(8) Crib bumpers, stuffed toys and pillows must not be used in cribs, infant beds, bassinets, or playpens.

(9) You must follow the recommendation of the American Academy of Pediatrics, 1-800-505-CRIB, placing infants on their backs each time for sleep.

(10) You may use toddler beds with a standard crib mattress that is sufficient in length and width for the comfort of children under six years of age.

(11) You must not allow children to use the loft style beds or upper bunks of double-deck beds if using them due to age, development or condition could hurt them. Examples: Preschool age children, expectant mothers and children with disabilities.

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(1) You must have at least one telephone on the premises for incoming and outgoing calls. The telephone must be accessible for emergency use at all times.

(2) You must post emergency phone numbers next to the phone.

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(2) In addition, group care facilities must have nonbreakable light fixture covers or shatter resistant light bulbs or tubes.

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(1) You must have separate and adequate facilities for storing soiled and clean linen.

(2) You must provide adequate laundry and drying equipment, or make other arrangements for getting laundry done on a regular basis.

(3) You must locate laundry equipment in an area separate from the kitchen and child care areas unless you are doing foster care in your home.

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(1) You must provide at least one indoor flush-type toilet, one nearby hand-washing sink with hot and cold running water, and

a bathing facility.

(2) You must comply with all of the following requirements for toilet and bathing facilities:

(a) Toilet and bathing facilities must allow privacy for children who are five years of age or older and opposite genders.

(b) Toilet, urinals, and hand-washing sinks must be the appropriate height for the children served, or have a safe and easily cleaned step stool or platform that is water-resistant.

(c) Hand-washing and bathing facilities must be provided with hot running water that does not exceed one hundred twenty degrees.

(d) All bathing facilities must have a conveniently located grab bar unless we approve other safety measures, such as nonskid pads.

(e) You must provide potty-chairs and toilet training equipment for toddlers. You must regularly maintain this equipment and keep it in sanitary condition. You must put potty-chairs, when in use, on washable, water-resistant surfaces.

(f) In group care facilities, whenever urinals are provided, the number of urinals must not replace more than one-third of the total number of required toilets.

(g) You must provide soap and clean towels, disposable towels or other approved hand-drying devices to the persons under your care.

(h) In programs providing care to expectant mothers:

(i) Bathing facilities must have adequate grab bars in convenient places; and

(ii) All sleeping areas must have at least one toilet and hand-washing sink on the same floor.

(3) There shall be at least one indoor flush-type toilet and one nearby handwashing sink with hot and cold or tempered running water. The following ratios of persons normally on the premises to bathrooms at the facilities shall apply:

	Toilets	Handwashing Sinks	Bathing Facilities
Group care programs and facilities	Two minimum and 1:8 ratio	Two minimum and 1:8 ratio	One minimum and 1:8 ratio
Foster family home and staffed residential home	One minimum	One minimum	One minimum

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(a) A public water supply or a private water supply approved by the local health authority at the time of licensing or relicensing; and

(b) Disposable paper cups, individual drinking cups or glasses, or angled jet type drinking fountains.

(2) You must not use bubbler type fountains or common drinking cups.

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(2) The health history must include:

(a) The date of the child's last physical examination;

(b) Allergies;

(c) Any special health problems;

(d) A history of immunizations;

(e) Clinical and medical diagnoses and treatment plans; and

(f) All currently prescribed medications.

(3) When leaving the home or facility, the health history of the child must go with the child to the next placement for continuity of care.

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(a) Been under regular medical supervision; or

(b) Had a physical exam by a physician, a physician's assistant, or an advanced registered nurse practitioner (ARNP).

(2) A physical exam (EPSDT) must be completed within thirty days of placement and annually thereafter.

Note: You may contact the child's social worker for information on this.

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(2) You may accept a child who has not received all immunizations on a conditional basis if immunizations are started as soon as medically possible.

(3) If you are providing care and have minor children of your own who are on the premises of a home or facility, your children must have proof of current immunizations.

(4) The department may give conditional approval for any of your own children who have not received all immunizations as long as their immunizations are started soon as medically possible.

(5) The department may grant exceptions to this requirement for immunizations for your children in two situations:

(a) You, as parent or guardian, have signed a statement indicating your religious, philosophical or personal objections to the requirement; or

(b) You have a physician's statement indicating that a valid medical reason exists for not obtaining immunizations for your own child.

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General communicable diseases and infections

(1) In each home or facility, other than a foster home, staff with a reportable communicable disease, as defined by the department of health, in an infectious stage must not be on duty until they have a physician's approval for returning to work.

(2) Each home or facility, other than a foster home, that cares for severely and multiple-handicapped children must have an infection control program supervised by a registered nurse.

(3) Foster homes with medically fragile children may use other alternatives, such as in-home nursing services, to consult on infection control procedures.

Tuberculosis

(4) Applicants for a license who have been approved for unsupervised access to children in a home or facility must have a tuberculin (TB) skin test by the Mantoux method of testing. They must have this skin test upon being employed or licensed unless:

(a) The person has evidence of testing within the previous twelve months;

(b) The person has evidence that they have a negative chest x-ray since a previously positive skin test;

(c) The person has evidence of having completed adequate preventive therapy or adequate therapy for active tuberculosis.

(5) The department does not require a tuberculin skin test if:

(a) A person has a tuberculosis skin test that has been documented as negative within the past twelve months; or

(b) A physician indicates that the test is medically unadvisable.

(6) Persons whose tuberculosis skin test is positive must have a chest x-ray within thirty days following the skin test.

(7) The department does not require retesting unless a person believes they have been exposed to someone with tuberculosis or if testing is recommended by their health care provider.

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(2) If you care for children in the custody of a tribal court you must follow the direction of that court regarding giving or applying prescription and nonprescription medications or ointments.

(3) Only you or another authorized care provider may give or have access to medications for the child under your care;

(4) Give medications, prescription and nonprescription, only on the written approval of a parent, person or agency having authority by court order to approve medical care;

(5) Except for foster homes, keep a record of all medications you give a child;

(6) Foster homes must keep a record of all prescription medication given to foster children; and

(7) Properly dispose of medications that are no longer being taken or have expired.

Prescription medications

(8) You or another authorized care provider must:

(a) Give prescription medications:

(i) Only as specified on the prescription label; or

(ii) As otherwise approved by a physician or another person legally authorized to prescribe medication.

(b) Check with the physician or pharmacist about possible side effects for any prescription medications and interactions with nonprescription drugs the child is taking.

Psychotropic medications

(9) Care providers must not approve giving psychotropic medications to a child in care. Approval can only be given by one of these:

(a) The child's parent;

(b) Dependency guardians;

(c) A court order; or

(d) The child's social worker, if:

(i) The child is legally free and in the permanent custody of the department; or

(ii) It is impossible to obtain informed parental consent after normal work hours, on weekends, or on holidays.

(10) Children who are at least thirteen years old may decline to take prescription psychotropic medication. If this happens contact the child's social worker immediately.

Nonprescription medications

(11) Children taking psychotropic medications must have the prescribing physician's authorization before any nonprescription drugs are given.

(12) You or another authorized care provider must follow these requirements for nonprescription medications. You must:

(a) Give certain classifications of nonprescribed medications, only with the dose and directions on the manufacturer's label for the age and/or weight of the child needing the medication. These nonprescribed medications include but are not limited to:

(i) Nonaspirin antipyretics/analgesics, fever reducers/pain relievers;

(ii) Nonnarcotic cough suppressants;

(iii) Decongestants;

(iv) Anti-itching ointments or lotions intended specifically to relieve itching;

(v) Shampoo for the removal of lice;

(vi) Diaper ointments and powders intended specifically for use in the diaper area of children;

(viii) Sun screen; and

(ix) Antibacterial ointments for first aid use.

(b) Give any other nonprescription medications only when approved in writing by a physician. These nonprescription medications may be given with a physician's standing order. Physician's standing orders must be patient specific.

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Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-148-0355   May I accept medicine from a child's parent or guardian?   (1) The only medicine you may accept from the child's parent, guardian, or responsible relative is medicine in the original container labeled with:

(a) The child's first and last names;

(b) The date the prescription was filled;

(c) The medication's expiration date; and

(d) Legible instructions for administration (manufacturer's instructions or prescription label).

(2) You must notify the child's social worker when you receive a prescription from a child's parent or guardian.

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(2) You must notify the child's social worker and physician about any adverse reactions the child has to medications.

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(a) They are physically and mentally capable of properly taking the medicine; and

(b) The social worker approves in writing.

(2) You must keep the written approval by the child's social worker in your records.

(3) When a child is taking their own medication, the medication and medical supplies must be kept locked so they are inaccessible to unauthorized persons.

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(2) For an educational and social environment during mealtimes, children must not be routinely separated from the adults and/or required to have separate menus unless ordered by the child's health care provider.

(3) You must provide the facilities for proper storage, preparation, and service of food to meet the needs of the program.

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(2) The time interval between the evening meal and breakfast must not be more than fourteen hours.

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(1) Serve only pasteurized milk or a pasteurized milk product.

(2) Not serve the following types of milk to any child less than twenty-four months of age unless you have written permission by a physician:

(a) Skim milk;

(b) Reconstituted nonfat dry milk; and

(c) One and two percent butterfat milk.

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(2) In foster homes, all home-canned foods must be preserved following published procedures that are approved by the extension service.

(3) You must be able to provide the printed procedure that you followed.

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(1) In group care settings, all formulas must be in sanitized bottles with nipples and labeled with the child's name and date prepared if more than one child is bottle-fed.

(2) You must refrigerate filled bottles if bottles are not used immediately and contents must be discarded if not used within twenty-four hours.

(3) If you reuse bottles and nipples, you must sanitize bottles and nipples.

(4) If breast milk is provided by anyone other than a baby's biological mother, approval must be obtained from the child's social worker.

(5) Infants who are six months of age or over may hold their own bottles as long as an adult remains in the room and within observation range. You must take bottles from the child when the child finishes feeding or when the bottle is empty.

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(1) You must separate diaper-changing areas from food preparation areas.

(2) You must sanitize diaper-changing areas between each use or you must use a nonabsorbent, disposable covering that is discarded after each use.

(3) For cleaning children, you must use either disposable towels or clean cloth towels that have been laundered between each use.

(4) You and any caregiver must wash hands before and after diapering each child.

(5) In group care programs, you must use disposable diapers, a commercial diaper service, or reusable diapers supplied by the child's family.

(6) In group care programs, diaper-changing procedures must be posted at the changing areas.

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(1) The child may take these belongings upon leaving your home or facility; or

(2) If it is impossible for the child to take their belongings at the time they leave, you are require to secure the child's belongings for up to thirty days and cooperate with the child's social worker to transfer the belongings to the child, as soon as possible.

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(2) You must respect the religious rights of the children under your care.

(3) Children have the right to practice their own faith.

(4) Children have the right not to practice your faith without consequences.

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The exceptions to this requirement are the individual programs that have contracts that specify a child can not be denied admission.

(2) A joint decision may be made by the provider and the placement agency to serve the child elsewhere, for the health and safety of the child or others.

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(2) The children in your care must not be required to do basic maintenance of equipment, or of the home or facility.

(3) Children may do work assignments other than household tasks that are appropriate to their age and physical conditions and are part of their service plan. You must provide adequate monetary compensation for the work they do.

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Note: The social worker with the agency having legal custody of the child is the contact person.

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(2) You must supervise children who help with food preparation in the kitchen, based on their age and skills.

(3) Preschool children and children with severe developmental disabilities must not be left unattended in a bathtub or shower.

(4) Foster parents and facility staff must provide the children in their care with appropriate adult supervision, emotional support, personal attention, and structured daily routines and living experiences.

(5) In group care children must be supervised during sleeping hours by at least one awake staff when:

(a) There are more than six children in care; and

(b) The major focus of the program is behavioral rather than the development of independent living skills such as a teen parent program or responsible living skills program; or

(c) The youth's behavior poses a risk to self or others.

(6) In foster home and staffed residential care, children must be supervised during sleeping hours by at least one awake staff when it is part of the written supervision plan with the child's social worker.

(7) Adequate supervision should be arranged and maintained during times of crisis when one or more family members or staff members may be unavailable to provide the necessary supervision or coverage for other children in care.

(8) When special supervision is required and agreed upon between the department and the agency or foster parent, the agency or foster parent provides the necessary supervision. This supervision may require auditory or visual supervision at all times.

(9) When a child has exhibited behavior in a previous placement or the placement agency believes the child poses a risk to other children the agency must inform the provider and jointly develop a plan to address the risk.

(10) When a child exhibits behavior that pose a safety risk to other children in care, the child must not share a bedroom with other children.

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(2) Discipline must be based on an understanding of the child's needs and stage of development.

(3) Discipline must be designed to help the child under your care to develop inner control, acceptable behavior and respect for the rights of others.

(4) Discipline must be fair, reasonable, consistent, and related to the child's behavior.

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(a) Spanking children with a hand or object;

(b) Biting, jerking, kicking, hitting, or shaking the child;

(c) Pulling the child's hair;

(d) Throwing the child;

(e) Purposely inflicting pain as a punishment;

(f) Name calling, using derogatory comments;

(g) Threatening the child with physical harm;

(h) Threatening or intimidating the child; or

(i) Placing or requiring a child to stand under a cold water shower.

(2) You must not use methods that interfere with a child's basic needs. These include, but are not limited to:

(a) Depriving the child of sleep;

(b) Providing inadequate food, clothing or shelter;

(c) Restricting a child's breathing;

(d) Interfering with a child's ability to take care of their own hygiene and toilet needs; or

(e) Providing inadequate medical or dental care.

(3) You must not use methods that deprive a child of necessary services. These include, but are not limited to, contacting:

(a) The assigned social worker;

(b) The assigned legal representative;

(c) Parents or other family members who are identified in the case plan; or

(d) Individuals providing the child with therapeutic activities as part of the child's case plan.

(4) You must not use medication in an amount or frequency other than that prescribed by a physician or psychiatrist.

(5) You must not use medications for a child that has been prescribed for someone else.

(6) You must not physically lock doors or windows in a way that prohibits a child from exiting.

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(2) If your discipline methods change, you must immediately provide a new statement to your licensor describing your current practice.

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(2) In foster homes, in emergencies and only when the child's behavior poses an immediate risk to physical safety may you use physical restraint. The restraint must be reasonable and necessary to:

(a) Prevent a child on the premises from harming themself or others; or

(b) Protect property from serious damage.

(3) If your group care program is approved by DLR for the use of physical restraint, the licensee and staff must be trained in the appropriate use of restraining techniques in accordance with the department's behavior management policy before restraining a child.

(4) Medication prescribed by a physician to control behavior must be only given as prescribed.

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(1) Use physical restraint as a form of punishment or discipline.

(2) Use mechanical restraints, such as handcuffs and belt restraints.

(3) Use locked time-out rooms.

(4) Use physical restraint techniques that restrict breathing, inflict pain as a strategy for behavior control, or that might injure a child. These include, but are not limited to:

(a) Restriction of body movement by placing pressure on joints, chest, heart, or vital organs;

(b) Sleeper holds, which are holds used by law enforcement officers to subdue a person;

(c) Arm twisting;

(d) Hair holds;

(e) Choking or putting arms around the throat; or

(f) Chemical restraints, including but not limited to pepper spray.

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(2) For group care programs, the director or program supervisor must review any incident with the staff who used physical restraint to ensure that the decision to use physical restraint and its application were appropriate.

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(2) You must follow the children's administration's behavior management guideline policy regarding the information to be reported.

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(2) The approval must be in writing and signed by the division of licensed resources director or designee.

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(a) Protect and nurture children in a safe, healthy environment with unconditional positive support;

(b) Support relationships among children and their parents, siblings, and kin;

(c) Meet the developmental needs of the child by:

(i) Helping the child cope with separation and loss;

(ii) Helping the child build positive attachments to appropriate adults;

(iii) Building self-esteem;

(iv) Giving positive guidance;

(v) Supporting cultural identity;

(vi) Using discipline appropriate to the child's age and stage of development;

(vii) Supporting intellectual and educational growth;

(viii) Encouraging and modeling positive social relationships and responsibilities; and

(ix) Helping the child gain age appropriate skills for independence.

(2) Foster parents must support the permanent placement plan for the child, focusing first on the birth family reuniting, and then, on options leading to a permanent placement.

(3) Foster parents are encouraged to participate as members of the child's treatment team.

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(1) Assist the child to attend school on a regular basis if this is part of the child's service plan;

(2) Provide a suitable study area for the children under your care; and

(3) Provide opportunities to learn appropriate skills for the development of self-sufficiency.

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(2) You need proof of completion of current first-aid/CPR training that is geared for the ages of the foster children you want in your home.

(3) You need proof of completion of HIV/AIDS training.

(4) The primary care givers must complete all required DLR-approved training after licensing.

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(2) In a two-parent household, the total number of children in your home is restricted to six children, including your own children.

(3) In a single parent household, the total number of children in your home is restricted to four children, including your own children.

(4) A home may be licensed for the care of at least one child when the foster parents have more of their own children than specified in subsection (2) of this section, if they meet the other licensing requirements.

(5) You may have only two children under two years of age in your home at a time. This includes foster children and your own children.

(6) The capacity restrictions in this section may be exceeded in extraordinary situations, such as to place a sibling group, to place a child with a relative, or because the family has demonstrated exceptional abilities in relation to the special needs of a child, if this appears to be in the best interest of the child and would not jeopardize the health and safety of the other children in the home. Approval to exceed the capacity restrictions must be in writing and signed by the DLR manager or designee.

(7) The department may license a foster home for up to three foster children with mental or physical disabilities that are severe enough to need semi-skilled maintenance or supportive services if:

(a) Your training and/or experience qualifies you to provide proper care;

(b) The children's treatment requires nursing service oversight; and

(c) The total number of children with mental or physical disabilities in your home is three or fewer.

(8) The department may license a foster family for up to two nonmobile children.

(9) While providing respite care, you may only exceed the number of children you are licensed to serve with prior approval by the DLR director or designee.

(10) The department may license a foster home to serve up to four children with developmental disabilities as defined in RCW 71A.10.020, at any one time.

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(2) At least one parent must be available to respond to school crisis.

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(2) Respite care may be arranged in advance or on an emergency basis.

(3) Respite care may be arranged to support the care a foster parent is providing or to provide substitute care in the absence of foster parents.

(4) Respite care given outside the foster parent's home must be provided by licensed providers.

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(1) The child's social worker; or

(2) The child placing agency case manager, if any.

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Note: The social worker with the agency having legal custody of the child is the contact person.

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(2) The social summary must serve as the basis of the child's admission to care.

(3) If a child needs to be accepted for emergency care, such as placement in a crisis residential center, the department does not require the social study to be completed prior to admission. In these cases, if the child remains in care beyond thirty days, a summary must be completed as soon as possible.

(4) The study must contain the following information for the child:

(a) Copies of psychological or psychiatric evaluations, if any, on the child under care.

(b) A narrative description of the child's background and family that identifies the immediate and extended family resources;

(c) The child's interrelationships and the problems and behaviors that have required care away from his or her own home;

(d) The child's primary and alternate permanency plan;

(e) Previous placement history, if any; and

(f) An evaluation of the child's need for the particular services and type of care you provide.

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(2) The treatment plan must:

(a) Identify the service needs of the child, parent or guardian;

(b) Describe the treatment goals and strategies for achieving those goals;

(c) Include a running account of the treatment received by the child and others involved in the treatment plan, such as any group treatment or individual counseling; and

(d) Be updated at least quarterly to show the progress toward meeting goals and list barriers to the permanent plan.

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(2) You must send to DLR a detailed written program description outlining educational, recreational, and therapeutic services you will provide to children and their families. A sample of the schedule of daily activities for children under care must be included.

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(a) Develop or arrange for an educational plan for each child in care who has not completed high school and/or the GED (high school equivalency examination);

(b) Support each child participating in their education plan; and

(c) Provide suitable study areas for children under your care.

(2) If the instruction is given on your premises, you must:

(a) Have the program certified by the office of the superintendent of public instruction and provide classrooms separate from the living area;

(b) Send the department a written description of how you will provide an educational program for children under your care; and

(c) Provide or arrange for independent living skills education for developing self-sufficiency for the children under your care.

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(a) Isolation;

(b) Aseptic procedures;

(c) Reporting communicable diseases;

(d) Hygiene, including hand washing, using the toilet, diapering, and laundering.

(2) Group care facilities must maintain current written medical policies and procedures to be followed on:

(a) Prevention of the transmission of communicable diseases including:

(i) Hand washing for staff and children;

(ii) Management and reporting of communicable diseases.

(b) Medication management;

(c) First aid;

(d) Care of minor illnesses;

(e) Actions to be taken for medical emergencies;

(f) Infant care procedures when infants are under care; and

(g) General health practices.

(3) If you are licensed as a group home or as a facility that can care for thirteen or more persons at once, you must arrange to have one of the following help you develop and periodically review your medical policies and procedures:

(a) An advisory physician,

(b) A physician's assistant, or

(c) A registered nurse.

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(a) These must include at least monthly visits unless a different agreement is specified in the individual child's treatment plan.

(b) The nurse must be registered and currently licensed in the state of Washington.

(2) The nurse's name, address and telephone number must be readily available to the staff at your home or facility.

(3) The nurse must assist the agency in setting up a program that provides for regular medical check-ups and follow-up for special health care needs specified by the child's physician or your staff.

(4) The nurse must advise and assist nonmedical staff at your home or facility in maintaining child health records, meeting daily health needs and caring for children with minor illnesses and injuries.

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(1) One person who provides social services must have a master's degree in social work or a closely related field from an accredited school.

(2) Social service staff without a master's degree in social work or closely related field must have a bachelor's degree in social work or a closely related field. A person with a master's degree must consult at least eight hours per month with any social service staff who have only a bachelor's degree.

(3) When social services are provided by another agency, you must have a written agreement with the agency describing the scope of service they provide. Written agreements must meet the requirements of this rule.

(4) A social service staff person must review and sign approving the child's treatment plan.

(5) A social service staff person must review and sign approving licensing application packets before they are submitted to DLR.

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(a) A master's degree from a recognized school of social work or similar academic training in the field they will be advising;

(b) The training, experience, knowledge and demonstrated skills in each area that he or she will be supervising; and

(c) The ability to ensure your staff develop their skills and understanding needed to effectively manage their cases.

(2) Consultants may be hired as staff or operate under a contract with your program.

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(1) If you have five or more employees or volunteers, your training plan must be in writing.

(2) You must discuss with the staff your policies and procedures as well as the rules contained in this chapter.

(3) You must provide or arrange for your staff to have training for the services that you provide to children under your care.

(4) Your training on behavioral management must be approved by DLR and must include nonphysical age-appropriate methods of redirecting and controlling behavior, as described in the department's behavior management policy.

(5) You must record the amount of time and type of training provided to staff.

(6) This information must be kept in each employee's file or in a separate training file.

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Type of Program	Minimum Ratio of Full-Time Social Service Staff to Children Under Care
Day treatment program	1 to 15
Group homes	1 to 25
Child-placing agency	1 to 25
Maternity services	1 to 25
Regular and secure crisis residential centers	1 to 5

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(2) In your staffed residential home, if you care for more than one nonmobile child at a time, the care for both children must be on the ground floor.

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(1) Hazardous areas must be separated from the staffed residential home or group care facility by at least a "one-hour" fire-resistant wall. Hazardous areas include rooms or spaces containing:

(a) A commercial-type cooking kitchen;

(b) A boiler;

(c) A maintenance shop;

(d) A janitor closet;

(e) A woodworking shop;

(f) Flammable or combustible materials; or

(g) Painting operations.

(2) We do not require a fire-resistant wall when:

(a) A kitchen contains only a domestic cooking range; and

(b) Food preparation does not produce smoke or grease-laden vapors.

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(1) Smoke detectors must have a UL approval sticker and sound an alarm that is audible in all sleeping and napping areas.

(2) In new construction, required smoke detectors must receive their primary power from building wiring from a commercial source. Wiring must be permanent, with a disconnecting switch only for overcurrent protection.

(3) Smoke detectors must also:

(a) Be equipped with a battery backup; and

(b) Emit a signal when the batteries are low.

(4) If installed in existing buildings or buildings without commercial power, smoke detectors may be solely battery operated.

(5) Single-station smoke detectors must be tested at monthly intervals or in a manner specified by the manufacturer. Records of such testing must be maintained upon the premises.

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(1) You must request the local fire department to visit your home or facility to:

(a) Assist care givers in meeting all necessary fire safety requirements; and

(b) Become familiar with your home or facility.

(2) You must assure that furnace rooms are:

(a) Maintained free of lint, grease, and rubbish; and

(b) Suitably isolated, enclosed, or protected.

(3) Flammable or combustible materials must be stored away from exits and in areas that are not accessible to children. Combustible rubbish must not be allowed to collect and must be removed from the building or stored in closed, metal containers away from building exits.

(4) All trash must be removed daily from the building and thrown away in a safe manner outside the building. All containers used for the disposal of waste material must consist of noncombustible materials and have tops.

(5) All electrical motors must be kept free of dust.

(6) Open-flame devices capable of igniting clothing must not be left on, unattended or used in a manner that could result in an accidental ignition of children's clothing.

(7) Candles must not be used.

(8) All electrical circuits, devices and appliances must be properly maintained. Circuits must not be overloaded. Extension cords and multi-plug adapters must not be used in place of permanent wiring and proper outlets.

(9) House and facility numbers must be clearly visible from the street or road in front of the property. Where the home or facility is not clearly visible from the road, the address must be posted at the head of the driveway.

Note: This is to allow emergency vehicles and fire trucks to easily find addresses.

(10) Fireplaces, woodstoves, and similar devices must be installed and approved according to the rules that were in effect at the time of installation (see the local building permit). These devices must be properly maintained and must be cleaned and certified at least once a year or maintained according to the manufacturer's recommendations.

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(1) You and your staff must be familiar with all aspects of the fire drill.

(2) You and your staff must be able to:

(a) Operate all fire extinguishers installed on the premises;

(b) Test smoke detectors (single station types); and

(c) Conduct frequent inspections of the home or facility to identify fire hazards and take action to correct any hazards noted during the inspection.

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(2) You must maintain a written record on the premises that indicates the date and time that drill practices were completed.

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(2) If a facility is certified by the department of health, such as a secure residential treatment center, the facility must meet construction and fire safety standards for psychiatric hospital security rooms when they have a secure CRC or a secure residential treatment center within the physical structure.

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(1) If you operate a facility other than a foster home or a staffed residential home you must prepare and date daily menus, including snacks, at least one week in advance.

(2) You must provide for the proper storage, preparation, and service of food to meet the needs of the program.

(3) Your program must be in compliance with the department of health standards in chapter 246-215 WAC on food service sanitation.

(4) A menu must specify a variety of foods for adequate nutrition and meal enjoyment.

(5) You must keep the menus on file for a minimum of six months so that we can review your menus.

(6) You must post each person's dietary restrictions, if any, for staff to follow.

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(1) Group home programs;

(2) Independent living skills programs;

(3) Maternity services;

(4) Services to children with severe developmental disabilities and medically fragile children; and

(5) Crisis residential centers and secure crisis residential centers; and

(6) Day treatment programs. Day treatment programs are considered group care programs under this chapter, though they are not twenty-four-hour residential programs.

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(a) A clean, homelike environment;

(b) Basic necessities such as adequate food, appropriate clothing and recreational opportunities;

(c) Safety;

(d) An age-appropriate environment with necessary structure, routine, and rules to provide for a healthy life, growth and development.

(2) Your program must be staffed with employees who are competent to provide for the safety and needs of the children in your care.

(3) Your program must have a written statement that includes your mission, goals, and a description of the services you provide.

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(a) Have behavior that cannot be safely or effectively managed in foster care;

(b) Need temporary placement awaiting a more permanent placement;

(c) Need emergency placement during a temporary disruption of a current placement;

(d) Have emotional, physical, or mental disabilities; or

(e) Need a transitional living setting.

(2) If your group care program serves children with severe developmental disabilities, medically fragile children, maternity services, or meets RCW 74.15.020 (2)(m), the children may be younger than six years of age.

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(a) Be able to communicate to the department the roles, expectations and purposes of the program; and

(b) Work with representatives of other agencies.

(2) They must also meet one of these education or experience requirements:

(a) Have a bachelor's degree in social science or closely related field from an accredited school, and have at least two years' full-time relevant experience; or

(b) Have a minimum of two years of successful, full-time relevant experience, such as working in a group care facility; or

(c) Have a minimum of two years as a foster parent with a letter of recommendation from the licensing agency and/or supervising agency.

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(1) Coordinates the day-to-day operations of the program;

(2) Supervises the child care staff;

(3) Oversees the completion of each child's plan of care or treatment.

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(1) A bachelor's degree in a social science or closely allied field from an accredited school; or

(2) Five years of successful full-time experience in a relevant field; and

(3) Supervisory abilities that promote effective staff performance; and

(4) Relevant experience, training, and demonstrated skills in each area that he or she will be supervising.

(5) The same person may have the responsibilities of the executive director and the on-site program manager if that person meets the qualifications for both positions.

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(1) Be at least twenty-one years old;

(2) Exception: Child care staff may be eighteen to twenty years old if enrolled and participating in an internship program with an accredited college or university; and supervised by staff twenty-one years or older;

(3) Have a high school diploma or GED;

(4) Have one year of experience working with children;

(5) Have the skills and abilities to work successfully with the challenging behaviors of children in care; and

(6) Have effective communication and problem solving skills.

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(1) The ratio for group homes is at least one child care staff member on site for every eight children during waking hours.

Note: Crisis residential centers, staffed residential homes, maternity programs, and programs for children with severe developmental disabilities have different requirements.

(2) At least two adults, including at least one child care staff person, must be on site whenever more than eight children are on the premises.

(3) To keep the proper ratio of staff to children, the executive director, on-site program manager, support staff and maintenance staff may serve temporarily as child care staff if they have adequate training.

(4) During sleeping hours of youth, at least one staff person must be awake in all group home programs when:

(a) There are more than six youth in care; and

(b) The major focus of the program is behavioral change rather than the development of independent living skills, such as teen parent and independent living skills programs; or

(c) The youth's behavior poses a safety risk to self or others.

(5) When only one child care staff is on site, a second staff must be on call.

(6) You must have relief staff so that all staff can have the equivalent of two days off a week.

(7) If you have more than one program in one building, such as a group care program and a crisis residential center, you must follow the most stringent staffing ratio requirements.

(8) For certified juvenile detention facilities, at least one child care staff member must be on duty for every ten children in care during the sleeping and waking hours.

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(1) You must provide rooms that are ample in size and properly furnished for the number of children you serve.

(2) You must have a comfortably furnished living room.

(3) You must have a dining room area that is ample in size and suitably furnished for your residents.

(4) Exception: Juvenile detention facilities are not required to meet these first three standards.

(5) With more than twelve children, you must provide at least one separate indoor recreation area. Its size and location must be sufficient for the age and number of the children to engage in recreational and informal education activities.

(6) You must provide a room or area that is used as an administrative office. In addition, suitable offices must be provided for social service staff. In facilities caring for fewer than thirteen children, these offices may be combined with the administrative office.

(7) You must provide a space that can be used as a visiting area.

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(2) A special care room must:

(a) Be located in a place that easily allows the person to be supervised;

(b) Have toilet and lavatory facilities that are easily accessible to any person staying in the special care room.

(3) After each use have the area and equipment sanitized if used by any person who is suspected of having a communicable disease.

(4) You may use the special care room for other purposes when it is not needed for the separation and care of an ill or injured person.

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(2) All food service facilities and food handling practices in day treatment programs and group care facilities must comply with rules and regulations of the state board of health governing food service sanitation (see chapter 246-215 WAC).

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(1) Foster homes;

(2) Staffed residential homes;

(3) Group homes for new mothers with infants;

(4) Independent living programs; and

(4) Child placing agencies.

Note: The rules in WAC 388-148-0745 through 388-148-0795 apply exclusively to licensing requirements for agencies providing or arranging maternity service.

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Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-148-0750   What maternity services must I provide?   If you operate a licensed program for expectant mothers and new mothers with infants, you must provide or arrange for the following services:

(1) Information and referral services to every expectant and new mother who applies for care.

(2) Individual or group counseling sessions, if necessary, about the following topics:

(a) Pregnancy counseling;

(b) Independent living education;

(c) Infant and child care training;

(d) Living arrangements;

(e) Medical care planning;

(f) Legal issues;

(g) Vocational or educational guidance;

(h) Plans for the child;

(i) Financial, emotional or psychological problems;

(j) Relations with parents and birth father; and

(k) Home management and consumer education.

(3) An expectant mother's delivery in a licensed hospital or licensed birthing facility.

(4) Postpartum medical examinations, as prescribed by a physician, to a new mother.

(5) Childcare, as needed.

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(2) If you do not directly provide maternity services to an expectant or new mother in your facility, you must either:

(a) Arrange for these services through formal agreements with other community agencies; or

(b) Assist the clients in your program to get these services.

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(1) The department requires that you provide us with a written program description about the daily activities you offer. The program description must outline educational, recreational, and therapeutic services that you intend to provide to expectant mothers and new mothers with infants.

(2) You must also provide us with a schedule of typical daily activities for the mothers under your care.

Exception: Foster homes are not required meet the standard in this section.

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(1) Pregnancy hygiene;

(2) Suitable preparation for childbirth;

(3) The physiological changes during pregnancy;

(4) Examinations and childbirth procedures;

(5) Postnatal and pediatrics care;

(6) Contraception and family planning;

(7) Nutritional requirements for mother and child;

(8) Child health and development; and

(9) Psychological and emotional changes during and after pregnancy.

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(2) The childcare home or facility must meet licensing requirements (see chapter 388-130 or 388-155 WAC).

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(1) These programs must employ sufficient numbers of residential staff to meet the physical, safety, health and emotional needs of the residents. Residential staff are in charge of supervising the day-to-day living situation for youth.

Note: Child care staff may carry out any maintenance tasks that do not detract from their primary function.

(2) When youth are on the premises, the ratio of staff to residents must be as follows:

(a) At least one residential staff member must be on duty for every eight mothers.

(b) When more than eight persons (including mothers and children) are on the premises, at least two adults, including at least one child care staff must be on duty.

(3) You must have relief staff so that all staff can have the equivalent of two days off a week.

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(2) If your facility offers medical clinics, you must have a separate, adequately equipped examination room with adequate nursing equipment.

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(2) Day treatment is for children who are:

(a) Unable to adjust to school programs due to disruptive behavior, family stress, learning disabilities or other serious emotional disabilities; and/or

(b) Are unable to profit from outpatient child guidance clinic services and related programs.

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Note: The executive director and on-site program manager may be the same person if that person is qualified for both positions.

(2) Either the executive director or on-site program manager must be on the premises while the children are in care. Another competent person may be left in charge during the director's and/or program supervisor's temporary absence.

(3) The qualifications for executive director and on-site program manager are outline in WAC 388-148-0700 and 388-148-0715, respectively.

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(1) Receive regular consultation from a child psychiatrist;

(2) Provide or arrange for a psychologist for psychological testing and related services if the child's school does not provide these services;

(3) Provide or arrange for teaching by certified teachers qualified by training or experience in remedial education; and

(4) Use group counselors who are qualified by training or by experience in the care of disturbed children.

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(a) An individualized treatment plan suited to the unique needs of each child in care; and

(b) Care by physicians, including surgeons, general and family practitioners, and specialists in the child's particular diagnosis on either a referral, consultative, or ongoing treatment basis.

(2) You must also provide the following nursing services, if prescribed by a physician, if you care for medically fragile children, or children with severe developmental disabilities unless these children are in a foster home:

(a) Sufficient licensed nursing staff to meet the nursing care needs of the children; or

(b) Regular nursing consultation that includes at least one weekly on-site visit by a registered nurse.

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(1) The plan must describe:

(a) The care given for each child;

(b) The goals to be accomplished; and

(c) The professional services responsible for each element of care.

(2) The care plan must be reviewed, evaluated, and updated annually by professional staff involved in the care of the child to re-evaluate each child's condition, progress, prognosis and need for ongoing care and services.

(3) You must record progress reports in the child's record on a quarterly basis.

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(1) The registered nurse's name, address, and telephone number must be readily available.

(2) The agency or program must have the nurse assist in implementing a regular health care program that both:

(a) Oversees the health of all children; and

(b) Provides follow-up care of special health needs identified by the child's physician or facility or program staff.

(3) The agency or program must have the nurse advise and assist nonmedical personnel in maintaining medical records, meeting daily health needs, and caring for children with minor illnesses and injuries.

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(1) If you have four or more infants, you must arrange for monthly on-site visits with a registered nurse that is trained or experienced in the care of young children.

(2) You must have a written agreement with the registered nurse about your infant care program.

(3) If you have children with severe developmental disabilities requiring nursing services, you must have a registered nurse on staff or under contract.

(4) The nurse must advise you and your staff on your infant care program and your child health program.

(5) You must document the nurse's on-site visits.

(6) The nurse's name and telephone number must be posted or otherwise available in your home or facility.

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(2) If you do not have a room for physical and occupational therapy, you must arrange for these therapies outside of your facilities.

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(1) If you are licensed to care for thirteen or more children, you must provide separate, safe play areas for children under one year of age or children not walking. The department must approve the rooms or areas.

(2) Children under one year of age must be cared for in rooms or areas separate from older children.

(3) No more than eight children under one year of age may be in the room at a time.

(4) Hand-washing facilities must be available in these rooms.

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(1) All modified diets must be planned, reviewed, and approved by a dietitian. You must use the services of a dietitian who meets current registration requirements of the American dietetic association.

(2) You must follow the dietary plan for each child as prescribed by the child's physician. You must document in the child's file that staff are following the physician's order.

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(a) Information you received upon admission including family background, current diagnosis and medical status, an inventory of personal belongings, medical history, and a report of a physical examination and diagnosis by a physician;

(b) Information about the child's daily care including treatment plans, medications, observations, medical examinations, physicians' orders, allergic responses, consent authorizations, releases, diagnostic reports, and revisions of assessments;

(c) Upon discharge, a summary including diagnoses, treatments, and prognosis by the person responsible for providing care, and any instructions and referrals for continuity of care; and

(d) Evidence of meeting criteria for eligibility for services from the division of developmental disabilities.

(2) If the child has died, you must also have the following information:

(a) The time and date of death;

(b) Apparent cause of death;

(c) Notification of the physician and relevant others (including the coroner if necessary); and

(d) Regarding the disposal of the child's body and how the child's personal effects will be dealt with.

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(2) A foster home may be licensed as a family CRC. The foster home licensed, as a CRC, must meet the licensing standards for foster homes outlined in this chapter.

(3) Family CRCs and regular CRCs are not locked facilities, but are operated in a way that reasonably assures that youth placed there will not run away.

Note: Regular CRCs are also known as semi-secure CRCs, as referred to in RCW 13.32A.030 (13) and (14).

(4) A secure facility is designed and operated to prevent a youth from leaving without permission of the staff. This facility has locking doors, locking windows, or secured perimeters.

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(1) Be a free-standing facility, separate unit, or separate building within a campus with windows and exterior doors that prevent exit.

(2) Meet or exceed the current state building code when locking doors and windows prevent exit.

(3) Ensure that no youth is kept in a locked room that isolates the youth from the general population and/or staff.

(4) Maintain a recreation area, within the secured facility or secured on the property of the facility, that can support youth's vigorous physical activity. (Any fences used to secure the recreation area must meet or exceed the specifications of the level-two CRC referenced in WAC 388-148-0890(3)).

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(1) Prevent unauthorized entering and exiting with a nonscalable fence around the perimeter of the facility property;

(2) Not prevent exit by locking facility doors or windows;

(3) Design the nonscalable fence that does not cause injury, such as avoiding use of electrification, razor wire or concertina wire;

(4) Ensure that no youth is kept in a locked room that isolates him or her from the general population and/or staff; and

(5) Maintain a recreation area surrounded by a nonscalable fence that can support youth's vigorous physical activity.

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(2) Staff assigned to the secure crisis residential center youth must not be simultaneously assigned to the juvenile detention center residents on the same shift.

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All CRCs

A crisis residential center (CRC) provides emergency, temporary residence to youth ages twelve through seventeen who meet one of the following criteria:

(1) Are beyond the control of their parents or guardians and behave in a way that endangers any person's welfare;

(2) Need assistance getting food, shelter, health care, clothing, educational services, and/or resolving family conflicts;

(3) Need temporary protective custody; or

(4) Have parents who are not able or willing to continue efforts to keep the family together.

Secure CRCs

Youth ordered by the court to serve time for contempt on CHINS, APY, or truancy orders may be ordered into a secure CRC that is co-located with a detention facility.

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(1) Are runaways;

(2) Are in dangerous situations; or

(3) Are in violation of curfew.

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All CRCs

(1) The director or designee of a crisis residential center (CRC) must immediately notify the parents of the youth who has been admitted.

(2) If the director or designee of any CRC is unable to contact the youth's parents within, forty-eight hours, he or she must:

(a) Contact the department and request that the case be reviewed for dependency filing under chapter 13.34 RCW or "child in need of services" filing under chapter 13.32A RCW; and

(b) Document the contact with the department in the youth's case record.

Secure CRCs

(3) Within the first twenty-four hours after admitting a youth to a secure crisis residential center, and each twenty-four hours after, the director or designee must assess the youth's risk of running.

(4) The CRC director or designee must determine what type of CRC, regular or secure, would be best for the youth.

(5) The CRC director or designee must use the following criteria in making the decision, considering the safety, health and welfare of the youth and others:

(a) The youth's age and maturity;

(b) The youth's physical, mental, and emotional condition upon arrival at the center;

(c) The circumstances that led to the youth's placement at the facility;

(d) The youth's behavior;

(e) The youth's history of running away;

(f) The youth's willingness to cooperate in conducting the assessment;

(g) The youth's need for continued assessment, protection, and intervention services in a CRC; and

(h) The likelihood the youth will remain at a CRC.

(6) The CRC director or designee must put the decision about the youth's status in writing in the youth's file.

(7) After a youth is admitted, the CRC director or designee must ensure that a youth is assessed for any health needs requiring immediate attention.

(8) By the first school day after admission, the crisis residential center staff must:

(a) Notify the youth's school district about the youth's placement; and

(b) Assess the youth for any educational needs as a part of the assessment process for inclusion in the discharge summary.

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(1) Has been in the secure facility for at least twenty-four hours; and

(2) Is considered likely to remain at a regular CRC facility.

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(1) Obtain the department's agreement with the transfer decision.

(2) Communicate with the CRC where the youth is being relocated:

(a) Assure mutual agreement with the transfer decision; and

(b) Make sure that space for the youth is available to support the transfer.

(3) Document all communication related to the transfer into the youth's file.

(4) The CRC director or designee initiating the transfer must establish and maintain the following written documents:

(a) Transfer procedures for the transfer of youth to another crisis residential center; and

(b) Protocols/agreements with the other crisis residential center's director for youth transfers.

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(1) Youth may stay in any crisis residential center (CRC) for up to five days.

(2) If a youth has been transferred between CRCs, the total number of days spent in both CRCs may not exceed five days.

Secure CRCs

(3) Any youth admitted to a secure CRC must remain there for at least twenty-four hours, unless their parent or guardian removes them.

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(a) A description of the CRC's program and services;

(b) The physical facility;

(c) The department-approved policy that states that youth may not have guns and other weapons, alcohol, tobacco, and drugs within the facility; and

(d) The department-approved policy on client visitation that includes access to the youth's attorney.

(2) Written documentation of this orientation must be in each youth's file.

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(a) Assessment of the family in order to develop a treatment plan for the youth;

(b) Family counseling focused on communication skills development and problem solving;

(c) Individual and/or group counseling; and

(d) Referrals to transition the family to community-based services.

(2) Intervention services must be documented, in writing, in the youth's case record.

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(2) A CRC must develop policies and procedures when the behavior management practices include use of physical restraint, including:

(a) Who may authorize the use of physical restraint; and

(b) Under what circumstances physical restraint may be used, including time limitations, re-evaluation procedures, and supervisory monitoring.

(3) Written policies and procedures about using physical restraint must be submitted to the department for approval before the policies and procedures are implemented.

(4) All staff must be trained in behavior management techniques prior to using physical restraint.

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(2) The purpose of the multidisciplinary team is to evaluate the youth and the youth's family and when agreed to by the family, assist the with any of the following services:

(a) Developing a plan for accessing available social and health-related services;

(b) Obtaining referrals to a chemical dependency specialist and/or county-designated mental health professional;

(c) Recommending no further intervention because the youth and family have worked out the problems that were causing family conflicts; and

(d) Reconciling the youth and family.

(3) Members of multidisciplinary teams may include:

(a) Educators;

(b) Law enforcement personnel;

(c) Court personnel;

(d) Family therapists or mental health providers;

(e) Chemical dependency treatment providers;

(f) Licensed health care practitioners;

(g) Social service providers;

(h) Youth residential placement providers;

(i) Other family members;

(j) Church representatives; and

(k) Members of the family's community.

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(2) The director or designee also may set up a multidisciplinary team when he or she:

(a) Believes that the:

(i) Youth is a "child in need of services" under RCW 13.32A.030; and

(ii) Parent is unavailable or unwilling to continue efforts to maintain the family structure.

(b) Needs help contacting the youth's parents. If the director or designee is unable to contact the parent or guardian within forty-eight hours, the director or designee must:

(i) Contact the department and request the case be reviewed for a dependency filing under chapter 13.34 RCW or a "child in need of services" filing under chapter 13.32A WAC; and

(ii) Document this information in the child's case file.

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(2) The director or designee must:

(a) Tell the youth's parents or guardians about the multidisciplinary team if the parents did not make the initial request to form a team;

(b) Advise the parents of their right to select additional members; and

(c) Assist in getting prompt involvement of additional persons that the parent or youth have requested to be added to the multidisciplinary team.

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(2) Parents may disband the multidisciplinary team:

(a) Unless a dependency petition has been filed (under RCW 13.32A.140); or

(b) After a dispositional hearing has taken place ordering out-of-home placement for the youth.

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Additional CRC youth care staff qualifications

(2) Additional requirements for youth care staff that work in a CRC are as follows:

(a) At least fifty percent of the youth care staff must have completed:

(i) A bachelor's degree; or

(ii) At least two years of college and one year of work in a residential care program for adolescents.

Note: Youth care staff may substitute experience for education on a year-for-year basis. A Bachelor of Arts degree in behavioral or social science may substitute for experience.

(3) The remaining youth care staff must have at least a high school diploma or GED and one of the following:

(a) One year of successful experience working with youth in a group setting;

(b) One year of successful experience as a foster parent for three or more children;

(c) Have skills and abilities to work successfully with the challenging behaviors of children in care; and

(d) Have effective communication and problem solving skills.

Note: Two years of college may be substituted for the required experience.

(4) Each youth care staff person must be at least twenty-one years of age, unless they are between eighteen and twenty-one, enrolled and participating in an internship program with an accredited college or university.

Note: Staff under twenty-one years of age must be supervised by a staff twenty-one years old or older.

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Regular CRCs

(2) At all times, regular crisis residential centers must have at least one youth care staff on duty for every four youth in care.

(3) Regular crisis residential centers must have at least two awake youth care staff on duty during waking hours.

(4) Regular crisis residential centers must have at least one awake youth care staff on duty during sleeping hours of the youth. One or more additional (back-up) staff must be on the premises during sleeping hours to maintain staffing ratios.

Under extraordinary circumstances, the DLR director may approve an alternative back-up plan.

Secure CRCs

(5) At all times, secure crisis residential centers must have at least two staff on site at all times when youth are present.

(6) At all times, secure crisis residential centers must have at least one youth care staff on duty for every three youth in care.

(7) At all times, secure crisis residential centers that are located in the same facility as detention facilities must have the at least one awake youth care staff on duty for every four youth in care.

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(a) Presentation of the CRC agency's policies and procedures manual;

(b) Behavior management techniques;

(c) Crisis intervention techniques;

(d) Family intervention techniques;

(e) Child abuse and neglect reporting requirements;

(f) Youth supervision requirements; and

(g) HIV/AIDS/Blood-borne pathogen training.

(2) Staff working at a CRC must complete a minimum of twenty-four hours of on-going education and in-service training annually. This training must include:

(a) Crisis intervention techniques, including verbal de-escalation, positive behavior support, and physical response/restraint training as approved by the department;

(b) Behavior management techniques;

(c) Substance abuse;

(d) Suicide assessment and intervention;

(e) Family intervention techniques;

(f) Cultural diversity;

(g) Mental health issues and interventions;

(h) Mediation skills;

(i) Conflict management/problem-solving skills;

(j) Physical and sexual abuse; and

(k) Emergency procedures.

(3) All staff working at a CRC must have current first aid and CPR training.

(4) The director or designee of the CRC must document completion of all training in each staff person's personnel file.

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(2) In addition, a CRC must record:

(a) The time and date a placement is made;

(b) The names of the person and organization making the placement; and

(c) Reasons for the placement.

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(2) You must have a policy on the use and retention of these logs, including but not limited to staff briefings between shifts to verify:

(a) Where youth are physically located at each shift change; and

(b) That weekly inspections take place of any security devices.

(3) You must retain these logs for seven years.

(4) You must also maintain a log and written report that identifies all incidents requiring physical restraints for a youth. (see WAC 388-148-0495)

(5) Within seven days of a youth's discharge, you must send the child's social worker a written summary that includes, but is not limited to:

(a) Community-based referrals;

(b) Assessment information on the family and child;

(c) Family reconciliation attempts;

(d) Contacts with families and professionals involved;

(e) Recommendations for all family members;

(f) Medical and health related issues; and

(g) Any other concerns, such as legal issues and school problems.

(6) You must retain a copy of any discharge summaries in the youth's case record at the secure crisis residential center.

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(1) Are unable to successfully live in a foster home;

(2) Have emotional disturbances or physical or mental disabilities;

(3) Are medically fragile; or

(4) Are in transition from residential care to a foster home.

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(1) The number of children served at one time;

(2) The expectations of services to be provided;

(3) The steps to be taken to include the child's family;

(4) The plan on how coordination will occur with community partners;

(5) The plan on how permanency planning for the children will take place;

(6) A safety and supervision plan for each child; and

(7) A behavior management plan for each child, as appropriate.

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(2) You must provide care and supervision for children you serve in a staffed residential home, considering their ages and physical conditions.

(3) You must submit a written program description for department approval that includes:

(a) A list of services that you will provide to children and their families;

(b) Who and how these services will be carried out; and

(c) A schedule of typical daily activities for the children under your care.

(4) Services for children must include:

(a) Transportation;

(b) Teaching social and living skills;

(c) Opportunities for play and recreation; and

(d) Opportunities to participate in community and cultural activities.

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(2) The on-site program manager or a person meeting the same qualifications must be on the premises of the staffed residential home during business hours when children are under care if:

(a) There are more than six children in care; and

(b) The major focus of the program is behavioral rather than the development of independent living skills such as a teen parent program or responsible living skills program; or

(c) The youth's behavior poses a risk to self or others.

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(2) To keep the proper ratio of staff to children, the director, support staff and maintenance staff may serve as child care staff if they have adequate training.

(3) The ratio for staffed residential homes is, at least, one child care staff for every six children during waking hours of children.

(4) During sleeping hours of youth, at least, one staff person must be awake when:

(a) There is a written supervision agreement or a contract with the department of social and health services specifying an awake staff for either the program or a specific child; or

(b) The youth's behavior poses a safety risk to self and/or others.

(5) The need for overnight supervision must be documented in each child's treatment plan, if awake supervision is necessary.

(6) You may only be licensed for maximum of three pregnant or parenting youth

(7) When only one child care staff person is on duty, a second person must be on call and available to respond within one half-hour.

(8) You must have relief staff so that all staff can have the equivalent of two days off a week. This is not required for family members if the staffed residential home a family residence.

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(1) The department may license a staffed residential home for six or fewer children. The total number of children in your home or facility must not exceed six at any time.

(2) The department may restrict the number of children in a staffed residential home according to the age and needs of the children.

(3) If only one staff person is on duty at a staffed residential home providing maternity services, that home must not care for more than four persons under the age of eighteen. An additional staff person is required to care for more than four children.

(4) You may have only two children under two years of age in your home at a time.

(5) The department may license a staffed residential home for up to three children with mental or physical disabilities that are severe enough to require nursing care if you meet the following conditions:

(a) You provide staff that are qualified by training and experience to provide proper care, including necessary medical procedures; and

(b) The children's treatment is under the supervision of physicians.

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(1) You must provide rooms that are ample in size and properly furnished for the number of children you serve.

(2) You must provide each of the following rooms or areas:

(a) Bedrooms that meet general licensing requirements (WAC 388-148-0260 through 388-148-0270) and have additional space for any special medical equipment needed by children;

(b) At least one comfortably furnished living room;

(c) A dining room area that is ample in size and suitably furnished for your residents;

(d) At least one separate indoor recreation area with a size and location that is suitable for recreational and informal education activities;

(e) A room or area that may be used as an administrative office; and

(f) A visiting area where visitors can have privacy.

(3) The licensor and staffed residential home director may decide what rooms may have multiple uses (for example, dining room and recreation area or visiting area and living room).

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(1) Certification of eligible foster homes meeting full licensing requirements;

(2) Maternity services to expectant mothers;

(3) Specialized (treatment) foster care;

(4) Residential care programs, such as group homes, crisis residential centers, and independent living skills programs; and

(5) Adoption services.

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(a) The mental and physical health histories of the birth parents;

(b) A written health history for each child prior to placement, including a history of immunizations, allergies, previous illnesses, and conditions that may adversely affect the child's health; and

(c) The developmental and psychological history for the adoptive children.

Note: You must arrange for the child's medical examinations, immunizations, and health care as required by WAC 388-148-0335 and 388-148-0340.

(2) The adoptive parent(s) must sign one copy of the report, showing that they have received the information. You must retain this signed copy in the child's permanent file.

(3) When the child is being placed for adoption, your report must not contain information that might identify the birth parents.

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(1) The out-of-state agency must be fully licensed, certified, or recognized for child-placing functions in its own home state or country.

(2) All public and private agencies must comply with the requirements of the "interstate compact on the placement of children (ICPC)" (see RCW 26.34.011).

Note: Contact the ICPC program manager with children's administration for more information.

(3) The in-state facility receiving children is responsible for:

(a) Conducting a study of the home where the child will be placed;

(b) Related case management; and

(c) Supervising the placement until the child is legally adopted, reaches eighteen years of age, or returns to the originating state.

(4) An out-of-state agency must give us copies of the following written documents:

(a) Written agreements with Washington state agencies;

(b) Evidence of the agency's legal authority to place the child; and

(c) Certification that the agency will assume financial responsibility for any child placed in Washington state until the child is adopted, financially independent, or reaches the age of eighteen.

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(2) A foster home must be certified by your child-placing agency as meet the licensing requirements your child-placing in order to be licensed by the department.

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(1) The licensed child-placing agency that certified the foster home; or

(2) The department, as long as these conditions are met:

(a) The child is in the legal custody of, or is under the department's supervision; and

(b) The child placements are approved in advance in writing by the child-placing agency responsible for supervising the foster home or facility.

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Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-148-1095   May different child-placing agencies shall eligible foster parents for placement?   (1) Different child-placing agencies may share eligible foster parents for placement as long as safety and health requirements are met.

(2) The participating agencies must have written agreements between them specifying the criteria and conditions for sharing foster parents prior to the placement of the children. This includes child-placing agencies placing children in DCFS foster homes.

(3) The written agreements must specify roles and responsibilities of each agency.

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(a) The child's basic right to their own home and family;

(b) The importance of providing skillful professional service to the child's birth parents to help them meet each child's needs in the home;

(c) Each child's individual needs, cultural, and religious background and family situation;

(d) The wishes and participation of each child's parent(s); and

(e) The selection of a foster home that will enhance each child's capacities and meet each child's individual needs.

(2) You must use a written social summary for each child as the basis for acceptance for foster care and related social services.

(3) Every foster care placement that you facilitate must be based on well-planned, individual preparation of the child and the child's family. However, in an emergency situation, you may place a child in a foster home prior to preparing the child and the child's family.

(4) A child may be placed in foster care only with the written consent of the child's parents, a protective custody order, or under a court order. This consent or order must include approval for emergency medical care or surgery.

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(2) You must inform the foster parents that this information is confidential and can not be shared with persons who are not involved with the care of the child.

(3) You must document in the child's file that you have shared this information at the time of placement.

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(2) You must recruit potential adoptive families that reflect the diversity of children in your community.

(3) You must provide adoptive applicants with the following services, at a minimum:

(a) Information about the adoption process;

(b) Your agency's policies, practices and legal procedures;

(c) Types of children available for adoption and implications for parenting different types of children; and

(d) Information on adoption support programs.

(4) You must document that you provided this information to the adoptive applicant in the applicant's file.

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(1) The applicants must submit an application (including a completed background inquiry form) to the child-placing agency.

(2) Once you have received an application, but before you have sign a contract for services, you must give the applicants a written statement about:

(a) The adoption agency's fixed fees and fixed charges to be paid by the applicant;

(b) An estimate of additional itemized expenses to be paid by applicant; and

(c) Specific services covered by fees that you offer for child placement or adoption.

(3) Your staff must complete an adoptive home study as required in RCW 26.33.190 with the participation of the applicant(s). For the study, your staff and the applicants need to decide about:

(a) The suitability of the applicant(s) to be adoptive parent(s); and

(b) The type of child(ren) for which the applicant or applicants are best suited.

(4) Your staff must accept or deny the application and give an explanation for your decision.

(5) You must file preplacement (home study) reports with the court (as required by RCW 26.33.180 through 26.33.190).

(6) Your staff must prepare the potential adoptive parent(s) for placement of a specific child by:

(a) Locating and providing information about the child and the birth family to the prospective adoptive family as described in chapter 388-25 WAC;

(b) Discussing the likely implications of the child's background for adjusting in the adoptive family.

(7) Your staff must re-evaluate the applicant(s) suitability for adopting a child each time an adoptive placement is considered.

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(1) If your child-placing agency is providing specialized adoptive services, you must have:

(a) Supervisory staff who have specialized training in the particular area of adoption that you want to provide; and

(b) A written in-service training program for staff in these specialized adoptive services.

(2) If you are facilitating the adoptive placement of children who have special needs, you must:

(a) Have adoptive families who are able to meet the children's special needs, such as behavioral disturbance, medical problems or developmental disabilities; or

(b) Have a plan for active recruitment of suitable adoptive families.

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     The following sections of the Washington Administrative Code are repealed:

WAC 388-73-010	Authority.
WAC 388-73-012	Definitions.
WAC 388-73-014	Persons and organizations subject to licensing.
WAC 388-73-016	Exceptions to rules.
WAC 388-73-018	Persons and organizations not subject to licensing.
WAC 388-73-019	Effect of local ordinances.
WAC 388-73-01950	Fire standards.
WAC 388-73-020	Certification of juvenile detention facility and exempt agency.
WAC 388-73-022	Application or reapplication for license or certification -- Investigation.
WAC 388-73-024	Licenses for homes supervised by licensed agency.
WAC 388-73-026	Licensing of employees.
WAC 388-73-028	Limitations on licenses and dual licensure.
WAC 388-73-030	General qualifications of licensee, adoptive applicant, and persons on the premises.
WAC 388-73-032	Age of licensee.
WAC 388-73-034	Posting of license.
WAC 388-73-036	Licensure -- Denial, suspension, or revocation.
WAC 388-73-038	Licensed capacity.
WAC 388-73-040	Discrimination prohibited.
WAC 388-73-042	Religious activities.
WAC 388-73-044	Special requirements regarding American Indians.
WAC 388-73-046	Discipline.
WAC 388-73-048	Corporal punishment.
WAC 388-73-050	Abuse, neglect, exploitation.
WAC 388-73-052	Interstate placement of children.
WAC 388-73-054	Client records and information -- All agencies.
WAC 388-73-056	Reporting of illness, death, injury, epidemic, child abuse, or unauthorized absence -- All facilities.
WAC 388-73-057	Reporting of circumstantial changes.
WAC 388-73-058	Earnings, allowances, personal belongings.
WAC 388-73-060	Work assignments.
WAC 388-73-062	Transportation.
WAC 388-73-064	Clothing.
WAC 388-73-066	Personal hygiene.
WAC 388-73-068	Personnel policies.
WAC 388-73-069	Consumption of alcoholic beverages.
WAC 388-73-070	Training.
WAC 388-73-072	Education and vocational instruction.
WAC 388-73-074	Social service staff.
WAC 388-73-076	Social study -- Treatment plans.
WAC 388-73-077	Multidisciplinary care plan for severely and multiply-handicapped children.
WAC 388-73-078	Clerical, accounting and administrative services.
WAC 388-73-080	Support and maintenance staff.
WAC 388-73-100	Site and telephone.
WAC 388-73-101	Wheeled baby walkers.
WAC 388-73-102	Equipment, safety, and maintenance.
WAC 388-73-103	Water safety.
WAC 388-73-104	Firearms.
WAC 388-73-106	Storage.
WAC 388-73-108	Bedrooms.
WAC 388-73-110	Special care room.
WAC 388-73-112	Kitchen facilities.
WAC 388-73-114	Housekeeping sink.
WAC 388-73-116	Laundry.
WAC 388-73-118	Toilets, handwashing sinks, and bathing facilities.
WAC 388-73-120	Lighting.
WAC 388-73-122	Pest control.
WAC 388-73-124	Sewage and liquid wastes.
WAC 388-73-126	Water supply.
WAC 388-73-128	Temperature.
WAC 388-73-130	Ventilation.
WAC 388-73-132	Health care plan.
WAC 388-73-134	First aid.
WAC 388-73-136	Medications controlled by licensee.
WAC 388-73-138	Self-administration of medications.
WAC 388-73-140	Health history, physical examinations, immunizations.
WAC 388-73-142	Infection control, communicable disease.
WAC 388-73-143	HIV/AIDS education and training.
WAC 388-73-144	Nutrition.
WAC 388-73-146	Care of younger or severely and multiply-handicapped children.
WAC 388-73-200	Child-placing agency.
WAC 388-73-202	Required personnel.
WAC 388-73-204	Office space.
WAC 388-73-206	Out-of-country, out-of-state agencies.
WAC 388-73-208	Medical care.
WAC 388-73-210	Foster care licensees.
WAC 388-73-212	Foster care placements.
WAC 388-73-213	Certification to provide adoption services.
WAC 388-73-214	Adoption procedures.
WAC 388-73-216	Adoptive placements.
WAC 388-73-300	Foster family homes.
WAC 388-73-302	Orientation and training.
WAC 388-73-304	Capacity.
WAC 388-73-306	Foster parents -- Employment.
WAC 388-73-308	Absence from home.
WAC 388-73-310	Fire safety.
WAC 388-73-312	Family foster homes -- Services to person under care.
WAC 388-73-351	Staffed residential homes for children or expectant mothers.
WAC 388-73-353	Agency affiliation.
WAC 388-73-355	Function of staffed residential home for children or expectant mothers.
WAC 388-73-357	Capacity.
WAC 388-73-361	Required positions.
WAC 388-73-363	Nursing services.
WAC 388-73-365	Required rooms, areas, and equipment.
WAC 388-73-367	Staffed residential homes for children or expectant mothers--Services to person under care.
WAC 388-73-369	Fire safety--Staffed residential child care home for children or expectant mothers.
WAC 388-73-371	Location of care.
WAC 388-73-373	Occupancy separations.
WAC 388-73-375	Exits.
WAC 388-73-377	Windows.
WAC 388-73-379	Sprinklers.
WAC 388-73-381	Accessibility of exits.
WAC 388-73-383	Single station smoke detectors.
WAC 388-73-385	Fire extinguishers.
WAC 388-73-387	Fire prevention.
WAC 388-73-389	Sprinkler system maintenance.
WAC 388-73-391	Fire evacuation plan.
WAC 388-73-393	Fire evacuation drill.
WAC 388-73-395	Staff fire safety training.
WAC 388-73-500	Day treatment center.
WAC 388-73-502	Function of day treatment program.
WAC 388-73-504	Personnel.
WAC 388-73-506	Ratio of counselor and teaching staff to children.
WAC 388-73-508	Program.
WAC 388-73-510	Ill children.
WAC 388-73-512	Play areas.
WAC 388-73-600	Group care facilities.
WAC 388-73-602	Function of group care facility.
WAC 388-73-604	Daily activity program.
WAC 388-73-606	Required positions.
WAC 388-73-610	Required rooms, areas, and equipment -- Group care facilities.
WAC 388-73-700	Maternity services.
WAC 388-73-702	Types of maternity services.
WAC 388-73-704	Daily activities program.
WAC 388-73-706	Eligibility for service -- Required services.
WAC 388-73-708	Required personnel.
WAC 388-73-710	Services provided.
WAC 388-73-712	Health education.
WAC 388-73-714	Family life education.
WAC 388-73-718	Child care.
WAC 388-73-720	Medical service.
WAC 388-73-722	Required rooms, areas, equipment.
WAC 388-73-800	Crisis residential centers.
WAC 388-73-802	Limitations on number of facilities.
WAC 388-73-803	Crisis residential center--Admission.
WAC 388-73-804	Hours of operation.
WAC 388-73-805	Crisis residential center administrator requirements--Multidisciplinary teams.
WAC 388-73-810	Group crisis residential centers.
WAC 388-73-815	Group crisis residential centers -- Staffing.
WAC 388-73-820	Family crisis residential centers.
WAC 388-73-821	Behavior management--Secure crisis residential centers.
WAC 388-73-822	Secure crisis residential centers--Staff training.
WAC 388-73-823	Secure crisis residential centers--Program requirements.
WAC 388-73-825	Secure crisis residential center--Physical facility.
WAC 388-73-900	Facilities for severely and multiply-handicapped children.
WAC 388-73-901	Multidisciplinary care plan for severely and multiply-handicapped children.
WAC 388-73-902	Services provided.
WAC 388-73-904	Therapy room.

Washington State Code Reviser's Office