WSR 01-22-020

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Health and Rehabilitative Services Administration)

[ Filed October 26, 2001, 3:50 p.m. , effective January 1, 2002 ]

Date of Adoption: October 26, 2001.

Purpose: The purpose of the chapter is [to] establish standards for DSHS to provide, or contract to provide, individualized community residential services to eligible clients. This chapter impacts group homes and support living agencies. These are for-profit, nonprofit, and governmental organizations.

Citation of Existing Rules Affected by this Order: Amending WAC 388-820-010 Definitions, 388-820-020 Certification, 388-820-030 Administrative review conference -- Adjudicated proceeding process, 388-820-040 Client remuneration, 388-820-050 Personnel, 388-820-060 Staff training, 388-820-070 Instruction and support, 388-820-080 Nurse delegation, 388-820-090 Nurse delegation -- Penalties, 388-820-100 Transportation, 388-820-110 Exceptions when allowed, 388-820-120 Program set-up cost, and 388-820-130 Accounting procedures for client accounts.

Statutory Authority for Adoption: Title 71A RCW.

Adopted under notice filed as WSR 01-09-081 on April 18, 2001.

Changes Other than Editing from Proposed to Adopted Version: WAC 388-820-070(2) proposed: (2) These physical and safety requirements are also offered to clients who receive forty hours or less of residential services per month. If clients choose not participate in meeting these requirements, service providers must document these situations according to WAC 388-820-100.

WAC 388-820-070(2) adopted: For clients who receive forty hours or less of residential service per month.

(2) When clients receive forty hours or less of residential services per month, at least once every six months, the service provider must ensure the following physical safety requirements are met:

(a) A safe and healthy environment;

(b) An entrance and/or exit that does not rely solely upon windows, ladders, folding stairs, or trap doors;

(c) A safe storage area for flammable and combustible materials;

(d) Unblocked exits; and

(e) A working smoke detector, with a light-alarm for clients with hearing impairments, located close to sleeping rooms.

(3) The following supports are also offered to clients who receive forty hours or less of residential services. These clients may choose not to participate in meeting these requirements. This choice must be documented by the service provider, as per WAC 388-820-100. The supports offered include:

(a) Accessible telephone equipment;

(b) An evacuation plan developed and practiced with the client;

(c) A flashlight or a nonelectrical light source in working condition; and

(d) Basic first-aid supplies.

WAC 388-820-100(3) proposed: Did not exist.

WAC 388-820-100(3) adopted: The service provider must review this documentation with the client at least every six months. The client or client's guardian must sign the documentation after reviewing it.

WAC 388-820-210(2) proposed: (2) Ways to gather information for evaluation must include:

(a) Review of records;

(b) Interview of clients, legal representatives, and others with the client's consent; and

(c) Observation of staff and client interactions.

WAC 388-820-210(2) adopted: (2) To gather information, evaluators use a sample of clients that the service provider supports. Ways to gather information for evaluation must include:

(a) Review of records;

(b) Interview of clients, legal representatives, and others with the client's consent; and

(c) Observation of staff and client interactions.

WAC 388-820-210(5) proposed: Evaluators conduct an exit conference to present the evaluation report to the service providers and DSHS.

WAC 388-820-210(5) adopted: Evaluators conduct an exit conference to present the evaluation report to the service providers and DSHS. The service provider's administrator or designee must be present at this exit conference.

WAC 388-820-260 (2)(d) proposed: Client grievance procedures;

WAC 388-820-260 (2)(d) adopted: Client grievance procedures, including a client's right to file a complaint or suggestion without interference;

WAC 388-820-310 proposed: (2) An FBI check is required when an employee or volunteer has resided in the state for less than three years.

(3) Exception: The department may give a provisional background clearance of one hundred and twenty days when an FBI check is required.

WAC 388-820-310 adopted: (2) An FBI check is required when an employee or volunteer has resided in the state for less than three years. A provisional background check of one hundred and twenty days may occur. Service providers must follow the requirements under WAC 388-06-0500 through 388-06-0540.

(3) Deleted.

WAC 388-820-550(1) proposed: The DDD case resource manager must review the ISP with the client at least annually.

WAC 388-820-550(1) adopted: The DDD case resource manager must review the ISP with the client at least every twelve months.

WAC 388-820-620(2) proposed: The IFP must be reviewed at least annually by the service provider and client.

WAC 388-820-620(2) adopted: The IFP must be reviewed at least every twelve months by the service provider and client.

WAC 388-820-630(9) proposed: Contingency plan for "spend down" if needed. An example of "spend down" is the lump sum amount given from the Social Security Administration.

WAC 388-820-630(9) adopted: Contingency plan for expenditures if a client's resources exceed the CAP limit.

WAC 388-820-670(3) proposed: (3) A service provider must retain a signed loan agreement with the client and clearly document:

(a) The original amount of the loan;

(b) Payback schedules; and

(c) The balance owed.

WAC 388-820-670(3) adopted: (3) A service provider must retain a signed agreement with the client.

(4) Documentation must be kept for:

(a) The amount loaned;

(b) Payments; and

(c) The balance owed.

WAC 388-820-770 proposed: Nursing assistants have certain rights when nursing care tasks are delegated by the registered nurse.

(1) The service provider must post the toll-free telephone number, established by DSHS' aging and adult services administration, for complaints about the delegation of nursing tasks to nursing assistants. The telephone number must be posted in a conspicuous place for employees.

(2) The nursing assistant:

(a) May consent or refuse to consent to perform a delegated nursing care task; and

(b) Must not receive employer reprisal for refusing to accept the delegation of a nursing care task if the refusal is based on client safety issues.

WAC 388-820-770 adopted: Nursing assistants have certain rights when nursing care tasks are delegated by the registered nurse.

(1) The nursing assistant:

(a) May consent or refuse to consent to perform a delegated nursing care task; and

(b) Must not receive employer reprisal for refusing to accept the delegation of a nursing care task if the refusal is based on client safety issues.

(2) The service provider must post the toll-free telephone number (1-800-562-6078) established by DSHS' aging and adult services administration, for complaints about the delegation of nursing tasks to nursing assistants. This telephone number is also on DSHS forms: 13-678B, 13-680, and 13-681.

WAC 388-820-930(2) proposed: DSHS must evaluate requests for exceptions, considering the quality of the services, supervision, and the health and safety of the clients.

WAC 388-820-930(2) adopted: DSHS must evaluate requests for exceptions, considering:

(a) The health and safety of the clients;

(b) The quality of the services;

(c) Supervision; and

(d) The impact on client services.

(3) DSHS must send a copy of those requests that have significant impacts on client services to the client(s) involved. DSHS must then give the client an opportunity to comment before granting an exception.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 80, Amended 13, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 80, Amended 13, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 80, Amended 13, Repealed 0.
Effective Date of Rule: January 1, 2002.

October 26, 2001

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

OTS-4768.2

PURPOSE
AMENDATORY SECTION(Amending WSR 99-19-104, filed 9/20/99, effective 9/20/99)

WAC 388-820-010   ((Definitions.)) What is the purpose of this chapter?   (((1) "Agency" means the department-certified entity providing residential instruction and support services to clients.

(2) "Certification" means the determination of satisfactory compliance with the rules and regulations outlined as referenced under this chapter.

(3) "Client" means a person the division determines under RCW 71A.16.040 and WAC 275-27-026 eligible for division-funded services.

(4) "Client/provider account" means an account in the name of one client where the client or client's provider has the authority to make deposits or withdrawals. The banking laws under RCW 30.22.040 refer to this as an "agency account."

(5) "Client services" means instruction and support activities promoting the following client-centered benefits:

(a) Health and safety:

(i) Needing and using health services;

(ii) Dealing with illness and injury and first aid procedures;

(iii) Learning about basic nutrition;

(iv) Maintaining good health;

(v) Obtaining mental health services when needed;

(vi) Learning about human sexuality;

(vii) Being aware of fire evacuation plans;

(viii) Knowing emergency procedures, including how to use 911 or a local emergency number;

(ix) Being aware of burglary protection strategies; and

(x) Learning self-protection.

(b) Personal power and choice:

(i) Securing housing and furnishings reflecting personal preferences, life style, and financial means;

(ii) Expressing opinions and making decisions;

(iii) Learning and exercising rights and responsibilities;

(iv) Improving communication skills;

(v) Participating in various activities, including new experiences;

(vi) Exercising a voter's rights;

(vii) Learning about available protection and advocacy services; and

(viii) Making career choices.

(c) Positive recognition by self and others:

(i) Creating positive self-esteem and feelings of self-worth;

(ii) Choosing valued social roles; and

(iii) Having choices influencing valued perception of self and others.

(d) Integration in the physical and social life of the community:

(i) Residing in areas convenient to shopping, banking, eating, worshiping, learning, making friends, and otherwise participating in community life;

(ii) Assisting people to use available transportation;

(iii) Meeting new people and participating with other members of the community in shared activities; and

(iv) Accessing educational and vocational opportunities.

(e) Positive relationships:

(i) Establishing, maintaining, expanding, and improving relationships by providing personal interaction opportunities with people;

(ii) Involving the client's family, guardian, or representative in planning and decision making which affect the client;

(iii) Resolving disagreements among clients or among clients and family, friends, neighbors, and co-workers;

(iv) Coping with the loss of a significant relationship, such as the death of a friend or family member, end of a relationship, loss of a job, or change of staff.

(f) Competence and self-reliance:

(i) Learning and using skills useful to the client, such as meal planning, grocery shopping, meal preparation, cleaning laundry, using household appliances, money management and budgeting, and use of leisure time in settings where the skills are needed;

(ii) Identifying situations in which the client needs or desires assistance from others;

(iii) Accomplishing tasks requiring the assistance of staff or others; and

(iv) Acquiring and using adaptive devices and equipment.

(6) "Department" means the department of social and health services of the state of Washington.

(7) "Depositor," when utilized in determining the rights of persons to funds in an account, means a person who owns the funds.

(8) "Division" means the division of developmental disabilities of the department of social and health services.

(9) "Exemption" means the department's approval of a written request for an exception to a rule in this chapter.

(10) "Facility based" means a residence which is owned, leased, or rented by an entity other than the client.

(11) "Frequency" means how often a designated event has occurred.

(12) "Group home" means a residence licensed by the applicable state authority and operated by an agency certified by the division of developmental disabilities.

(13) "Group training home" means a residence meeting the definition of RCW 71A.22.020(2) and which is operated by an agency certified by the division of developmental disabilities as defined under RCW 71A.22.040.

(14) "Imprest fund" means a petty cash fund which has a pre-established limit. The total of the cash in the fund and receipts from withdrawals from the fund equal the pre-established limit.

(15) "Individual account" means one account in the name of one client primarily managed by a provider.

(16) "Individual client cash" means one client's cash controlled by the provider.

(17) "Instruction" means goal-oriented teaching addressing skill acquisition and skill enhancement.

(18) "Nonfacility based" means the client owns, leases, sub-leases, or rents a residence although others, except the department, may guarantee the client's credit.

(19) "Nursing assistant" means a nursing assistant-registered under chapter 18.88A RCW, or a nursing assistant-certified under chapter 18.88A RCW.

(20) "Provider" means the agency or individual with which the department contracts for providing client instruction and support services.

(21) "Reprisal" means any negative action taken as retaliation against an employee. A rebuttable presumption is raised that reprisal has occurred if a negative action occurs within a year of a refusal to delegate or accept delegation. Occurring as a result of a lawful employee action, "reprisal" includes, but is not limited to:

(a) Harassment;

(b) Firing;

(c) Demotion; or

(d) Disciplinary action.

(22) "Residence" means the place or home where a client resides.

(23) "Residential service" means work or duties performed by the provider to meet clients' daily living needs and enhance clients' lives.

(24) "Secretary" means the secretary of social and health services or the secretary's designee.

(25) "Severity" means the seriousness of the occurrence as determined by the:

(a) Actual or potential negative outcomes for residents; or

(b) Extent to which the resident's physical, mental, or psychosocial well-being is compromised or threatened.

(26) "Support" means:

(a) Assistance to a client in performance of necessary functions or tasks; or

(b) The performance of a task on behalf of a client, that is, someone else does the client's task.

(27) "Trust account" means an account containing two or more clients' funds where the provider has the authority to make deposits or withdrawals.)) (1) This chapter establishes standards for the department of social and health services (DSHS) to provide, or contract to provide, individualized community residential services to clients who:

(a) Are eligible to receive services by the division of developmental disabilities (DDD); and

(b) Receive support from certified service providers.

(2) Service providers support eligible clients to enable them to:

(a) Enjoy all rights and privileges under the Constitution and laws of the United States and the state of Washington; and

(b) Participate in community life and have control of their environment to the greatest extent possible.

(3) The authority for this chapter is Title 71A RCW.

[99-19-104, recodified as 388-820-010, filed 9/20/99, effective 9/20/99. Statutory Authority: Chapters 18.88A and 71A.12 RCW. 96-10-076 (Order 3978), 275-26-010, filed 5/1/96, effective 6/1/96. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-010, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), 275-26-010, filed 2/9/83.]

DEFINITIONS
AMENDATORY SECTION(Amending WSR 99-19-104, filed 9/20/99, effective 9/20/99)

WAC 388-820-020   ((Certification.)) What definitions apply to this chapter?   (((1) Initial certification.

(a) The agency's application for initial certification shall include a mission statement, budget forecast, staff coverage schedule, staff in-service training plan, and agency policies and procedures. The department shall provide the county a copy of the agency's application. The department shall review the recommendations from the county.

(b) The agency shall file with the department a statement of assurance stating the agency shall not:

(i) Refuse a client's admission to the agency;

(ii) Deny participation in the activities of the agency; or

(iii) Deny employment at the agency on the grounds of:

(A) Race;

(B) Religion;

(C) Marital status;

(D) Age;

(E) Sexual orientation;

(F) Color;

(G) Creed;

(H) National origin; or

(I) Handicapping condition, including communicable diseases and HIV/AIDS.

(c) The agency shall comply with:

(i) Relevant federal, state, and local laws and ordinances; and

(ii) Department-established standards of care, instruction, and support.

(d) Initial certification may be granted upon assurance the agency shall comply with the rules and regulations outlined under chapter 275-26 WAC within one hundred eighty days of the effective date.

(e) Upon receipt of initial certification, the agency shall be approved for receiving referrals and serving clients.

(f) In the event initial certification expires before the date of formal evaluation and review, the department may extend initial certification for a specified period of time, not to exceed one hundred eighty days.

(2) Regular certification.

(a) Upon the department's determination of satisfactory compliance with the rules and regulations described and referenced herein, through formal evaluation and review under WAC 275-26-030, the department may certify an agency as approved for continued referral of and service provision to clients.

(b) The agency's certification may be granted for either a one-year or two-year period, but the department may require a more frequent certification review.

(c) The county may submit recommendations to the department before certification.

(d) Regular certification may be extended for a period not to exceed one hundred eighty days.

(3) Provisional certification.

(a) An agency found out of compliance with the provisions of this chapter may be subject to provisional certification not to exceed one hundred eighty days.

(b) When the agency does not comply with the requirements of chapter 275-26 WAC within the one hundred eighty days, the department shall initiate certification revocation. If the agency contests the department's ruling, the agency may request an administrative review conference as described under WAC 275-26-022.

(c) The department's notice of denial, modification, suspension, or revocation of certification is governed by chapter 43.20A RCW and section 95, chapter 175, Laws of 1989.

(d) When an agency comes into compliance with the requirements of chapter 275-26 WAC within one hundred eighty days, the department may grant a regular one-year or two-year certification.

(4) Decertification:

(a) When the department determines the agency does not comply with this chapter the department may revoke the agency's certification as governed under chapter 43.20A RCW and section 95, chapter 175, laws of 1989;

(b) If the agency contests the department's decision, the agency may request an administrative review conference as described under WAC 275-26-022.)) "Agency" means an entity interested in becoming a service provider that offers residential instruction and support services to clients.

"Certification" means the determination by DSHS that an agency or service provider has satisfactorily complied with the requirements outlined in this chapter and in the department contract.

"Client" means a person who:

Has a developmental disability;

Is eligible under RCW 71A.10.020; and

Is authorized by DDD to receive residential services outlined in this chapter. (For eligibility criteria, see chapter 388-825 WAC.)

"Client services" means instruction and support activities that benefit clients, as specified under WAC 388-820-450 through 388-820-510.

"Community alternatives program (CAP)" means a Title XIX Medicaid waiver program that serves a specific number of individuals. This waiver is for particular home- and community-based services not covered under the Medicaid state plan. (See WAC 388-825-170 for more details.)

"Community protection services" (Community Protection Intensive Supported Living Services, or CP-ISLS) means intensive supported living services provided to clients who meet the criteria of "Individual with Community Protection Issues."

"DDD" refers to the division of developmental disabilities at DSHS.

"DSHS" refers to the department of social and health services of Washington state.

"Exceptions" means DSHS' approval of a written request for an exception to a rule in this chapter. (There are no exceptions to RCWs.)

"Group home" means residential services provided in a dwelling that is:

Owned, leased, or rented by an entity other than the client;

Licensed by the applicable state authority; and

Operated by a provider.

(See WAC 388-820-090 for further details.)

"Group training home" means a certified nonprofit residential facility that provides full-time care, treatment, training, and maintenance for clients, as defined under RCW 71A.22.020(2).

"IFP" refers to individual financial plan. (See WAC 388-820-620.)

"IISP" refers to the individual instruction and support plan for clients. (See WAC 388-820-560 through 388-820-580.)


"Individual with community protection issues" means a client identified by DDD as needing one or more of the following criteria:

The person has been convicted of or charged with a crime of sexual violence as defined in chapter 71.09 RCW, including, but not limited to, rape, statutory rape, rape of a child, and child molestation;

The person has been convicted of or charged with acts directed towards strangers or individuals with whom a relationship has been established or promoted for the primary purpose of victimization;

The person has been convicted of or charged with a sexually violent offense and/or predatory act, and may constitute a future danger;

The person has not been convicted and/or charged, but has a history of stalking, sexually violent, predatory, and/or opportunistic behavior which demonstrates a likelihood to commit a sexually violent and/or predatory act based on current behaviors that may escalate to violence;

The person has committed one or more violent crimes, such as murder, attempted murder, arson, first degree assault, kidnapping, or use of a weapon to commit a crime.

"Instruction" means goal-oriented teaching that is designed for acquiring and enhancing skills.

"ISP" refers to the individual service plan for clients. (See WAC 388-820-520 through 388-820-550.)

"Nursing assistant" means a person who is registered or certified by department of health under chapter 18.88A RCW. A nursing assistant performs certain nursing care tasks that are delegated by a registered nurse for a specific client in authorized settings. (See chapter 246-841 WAC for more details.)

"Reprisal" means any negative action taken as retaliation against an employee.

"Residential service" means client services offered by certified service providers.

"Secretary" means the secretary of the department of social and health services or the secretary's designee.

"Service provider" means an agency certified by and contracted with DDD to provide residential services to clients.

"Severity" means the seriousness of an incident. This is determined by the extent to which a client's physical, mental, or psychosocial well-being is or may be compromised or threatened.

"Support" means assistance as requested or needed by a client, based on their abilities, needs, and goals.

"Supported living" means residential services provided to clients living in their own homes, which are owned, rented, or leased by the clients or their legal representatives. (See WAC 388-820-080 for more details.)

"Trust account" means a bank account containing two or more clients' funds where the service provider has the authority to make deposits and withdrawals.

[99-19-104, recodified as 388-820-020, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-020, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 86-08-003 (Order 2349), 275-26-020, filed 3/20/86; 83-05-017 (Order 1945), 275-26-020, filed 2/9/83.]

RESIDENTIAL SERVICES: GENERAL REQUIREMENTS
AMENDATORY SECTION(Amending WSR 99-19-104, filed 9/20/99, effective 9/20/99)

WAC 388-820-030   ((Administrative review conference -- Adjudicative proceeding process.)) What are residential services?   (((1) Within twenty-eight days after a community residential support agency is notified of a certification determination it wishes to challenge, the agency shall request, in writing, that the division director or the division director's designee review such determination. The agency shall:

(a) Sign the request;

(b) Identify the challenged determination and the date thereof; and

(c) State as specifically as practicable the issues and regulations involved and the grounds for the agency's contention that the determination is erroneous. The agency shall include with the request copies of any documentation the agency intends to rely on to support its position.

(2) After receiving a timely request meeting the criteria of this section, the director shall contact the agency to schedule a conference for the earliest mutually convenient time. The director shall schedule the conference for no later than thirty days after a properly completed request is received, unless both parties agree, in writing, to a specific later date. The conference may be conducted by telephone unless either the department or the agency requests, in writing, the conference be held in person.

(3) The agency and appropriate representatives of the department shall attend the conference. The agency shall bring to the conference, or provide to the department in advance of the conference, any documentation the agency intends to rely on to support the agency's contentions. The parties shall clarify and attempt to resolve the issues at the conference. If additional documentation is needed to resolve the issues, a second session of the conference shall be scheduled for not later than thirty days after the initial session unless both parties agree in writing to a specific later date.

(4) Unless informal agreement has been reached at the conference, a written decision by the director of the division of developmental disabilities shall be furnished to the agency within sixty days after the conclusion of the conference.

(5)(a) An agency contesting the director's determination shall within twenty-eight days of receipt of the determination:

(i) File a written application for an adjudicative proceeding by a method showing proof of receipt with the office of appeals; and

(ii) Include in or with the application:

(A) A specific statement of the issue or issues and law involved;

(B) The grounds for contesting the director's determination; and

(C) A copy of the director's determination being contested.

(b) The proceeding shall be governed by the Administrative Procedure Act (chapter 34.05 RCW), RCW 43.20A.205, this chapter, and chapter 388-08 WAC. If any provision in this chapter conflicts with chapter 388-08 WAC, the provision in this chapter governs.)) Residential service is supports provided to eligible clients by service providers to enable clients to live in their community. These may include:

(1) Supported living services;

(2) Group home services; or

(3) Services provided in the group training home.

Residential services must follow the requirements outlined in this chapter.

[99-19-104, recodified as 388-820-030, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-022, filed 8/9/91, effective 9/9/91. Statutory Authority: RCW 34.05.220 (1)(a) and 71.12.030 [71A.12.030]. 90-04-074 (Order 2997), 275-26-022, filed 2/5/90, effective 3/1/90. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), 275-26-022, filed 2/9/83.]


AMENDATORY SECTION(Amending WSR 99-19-104, filed 9/20/99, effective 9/20/99)

WAC 388-820-040   ((Client remuneration.)) Who certifies residential services?   ((Clients performing work for the agency shall be given remuneration in accordance with wage and hour laws and requirements stipulated by federal and state law, unless the United States Department of Labor or state department of labor and industries has granted written exemption.)) Residential services are certified by DDD to support eligible clients.

[99-19-104, recodified as 388-820-040, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-050, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), 275-26-050, filed 2/9/83.]


AMENDATORY SECTION(Amending WSR 99-19-104, filed 9/20/99, effective 9/20/99)

WAC 388-820-050   ((Personnel.)) Where are residential services provided?   (((1) The owner or board of directors of the agency shall maintain current written personnel policies and procedures which shall be made available to all employees.

(2) Personnel policies and practices shall not discriminate against any employee or applicant for employment because of race, color, sex, religion, national origin, creed, marital status, sexual orientation, age, Vietnam era or disabled veteran status, or the presence of any sensory, mental, or physical handicap, including communicable diseases, and HIV/AIDS, provided the sensory, mental, or physical handicap does not prevent the job's specific performance.

(3) Agency-employed staff shall meet the following minimum requirements:

(a) Have a background inquiry clearance by the authorized state agency;

(b) Exhibit mature behavior and the ability to make independent judgments;

(c) Be twenty-one years of age or older when employed as an administrator;

(d) Be eighteen years of age or older when employed as a direct care staff; and

(e) Have attained a high school diploma or GED equivalent. Current employees are exempt from subsection (3)(e) effective the date of this amendatory act.

(4) Agency employees shall treat a client with dignity and consideration, respecting the client's civil and human rights at all times.

(5) The performance of the administrator and each employee shall be evaluated, in writing, annually or more often by the agency. An owner/administrator is exempt from this requirement.

(6) The administrator or administrator's designee shall be responsible for:

(a) Recruiting, employing, and arranging for residential services staff training;

(b) Terminating from employment any employee performing in an unsatisfactory manner; and

(c) Preparing and maintaining policies and procedures pertaining to clients personnel and financial records; and

(d) Securely storing client, personnel and financial records.

(7) Clients shall not be routinely involved in the instruction and support of other clients.)) Residential services may be offered by service providers in:

(1) The client's own home;

(2) Group homes; or

(3) The group training home.

[99-19-104, recodified as 388-820-050, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-060, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), 275-26-060, filed 2/9/83.]


AMENDATORY SECTION(Amending WSR 99-19-104, filed 9/20/99, effective 9/20/99)

WAC 388-820-060   ((Staff training.)) Who may receive residential services?   (((1) The agency shall orient the new employee to the agency's philosophy, goals, policies, procedures, and program services within the first:

(a) Two weeks of employment for staff scheduled to work twenty hours or more per week; or

(b) Four weeks of employment for staff scheduled to work less than twenty hours per week.

(2) The agency shall ensure new employees receive a minimum of twelve hours of training during the first six weeks of employment. Such training shall include a combination of orientation, instruction, and on-the-job training.

(3) The agency shall provide a minimum of twenty training hours to each direct service employee during the subsequent five employment months. Such staff training shall include, but not be limited to:

(a) Basic first aid/CPR;

(b) Knowledge and transmission of Hepatitis B; and

(c) Knowledge and transmission of human immunodeficiency virus (HIV), and acquired immunodeficiency syndrome (AIDS).

(4) The agency shall review and explain the current instruction and support plan for each client for whom the employee provides direct services before the employee works alone with the client.

(5) The agency shall document orientation, review, and training activities.)) Clients who are at least eighteen years old and authorized by DDD may receive residential services.

[99-19-104, recodified as 388-820-060, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-070, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), 275-26-070, filed 2/9/83.]


AMENDATORY SECTION(Amending WSR 99-19-104, filed 9/20/99, effective 9/20/99)

WAC 388-820-070   ((Instruction and support.)) What physical and safety requirements exist for residential services?   (((1) The agency shall develop a written individual instruction and support plan (IISP) for each client:

(a) Based on the goals established in the department's individual service plan (ISP);

(b) Reflecting the client's preferences and concurrence;

(c) Identifying activities promoting one or more of the following client services:

(i) Health and safety;

(ii) Personal power and choice;

(iii) Positive recognition by self and others;

(iv) Integration in the physical and social life of the community;

(v) Positive relationships; and

(vi) Competence and self-reliance.

(d) Identifying the specific goal and describing the methods of instruction and support promoting client-centered benefits and independence in the community.

(2) The agency shall:

(a) Implement the individual instruction and support plan (IISP) in a manner:

(i) Appropriate to the age of the client;

(ii) Taking place or occurring in typical community settings; and

(iii) Resulting in opportunities for:

(A) Positive change;

(B) Personal growth; and

(C) Development toward maximum independence.

(b) Document progress toward achieving the benefits described in the individual instruction and support plan (IISP);

(c) Review the plan semi-annually or more often;

(d) Consult with other providers serving the client and other interested persons as needed to coordinate and promote the individual instruction and support plan (IISP); and

(e) Revise the individual instruction and support plan (IISP) as benefits are achieved.)) For clients who receive more than forty hours of residential service per month.

(1) When clients receive more than forty hours of residential services per month, the service provider must ensure that the following physical and safety requirements are met for the client:

(a) A safe and healthy environment;

(b) Accessible telephone equipment;

(c) An evacuation plan developed and practiced with the client;

(d) An entrance and/or exit that does not rely solely upon windows, ladders, folding stairs, or trap doors;

(e) A safe storage area for flammable and combustible materials;

(f) Unblocked exits;

(g) A working smoke detector, with a light-alarm for clients with hearing impairments, located close to sleeping rooms;

(h) A flashlight or a nonelectrical light source in working condition; and

(i) Basic first-aid supplies.

For clients who receive forty hours or less of residential service per month.

(2) When clients receive forty hours or less of residential services per month, at least once every six months, the service provider must ensure the following physical safety requirements are met:

(a) A safe and healthy environment;

(b) An entrance and/or exit that does not rely solely upon windows, ladders, folding stairs, or trap doors;

(c) A safe storage area for flammable and combustible materials;

(d) Unblocked exits; and

(e) A working smoke detector, with a light-alarm for clients with hearing impairments, located close to sleeping rooms.

(3) The following supports are also offered to clients who receive forty hours or less of residential services. These clients may choose not to participate in meeting these requirements. This choice must be documented by the service provider, as per WAC 388-820-100. The supports offered include:

(a) Accessible telephone equipment;

(b) An evacuation plan developed and practiced with the client;

(c) A flashlight or a nonelectrical light source in working condition; and

(d) Basic first-aid supplies.

For all clients:

(4) The service provider must ensure that documentation is kept, showing that physical safety requirements are met. The client may independently document that these requirements are met as long as the client's IISP shows this involvement.

(5) Residential services must be located in a residential neighborhood within reasonable distance of necessary resources, unless a client chooses to live in a remote area. Resources include stores, banks, laundromats, churches, job opportunities, and other public services.

(a) Exception: Group homes certified prior to 1983 may not follow this requirement.

(b) Exception: Clients who receive community protection services may not follow this requirement.

[99-19-104, recodified as 388-820-070, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-072, filed 8/9/91, effective 9/9/91.]


AMENDATORY SECTION(Amending WSR 99-19-104, filed 9/20/99, effective 9/20/99)

WAC 388-820-080   ((Nurse delegation.)) What are supported living services?   (((1) Before being authorized to perform a delegated nursing care task, staff shall:

(a) Be a nursing assistant-registered or nursing assistant-certified;

(b) Complete nurse delegation core training as approved by the department. The training includes but is not limited to:

(i) Nurse delegation laws and protocols;

(ii) Basic medical knowledge; and

(iii) Medication administration.

(c) The certified community residential services agency shall document this training activity and a certificate shall be issued to the nursing assistant upon completion of the required training.

(2) Nursing assistants delegated a nursing care task in compliance with the nursing care quality assurance commission requirements shall perform the task:

(a) In compliance with all requirements and protocols established by the commission in chapter 246-840 WAC;

(b) Only for the specific client who was the subject of the delegation; and

(c) Only with the consent of the client or a person authorized to provide consent for health care on behalf of the client under this section and RCW 7.70.065. "Persons authorized to provide consent for health care" shall be a member of one of the following classes of persons in the following order of priority:

(i) Legal guardian, if any;

(ii) An individual who holds a durable power of attorney for health care decisions;

(iii) The client's spouse;

(iv) The client's children who are at least eighteen years of age;

(v) The client's parents; and

(vi) The client's adult siblings.

(3) The nursing assistant shall not transfer delegated authority to perform the nursing care tasks to another nursing assistant.

(4) The nursing assistant:

(a) May consent or refuse to consent to perform a delegated nursing care task;

(b) Shall be responsible for the nursing assistant's own actions with regard to the decision to consent or refuse to consent to the performance of the delegated task; and

(c) The nursing assistant shall not be subject to any employer reprisal for refusing to accept delegation of a nursing care task.

(5) The agency shall post and keep posted in a conspicuous place or places where notices to employees are customarily posted, the toll free telephone number established by aging and adult services administration for receiving complaints regarding delegation of specific nursing tasks to nursing assistants.)) (1) Supported living services are instruction and supports offered by service providers to clients who live in or are establishing their own homes. Homes must be owned, rented, or leased by the clients or their legal representatives.

(2) Clients who receive supported living services are responsible for paying for their daily living expenses, such as rent, utilities, and food, using their personal financial resources.

(3) The level of support is based on each client's instruction and support needs. Support may range from one hour per month to twenty-four hours per day of staff support per client.

[99-19-104, recodified as 388-820-080, filed 9/20/99, effective 9/20/99. Statutory Authority: Chapters 18.88A and 71A.12 RCW. 96-10-076 (Order 3978), 275-26-074, filed 5/1/96, effective 6/1/96.]


AMENDATORY SECTION(Amending WSR 99-19-104, filed 9/20/99, effective 9/20/99)

WAC 388-820-090   ((Nurse delegation--Penalties.)) What are group homes?   (((1) The department shall impose a civil fine of not less than two hundred fifty dollars and not more than one thousand dollars on any provider that knowingly performs or knowingly permits an employee to perform a nursing task except as delegated by a nurse under:

(a) Chapter 18.88A RCW; and

(b) Chapter 246-840 WAC (nursing care quality commission regulations).

(2) When assessing civil fines, the investigator shall consider:

(a) Severity of occurrence;

(b) Frequency of occurrence; and

(c) Other relevant factors relating to the occurrence.

(3) The department shall make technical assistance available to providers for purposes of education and assistance in order to help providers comply with nurse delegation rules and protocols.

(a) The department's technical assistance program shall include:

(i) Requested or voluntarily accepted technical assistance visits during which or soon after which the department informs the provider of violation of law or agency rules;

(ii) How to access the technical assistance;

(iii) Printed information;

(iv) Information and assistance by phone;

(v) Training meetings;

(vi) Other appropriate methods to provide technical assistance; and

(vii) A list of organizations that provide technical assistance.

(b) The provider shall be given a reasonable period of time to correct violations identified during a technical assistance visit before any civil penalty provided by law is imposed for those violations except as provided in subsection (3)(c) of this section;

(c) A civil penalty may be issued during a technical assistance visit if:

(i) The provider has previously been:

(A) Subject to an enforcement action for the same or similar type of violation of the same statute or rule; or

(B) Given previous notice of the same or similar type of violation of the same statute or rule; or

(ii) The violation has a probability of placing a person in danger of death or bodily harm.

(d) Nothing in these rules obligates the department to conduct a technical assistance visit.

(4) Before imposition of a civil fine and for clarification purposes, the department may take substantially the following steps:

(a) Notify the agency of the concern;

(b) Give the agency an opportunity to explain circumstances or present additional information which may clarify concern;

(c) Request the agency to provide additional information if necessary;

(d) Nothing in this rule shall be construed to require the department to impose a fine if a determination is made that no unlawful delegation occurred.)) (1) Group homes are residences that are licensed as either a boarding home or an adult family home by aging and adult services administration in DSHS, under chapters 388-78A and 388-76 WAC, respectively.

(2) The service provider must ensure that group homes comply with all applicable licensing regulations.

(3) Group homes provide residential services to two or more clients.

(4) Clients who live in group homes pay costs of room and board from their own financial resources. (See WAC 388-820-120 for additional information.)

[99-19-104, recodified as 388-820-090, filed 9/20/99, effective 9/20/99. Statutory Authority: Chapters 18.88A and 71A.12 RCW. 96-10-076 (Order 3978), 275-26-076, filed 5/1/96, effective 6/1/96.]


AMENDATORY SECTION(Amending WSR 99-19-104, filed 9/20/99, effective 9/20/99)

WAC 388-820-100   ((Transportation.)) When must a service provider document a client's refusal to participate in services?   (((1) The agency shall ensure or provide transportation for medical emergencies and medical appointments and therapies.

(2) The agency shall assist the client with or arrange transportation, in conjunction with the client and the division, for:

(a) Implementation of the individual service plan (ISP);

(b) Implementation of the individual instruction and support plan (IISP);

(c) Work, school or other publicly-funded services;

(d) Leisure or recreation activities; and

(e) Client-requested activities.

(3) An agency vehicle used to transport clients shall be:

(a) In safe operating condition; and

(b) Properly insured for its usage.)) (1) A service provider must document a client's refusal to participate in:

(a) Physical and safety requirements, as outlined in WAC 388-820-070(2); and

(b) Health services under WAC 388-820-690.

(2) Documentation must include the following:

(a) A description of events relating to the client's refusal to participate in these services;

(b) A plan to inform the client of the benefits of these services;

(c) A description of the service provider's efforts to give the services to the client; and

(d) Any health or safety concerns that the refusal may pose.

(3) The service provider must review this documentation with the client at least every six months. The client or client's guardian must sign the documentation after reviewing it.

[99-19-104, recodified as 388-820-100, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-087, filed 8/9/91, effective 9/9/91.]


AMENDATORY SECTION(Amending WSR 99-19-104, filed 9/20/99, effective 9/20/99)

WAC 388-820-110   ((Exceptions when allowed.)) May a service provider offer services to nonclients in the same household as clients?   ((The department may permit the provider to exceed payment for service and payment for additional expenses. Exceptions will be based on a review by the division of the participating tenant's need for extraordinary level of tenant support services. The exception must be approved by the secretary and included in the contract.)) Service providers must notify DDD of their intent to offer services to nonclients who are in the same household with clients. DDD must approve any of these situations, considering the health, safety, and preference of the clients.

[99-19-104, recodified as 388-820-110, filed 9/20/99, effective 9/20/99. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), 275-26-097, filed 2/9/83.]


AMENDATORY SECTION(Amending WSR 99-19-104, filed 9/20/99, effective 9/20/99)

WAC 388-820-120   ((Program set-up cost.)) Who pays for a client's residential services?   (((1) The department may enter into a contractual agreement to reimburse the provider for costs incurred to establish the program. The provider's costs shall:

(a) Be based on a budget negotiated with the department; and

(b) Include client costs of establishing a residence.

(2) The provider shall submit the department-required billing documents.)) (1) DSHS must pay for residential services provided to clients under department contract at the contracted rate.

(2) DSHS must require a client to share the cost of services when mandated by federal or state statute or regulation.

(3) The service provider must inform DSHS when the client requires additional supports.

(a) The service provider must submit a written request with justification for additional service hours.

(b) DSHS may approve and provide payment for additional expenses or services.

(c) The service provider must retain a copy of department approval.

(4) For a client who is receiving group home services and support:

(a) The client must pay for cost of care or services from earnings or other financial resources. Clients receiving SSI are responsible only for the cost of room and board.

(b) DSHS may pay for these services only after a client has used his or her own financial resources.

(c) When a client's guardian or legal representative controls the client's income, estate, or trust fund, they must reimburse the service provider as described in WAC 388-820-120.

(5) Clients receiving supported living services must pay for their own housing, utilities, food, clothing, and other personal and incidental expenses from earnings and other financial resources.

[99-19-104, recodified as 388-820-120, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-107, filed 8/9/91, effective 9/9/91.]


AMENDATORY SECTION(Amending WSR 99-19-104, filed 9/20/99, effective 9/20/99)

WAC 388-820-130   ((Accounting procedures for client accounts.)) When may a service provider receive initial set-up funds from DSHS?   (((1) Clients' cash or bank accounts controlled by a provider shall be subject to the provisions of this chapter. Clients' accounts shall include, but not be limited to:

(a) Trust accounts;

(b) Client/provider accounts;

(c) Individual accounts;

(d) Individual client cash; and

(e) Imprest fund(s).

(2) An account the client independently manages shall not be subject to the provisions of this section.

(3) The provider shall protect a client's financial interests by:

(a) Making available to the requesting client the money held for the client unless a client's guardian or legal representative makes other arrangements;

(b) Securing a client's or client's guardian's or legal representative's written consent for the management of the client's account;

(c) Keeping the client's account current by maintaining a running balance;

(d) Reconciling the client's account to the bank statement monthly;

(e) Making deposits to the client's account within one week of receiving the client's money;

(f) Preventing the client's account from becoming overdrawn or showing a debit;

(g) Limiting imprest and individual client cash funds to a reasonable amount necessary for the needs of the client, not to exceed fifty dollars per client;

(h) Maintaining documentation to support financial transactions for the specific type of account:

(i) Trust account records shall include:

(A) A control journal;

(B) Monthly bank statements and reconciliations;

(C) Checkbook registers and bankbooks;

(D) Deposit receipts;

(E) Canceled checks;

(F) Receipts for purchases; and

(G) Itemized subsidiary ledgers showing deposits, withdrawals, and interest payments to individual clients.

(ii) Client/provider accounts or individual accounts shall include the following records:

(A) Monthly bank statements and reconciliations;

(B) Checkbook registers and bankbooks showing deposits, withdrawals, and interest payments to the client;

(C) Deposit receipts;

(D) Canceled checks; and

(E) Receipts for purchases.

(iii) Individual client cash fund records shall include:

(A) A detailed ledger;

(B) Monthly reconciliation to the cash amount;

(C) Detailed accounting of money received on behalf of the client, including cash received from writing checks over the purchase amount and disposition of money spent; and

(D) Receipts for purchases costing over twenty dollars.

(iv) Imprest fund records shall include:

(A) A subsidiary ledger;

(B) A monthly reconciliation to the cash amount;

(C) A detailed accounting of money received on behalf of the client and disposition of money spent;

(D) Receipts for purchases over the amount of twenty dollars;

(E) Itemized ledgers showing a client's deposits and withdrawals, and interest payments paid to clients.

(i) Notifying the department when the client's account reaches three hundred dollars less than the maximum amount allowable by federal or state law; and

(j) Making each client's account available for the secretary's audit and inspection.

(k) Making client funds available to the client or a new provider on the day of transfer or movement when there is change of ownership or a client moves.

(4) When a client's provider receives a check made out to the client, the provider assisting the client shall:

(a) Secure the client's signature and designation "for deposit only" and deposit the check to the client's account; or

(b) Secure the client's "x" mark in the presence of another witness; and

(i) Co-sign the check with the designation "for deposit only"; and

(ii) Deposit the check to the client's account.

(5) When a provider manages client/provider accounts and individual accounts, the agency and client checks shall:

(a) Be signed at the time of purchase only;

(b) Be signed by the client;

(c) Be initialed or signed by the staff assisting the client; and

(d) Not be written for amounts greater than a purchase unless the provider maintains required documentation described under subsection (3)(h)(ii) of this section.

(6) A provider shall pay overdraft charges, fees resulting from the provider's error or mismanagement when they control:

(a) Trust accounts;

(b) Client/provider accounts; and

(c) Imprest funds.

(7) A provider shall pay service charges for trust accounts and imprest funds when they control them.

(8) The agency shall retain all clients' financial records for a minimum of six years after audit, settlement or contract termination, including but not limited to:

(a) Client's related bankbooks;

(b) Bank statements;

(c) Checkbooks;

(d) Check registers; and

(e) All voided and canceled checks.

(9) The client's provider may loan money to the client from the provider's funds and collect the debt from the client by installments.

(10) The client's provider shall not:

(a) Charge the client interest for money loaned; or

(b) Borrow funds from the client.

(11) Upon a provider's transfer of ownership or movement of the client the previous provider shall within thirty days:

(a) Give the client, the client's guardian, or the client's legal representative a written accounting of all client's funds held by the provider;

(b) When applicable give the new provider a written accounting, in accordance with generally accepted accounting principles, of all transferred client funds;

(c) Obtain the client's, client's guardian's, or client's legal representative's written receipt for all the transferred funds; and

(d) When applicable, obtain the new provider's written receipt for the transferred funds.

(12) When a client becomes incapacitated or a client's whereabouts are unknown, the client's provider shall within thirty days transfer the client's funds to the client's legal guardian or to the department.

(13) When a client dies, the clients provider shall within thirty days transfer the client's funds to the client's legal guardian or to the department if the client does not have a legal heir.

(14) The provider shall not release client funds to a person other than the client or the client's guardian or legal representative without the written consent of the client or the secretary.)) (1) DSHS may enter into a contractual agreement to reimburse the service provider for costs incurred to establish services. The costs must be based on a budget negotiated with DSHS.

(2) DSHS may reimburse service providers for client costs of establishing a residence.

(3) For reimbursement, the service provider must submit the billing documents required by DSHS.

[99-19-104, recodified as 388-820-130, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-115, filed 8/9/91, effective 9/9/91.]

CERTIFICATION
NEW SECTION
WAC 388-820-140   What are the different types of certification?   There are three different types of certification that DDD approves for residential services:

(1) Initial certification;

(2) Regular certification; and

(3) Provisional certification.

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NEW SECTION
WAC 388-820-150   When may DDD grant initial certification to an agency?   (1) An interested agency must apply to DDD to be certified.

(2) DDD may grant initial certifications to agencies that meet the requirements outlined in this chapter.

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NEW SECTION
WAC 388-820-160   How does an agency apply for initial certification?   To apply for initial certification, an agency must go through the following application procedure.

(1) An agency's completed application must be submitted to the regional DDD office for initial certification in that region. The application must include:

(a) A letter of intent;

(b) A mission statement;

(c) A statement of assurance stating that the service provider will not discriminate against a client or employee (see WAC 388-820-280);

(d) Verification of financial stability;

(e) A budget forecast;

(f) A staff-coverage schedule;

(g) A staff in-service training plan;

(h) The agency's policies and procedures;

(i) Relevant experience and qualifications of the agency;

(j) A minimum of two professional references;

(k) A copy of the license if applying for a group home;

(l) The administrator's resume; and

(m) A list of the agency board of directors and affiliations, if applicable.

(2) DSHS must provide the county with a copy of the agency's application.

(3) The county may submit written recommendations about the application to DSHS within thirty calendar days after receiving the application. DSHS reviews the county's recommendations.

(4) An agency must comply within one hundred and eighty days of the certification's effective date with:

(a) Relevant federal, state, and local laws and ordinances; and

(b) Department-established requirements.

(5) DDD notifies the agency in writing that all documentation has been received and approves or denies initial certification.

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NEW SECTION
WAC 388-820-170   What happens after an agency receives initial certification?   After an agency receives initial certification, DDD decides whether to grant a residential services contract with that agency.

(1) Under initial certification, agencies that receive a contract with DDD become service providers. Once a contract is in place, a service provider is approved for receiving client referrals and serving clients in a particular region for up to one hundred and eighty days. Service providers must have a separate contract for each region where they receive referrals and serve clients.

(2) If DDD does not contract with an agency, initial certification will be valid for up to a year for that agency.

[]


NEW SECTION
WAC 388-820-180   May initial certification be extended for a service provider?   If the initial certification expires before DDD conducts a formal review and evaluation of a service provider, DDD may extend the initial certification up to one hundred and eighty days.

[]


NEW SECTION
WAC 388-820-190   How does a service provider receive regular certification?   (1) DSHS uses a formal review and evaluation process to determine whether a service provider has complied with certification requirements outlined in this chapter and the department contract.

(2) The county may submit recommendations about a service provider to DSHS.

(3) After determining that a service provider has complied with requirements, DSHS may approve a service provider for regular certification.

(a) This certification allows a service provider to continue to receive referrals and provide instruction and support to clients.

(b) Regular certification may be granted to service providers for up to two years.

(4) Regular certification may be extended for a period up to one hundred and eighty days.

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NEW SECTION
WAC 388-820-200   How often are reviews and evaluations done for service providers?   (1) DSHS must review and/or evaluate each service provider's services at least every two years.

(2) DSHS may review a client's records and activities at any time to see if the service provider continues to address the clients' needs for instruction and support activities.

(3) DSHS may conduct additional evaluations or audits of any service provider at its discretion.

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NEW SECTION
WAC 388-820-210   What occurs during review and evaluation?   (1) Service providers are evaluated, using this chapter and the DSHS contract requirements.

(2) To gather information, evaluators use a sample of clients that the service provider supports. Ways to gather information for evaluation must include:

(a) Review of records;

(b) Interview of clients, legal representatives, and others with the client's consent; and

(c) Observation of staff and client interactions.

(3) Information may also be gathered by conducting:

(a) Interviews with other entities contracted with DSHS; and

(b) Interviews with DSHS staff.

(4) The state-contracted evaluators conduct meetings with the service provider and DDD to discuss their preliminary findings and request additional information and clarification.

(5) Evaluators conduct an exit conference to present the evaluation report to the service providers and DSHS. The service provider's administrator or designee must be present at this exit conference.

(a) The evaluation report will include the service provider's operation history.

(b) If the service provider has not complied with certification requirements or with its contract with DSHS, the evaluator will note the findings in the report.

(c) The report must specify the corrective action plan. The corrective action plan and specific time frames are negotiated between the service provider and DSHS.

(d) At the conclusion of the exit conference, the service provider may request a copy of part or all of the draft report from the evaluator.

(e) The service provider may also submit a letter requesting a draft copy of the report to DDD headquarters within fourteen days of the exit conference.

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NEW SECTION
WAC 388-820-220   May service providers disagree with evaluation findings?   (1) If service providers disagree with evaluation findings, they must submit in writing documentation supporting their position within fourteen calendar days after:

(a) The exit conference; or

(b) Receipt of the draft of the evaluation report.

(2) After receiving the service provider's documentation, DDD must send written notification of its decision to the service provider within fourteen calendar days.

(3) The service provider's documentation and DDD's decision must become part of the final evaluation report.

(4) DDD must file a report of the evaluation results and send a copy to the service provider. At this time, the evaluation report is considered to be a public document.

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NEW SECTION
WAC 388-820-230   May a service provider receive provisional certification?   (1) A service provider that does not comply with all requirements of this chapter may receive provisional certification by DSHS.

(2) Provisional certification may not exceed one hundred eighty days.

(3) At the end of provisional certification:

(a) If the service provider has complied with certification requirements, DSHS may approve the service provider for regular certification.

(b) If the service provider has not complied with certification requirements, DSHS must revoke the service provider's certification and terminate the contract.

[]


NEW SECTION
WAC 388-820-240   When may DSHS decertify a service provider?   If a service provider does not comply with certification requirements, DSHS may decertify a service provider under chapter 43.20A RCW. Upon decertification, DSHS terminates the contract and stops all payments.

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ADMINISTRATIVE REQUIREMENTS: GENERAL
NEW SECTION
WAC 388-820-250   What are administrators of service providers required to do?   DSHS requires administrators of service providers to oversee all aspects of services delivered to clients, consistent with the DSHS contract. This includes:

(1) Overseeing all aspects of staff development, such as recruitment and staff training;

(2) Preparing and maintaining policies and procedures related to client services, personnel, and financial records; and

(3) Securely storing client, personnel, and financial records.

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NEW SECTION
WAC 388-820-260   Must service providers' administrative documents be approved by DDD?   Service providers must have DDD approval for several types of administrative documents.

(1) Service providers must have these written statements approved by DDD:

(a) A mission statement;

(b) Program description and admission criteria;

(c) An organizational chart and description showing all supervisory relationships; and

(d) Definition of staff roles and responsibilities, including the person designated to act in the absence of the administrator.

(2) Service providers must also have these policies and procedures approved by DDD:

(a) Background checks, as required under chapter 388-146 WAC;

(b) Client confidentiality and release of information;

(c) Client rights, which must include information on how to report suspected abuse, neglect, exploitation, and mistreatment;

(d) Client grievance procedures, including a client's right to file a complaint or suggestion without interference;

(e) Protection of client's financial interests, including management of client accounts, if applicable;

(f) Medication management, administration, and assistance;

(g) Plans for responding to missing persons; client emergencies, including access to medical, mental health, and law enforcement resources; and natural or other disasters;

(h) Notification of client's guardian and/or relatives in case of emergency; and

(i) Methods used for soliciting client input and feedback on services and support received.

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NEW SECTION
WAC 388-820-270   What are the requirements for personnel policies?   (1) Service providers must maintain current written personnel policies and procedures.

(2) Personnel policies and procedures must be available to all employees.

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NEW SECTION
WAC 388-820-280   What nondiscrimination requirements must agencies and service providers meet?   (1) When employing staff or supporting clients, agencies and service providers must not discriminate against any person on the basis of:

(a) Race;

(b) Color;

(c) Creed;

(d) Religion;

(e) National origin;

(f) Age;

(g) Gender;

(h) Presence of any sensory, mental, or physical disability, including HIV/AIDS conditions;

(i) Use of a trained dog guide or service animal by a person with a disability;

(j) Marital status;

(k) Disabled status or Vietnam Era veteran status;

(l) Sexual orientation; and

(m) Any other reasons prohibited by law.

(2) Exception: An employer may deny employment to a person if the decision is based upon a bona fide occupational qualification. (See chapter 49.60 RCW.)

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NEW SECTION
WAC 388-820-290   What staffing requirements must service providers meet?   (1) A service provider must have a designated administrator.

(2) Clients must have immediate access to staff, or the means to contact staff, at all times: Twenty-four hours a day, seven days a week.

(3) A service provider must provide adequate staff within contracted funds to administer the program and meet the needs of the clients.

(4) A service provider must have other staff available, as specified by the service provider's contract with DSHS.

(5) Each group home must maintain staffing that complies with:

(a) Boarding home or adult family home licensing requirements under chapter 388-78A or 388-76 WAC, respectively; and

(b) Contract requirements with the division of developmental disabilities.

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NEW SECTION
WAC 388-820-300   May clients instruct and support other clients?   Clients must not be routinely involved in the unpaid instruction and support of other clients.

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NEW SECTION
WAC 388-820-310   Do employees and volunteers need background checks?   (1) Employees and volunteers must have a background check cleared by DSHS before working alone, unsupervised with clients. Employee and volunteers waiting for background checks may work with clients only if they are directly observed by staff who have a DSHS background clearance.

(2) An FBI check is required when an employee or volunteer has resided in the state for less than three years. Service providers must follow the requirements under WAC 388-06-0500 through 388-06-0540 for provisional hire of employees awaiting Federal Bureau of Investigation (FBI) background checks.

(3) Clearances must be obtained for each service provider where the staff person works or volunteers.

(4) Clearances must be renewed as specified by DDD.

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NEW SECTION
WAC 388-820-320   What are the minimum requirements for staff employed by service providers?   Service provider staff must meet the following minimum requirements:

(1) Exhibit job-related competency and the ability to make independent judgments;

(2) Have a high school diploma or GED equivalent, unless the employees were hired before 1983;

(3) Be at least eighteen years of age when employed as a direct care staff, or at least twenty-one years of age when employed as an administrator; and

(4) Treat a client with dignity and consideration, respecting the client's civil and human rights at all times.

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NEW SECTION
WAC 388-820-330   What staff training is required?   The service provider must give specific training to staff. Within the first six months, staff must receive a minimum of thirty-two total hours of training that meet the following requirements.

(1) Before the employee works alone with clients, the service provider must explain the following to the employee:

(a) The current instruction and support plan for the employee's clients;

(b) Emergency procedures for clients;

(c) The DSHS-approved policy on abuse and neglect; and

(d) Client confidentiality.

(2) Within the first four weeks of employing a staff person, the service provider must provide training that includes:

(a) The service provider's mission statement;

(b) Policies and procedures; and

(c) On-the-job training.

(3) Additional training within the first six months must include:

(a) First aid/CPR;

(b) Bloodborne pathogens with HIV/AIDS information; and

(c) Client services.

(4) Each employee must keep first aid/CPR certification and bloodborne pathogens training current.

(5) The service provider must document orientation and training activities.

(6) Group homes must also meet the training requirements mandated by the licensing requirements specified by DSHS.

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NEW SECTION
WAC 388-820-340   How often must performance reviews be conducted for staff of service providers?   (1) Written performance reviews for staff of residential service providers must be conducted at least annually and kept on file.

(2) If the service provider is a nonprofit organization, administrators must be evaluated annually by their supervisor or by the organization's governing board.

(3) If the service provider is a for-profit organization, owners are not required to have performance reviews.

(4) If the service provider is a governmental agency, administrators are evaluated by their supervisor.

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NEW SECTION
WAC 388-820-350   When must service providers have staff-coverage schedules approved by DDD?   (1) DDD must approve staff-coverage schedules for those service providers who have on-duty staff twenty-four hours a day.

(2) The staff-coverage schedules must be approved at the following times:

(a) Before certification review takes place;

(b) When household configuration changes affect funding; and

(c) When additional staffing is requested.

(3) Staff-coverage schedules may be requested by DDD at any time.

(4) Each service provider must retain copies of the approved staff-coverage schedules.

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NEW SECTION
WAC 388-820-360   What happens when a service provider's ownership changes?   (1) A service provider must inform DSHS in writing sixty days before a change of ownership occurs.

(2) On the effective date of a change of ownership, DSHS must terminate the department's certification and contract with the previous service provider.

(3) DSHS must withhold final payment to the previous service provider until that service provider submits and DSHS accepts all reports and required documents.

(4) DSHS is under no obligation to contract with the new owner entity.

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NEW SECTION
WAC 388-820-370   When may a client's service provider change?   A client's service provider may change when:

(1) A client stops receiving residential services and supports from a service provider;

(2) A service provider transfers ownership; or

(3) The client chooses a different service provider.

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ADMINISTRATIVE REQUIREMENTS: CLIENT RECORDS
NEW SECTION
WAC 388-820-380   Are clients' records considered confidential?   (1) The service provider and staff must consider all client record information privileged and confidential. Copies of client record information are available to:

(a) DSHS, the client, and/or legal representative upon their request to the service provider; and

(b) The county developmental disabilities board with DDD approval, as allowed under RCW 71A.14.070.

(2) Any other transfer or inspection of records must be authorized by a release of information form that:

(a) Specifically gives information about the transfer or inspection; and

(b) Is signed by the client or guardian.

(3) A signed release of information is valid for up to one year.

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NEW SECTION
WAC 388-820-390   How long does a service provider need to keep client records?   (1) While supporting a client, a service provider must keep a client's records from at least the past four years.

(2) After a client's participation with a service provider ends, the client's records must be kept by the service provider for at least six years.

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NEW SECTION
WAC 388-820-400   What information do service providers need to keep in client records?   A service provider needs to keep certain information in client records to fulfill DSHS requirements. The client's records must include, but not be limited to, the following:

(1) The client's name, address, and Social Security number.

(2) The name, address, and telephone number of the client's relative, guardian or legal representative.

(3) Copies of legal guardianship papers, if any.

(4) Client health records, including:

(a) The name, address, and telephone number of the client's physician, dentist, mental health service provider, and any other health care service provider;

(b) Health care service providers' instructions about health care needed, including appointment dates and date of next appointment if appropriate;

(c) Written documentation that the health care service providers' instructions have been followed; and

(d) A record of major health events and surgeries when known.

(5) A copy of the client's individual service plan (ISP).

(6) The client's individual instruction and support plan (IISP), including:

(a) Instruction and support activities for each client as a basis for review and evaluation of client's progress;

(b) Semiannual review of the IISP;

(c) Consultation with other service providers and other interested persons;

(d) IISP revisions and changes; and

(e) Other activities relevant to the client that the client wants included.

(7) Progress notes and incident reports on clients.

(8) The client's financial records for funds managed by the service provider, including:

(a) Receipts, ledgers and records of the client's financial transactions; and

(b) Client's related bankbooks, checkbooks, bank registers, tax records and bank statements.

(9) Burial plans and wills.

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NEW SECTION
WAC 388-820-410   Do service providers need to keep client's property records?   The service provider must assist clients in maintaining current, written property records when the clients receive forty hours or more a month of services. The record consists of:

(1) A list of items with a value of at least twenty-five dollars that the client owns when moving into the program;

(2) A list of personal possessions with a value of seventy-five dollars or more per item once the client is receiving services;

(3) Description and identifying numbers, if any, of the property;

(4) The date the client purchased the items after moving into the program;

(5) The date and reason for addition or removal from the record; and

(6) The signature of the staff or client making the entry.

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NEW SECTION
WAC 388-820-420   Are there requirements for record entries?   (1) The service provider must note all record entries in ink.

(2) Entries must be made at the time of or immediately following the occurrence of the event recorded, in legible writing, and dated and signed by the person making the entry.

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EMERGENCIES
NEW SECTION
WAC 388-820-430   Who must service providers notify in emergencies?   In emergencies, a service provider must:

(1) Notify the client's guardian or legal representative as soon as possible;

(2) Immediately report to DSHS about a serious incident or emergency, as specified in the contract; and

(3) Submit a written incident report to DSHS, as required by law or policy.

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ABUSE AND NEGLECT REPORTING
NEW SECTION
WAC 388-820-440   What abuse and neglect reporting requirements must service providers meet?   (1) Under chapter 74.34 RCW, all administrators, owners, staff and volunteers are mandated to report instances of suspected client abuse, neglect, exploitation, or mistreatment.

(2) Reports must be made to one of two different areas at DSHS:

(a) Service providers giving supported living services must report to adult protective services (APS); and

(b) Service providers giving services through group homes must report to residential care services (RCS).

(3) Reports must be made to law enforcement agencies, when appropriate.

(4) Service providers must have DSHS-approved policies and procedures that specify reporting requirements for client abuse, neglect, exploitation, or mistreatment.

(5) Each administrator, owner, staff person, and volunteer must sign this policy about reporting requirements. The service provider must place the signed policy in the personnel file for staff or volunteers.

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CLIENT SERVICES
NEW SECTION
WAC 388-820-450   What are client services?   Clients must receive instruction and support activities in one or more of these client services:

(1) Health and safety;

(2) Personal power and choice;

(3) Competence and self-reliance;

(4) Positive recognition by self and others;

(5) Positive relationships; and

(6) Integration in the physical and social life of the community.

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NEW SECTION
WAC 388-820-460   What health and safety support may a service provider offer to a client?   Service providers offer health and safety support to assist clients. This may include assisting clients to:

(1) Know when they need health services;

(2) Maintain good health;

(3) Learn about basic nutrition;

(4) Learn about human sexuality;

(5) Use health services, including mental health services;

(6) Manage and/or self-administer their medications;

(7) Deal with illness and injury;

(8) Apply first-aid procedures;

(9) Learn self-protection;

(10) Become aware of fire evacuation plans and burglary protection strategies; and

(11) Know emergency procedures, such as using 911 or a local emergency number.

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NEW SECTION
WAC 388-820-470   What support may a service provider offer to a client to increase personal power and choices?   Service providers support a client's personal power and choices. This may include assisting clients to:

(1) Secure housing and furnishings that reflect personal preferences, life style, and financial means;

(2) Express personal opinions and make decisions;

(3) Learn and exercise rights and responsibilities;

(4) Improve communication skills;

(5) Participate in a variety of activities of their choice, including new experiences;

(6) Exercise voter rights;

(7) Learn about and participate in self-advocacy and protection services; and

(8) Make career choices.

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NEW SECTION
WAC 388-820-480   What support may a service provider offer to increase a client's competence and self-reliance?   Service providers increase a client's competence and self-reliance. This may include assisting clients to:

(1) Develop and achieve their goals;

(2) Learn and use daily living skills, such as meal planning and preparation, grocery shopping, doing laundry, using household appliances, managing money, and using leisure time;

(3) Identify situations where the client needs or desires assistance from others;

(4) Complete or participate in all tasks within their abilities; and

(5) Acquire and use adaptive devices and equipment, as needed.

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NEW SECTION
WAC 388-820-490   How may service providers assist clients in gaining positive recognition?   Service providers encourage a client's positive recognition. This may include assisting clients to:

(1) Create positive self-esteem and feelings of self-worth;

(2) Choose valued social roles;

(3) Make choices that enhance their positive recognition by community members; and

(4) Present themselves in ways that are typical of other people in their community.

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NEW SECTION
WAC 388-820-500   What support may a service provider offer to increase the positive relationships in the client's life?   Service providers encourage clients in developing, maintaining, and expanding positive relationships. This may include assisting clients to:

(1) Improve their communication skills;

(2) Experience opportunities to meet and interact with other people;

(3) Initiate, build and sustain relationships;

(4) Involve the client's guardian, chosen family members or representative in planning and making decisions that affect the client;

(5) Resolve disagreements with peers, family, friends, staff, neighbors, and coworkers; and

(6) Cope with the loss of a significant relationship, such as the death of a friend or family member, the end of a relationship, the loss of a job, or a change of staff.

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NEW SECTION
WAC 388-820-510   How may a service provider assist clients with becoming integrated into their community?   Service providers encourage clients to become integrated into the physical and social life of the community. Service providers may assist clients to:

(1) Use community resources such as grocery store, bank, and social organizations;

(2) Use available transportation;

(3) Access educational and vocational opportunities; and

(4) Participate on boards, committees, or other positions of influence or status.

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CLIENT SERVICE PLANS
NEW SECTION
WAC 388-820-520   What is an individual service plan (ISP) for clients?   An individual service plan (ISP) is required for each client. The ISP outlines the support needs and interests of the client. The plan identifies the responsibilities of the service provider and other entities in supporting the client. Examples of other entities are: Vocational provider, therapists, nurses, and advocates. (See RCW 71A.18.010.)

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NEW SECTION
WAC 388-820-530   Who is responsible for completing and overseeing a client's ISP?   The client's DDD case resource manager is responsible for completing and overseeing a client's individual service plan (ISP).

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NEW SECTION
WAC 388-820-540   Who may participate in creating a client's ISP?   (1) The case resource manager must have face-to-face contact with the client in developing the individual service plan (ISP).

(2) The case resource manager must also involve the client's guardian or legal representative and the service provider.

(3) In creating a client's individual service plan (ISP), under RCW 71A.18.010, the client and DDD case resource manager may involve:

(a) Department staff; and

(b) Other interested persons invited by the client.

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NEW SECTION
WAC 388-820-550   How often must the ISP be reviewed?   (1) The DDD case resource manager must review the ISP with the client at least every twelve months.

(2) In addition, an ISP meeting must be held with the client at least every two years, under RCW 71A.18.010. The meeting must be held in the client's home unless requested otherwise by the client.

(3) A client may request a review of the ISP at any time.

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NEW SECTION
WAC 388-820-560   What is an individual instruction and support plan (IISP) for clients?   (1) An individual instruction and support plan (IISP) outlines the specific requirements for carrying out the residential services portion outlined in the individual service plan (ISP). The IISP must describe the methods of instruction and/or support needed to reach the client's goal.

(2) The IISP must be based on the goals of the individual service plan (ISP), reflect the client's preferences, and have the client's agreement.

(3) The IISP identifies activities and opportunities that promote one or more of the following client services:

(a) Health and safety;

(b) Personal power and choice;

(c) Positive recognition by self and others;

(d) Integration in the physical and social life of the community;

(e) Positive relationships; and

(f) Competence and self-reliance.

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NEW SECTION
WAC 388-820-570   Who may participate in developing the IISP for each client?   (1) The service provider must develop with each client a written individual instruction and support plan (IISP).

(2) The client may involve other interested individuals in developing the IISP.

(3) The service provider must facilitate the individual instruction and support plan (IISP) in a manner that:

(a) Is respectful and inclusive of the client;

(b) Is appropriate to the age of the client or is preferred by the client;

(c) Takes place or occurs in community settings; and

(d) Results in opportunities for clients to experience positive change and personal growth.

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NEW SECTION
WAC 388-820-580   Who oversees the IISP for each client?   (1) The service provider must oversee the progress made on each client's individual instruction and support plan (IISP).

(2) In overseeing each client's IISP, the service provider must:

(a) Consult with other service providers serving the client and other interested persons, as needed, to coordinate the IISP;

(b) Revise the IISP as goals are achieved, or as requested by the client and/or guardian; and

(c) Review and update the plan at least every six months.

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CLIENT FUNDS
NEW SECTION
WAC 388-820-590   May a service provider manage a client's funds?   (1) A service provider may manage a client's funds after either:

(a) Obtaining written consent from the client, the client's guardian or legal representative; or

(b) Becoming the designated payee by the source of the client's unearned income.

Note: An example is a client receiving unearned income from the Social Security Administration.
(2) A client's funds are considered to be managed by a service provider when the service provider:

(a) Has signing authority and may disperse a client's funds; and/or

(b) May limit access to client funds by not allowing funds to be expended.

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NEW SECTION
WAC 388-820-600   May a service provider hold bankbooks and bankcards for a client?   Clients may ask a service provider to hold their bankbooks and bankcards while still having access to their own funds. This must be documented in the client's individual instruction and support plan (IISP).

Note: In this situation, service providers are not necessarily considered managers of the client's funds.

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NEW SECTION
WAC 388-820-610   May a service provider combine agency and client funds?   A service provider may not combine client funds with any agency funds, such as agency operating funds.

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NEW SECTION
WAC 388-820-620   Does the service provider need to develop an individual financial plan (IFP) for clients?   (1) A financial management plan is required only for those clients whose funds are managed by the service provider. The client and service provider must develop this individual financial plan (IFP) together.

(2) The IFP must be reviewed at least every twelve months by the service provider and client.

(3) A copy of the IFP must be sent to:

(a) The guardian and/or legal representative; and

(b) The client's DDD case resource manager upon request.

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NEW SECTION
WAC 388-820-630   What information must the IFP include?   This plan must include all of the following items:

(1) The part of the client's funds and income that will be managed by the service provider;

(2) The part of client funds and income that will be managed by the client or legal representative;

(3) The type of accounts used;

(4) A budget process;

(5) Asset management, such as personal property, burial plan, retirement funds, stock, and vehicles;

(6) Cash management;

(7) Money management instruction and/or support;

(8) An explanation of which purchases require receipts;

(9) Contingency plan for expenditures if a client's resources exceed the CAP limit; and

(10) A signature of the client and the client's guardian, if any.

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NEW SECTION
WAC 388-820-640   How does a service provider manage client funds?   (1) For client's funds that the service provider manages, the service provider must:

(a) Separately track each client's money even when several clients reside together;

(b) Keep the client's account current by maintaining a running balance;

(c) Reconcile the client's account to the bank statement on a monthly basis;

(d) Make deposits to the client's account within one week of receiving the client's money;

(e) Prevent the client's account from being overdrawn;

(f) Ensure that individual cash funds do not exceed seventy-five dollars per person unless specified differently in the individual's financial plan; and

(g) Retain receipts for purchases of over twenty-five dollars.

(2) When a client's service provider receives a check made out to the client, the service provider assisting the client must either:

(a) Get the client's signature and designation "for deposit only," and deposit the check in the client's account; or

(b) Get the client's "x" mark in the presence of another witness, cosign the check with the designation "for deposit only," and deposit the check in the client's account.

(3) If the check for a client is made out to a payee other than the client, the payee signs the check.

(4) Clients must never sign a blank check.

(5) When clients use checks for purchases, they must sign checks at the time of purchase unless specified differently in their individual financial plan.

(6) The service provider must document the names of any staff who assist a client with financial transactions.

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NEW SECTION
WAC 388-820-650   What documentation must service providers keep to protect a client's financial interests?   Service providers must keep certain documentation for the part of funds they manage for clients. This protects clients' financial interests.

(1) Documentation for bank and cash accounts must include monthly reconciliation of bank and cash accounts that are verified and initialed by a second party who did not make or assist in the transaction.

(2) Other documentation that a service provider must keep for client financial transactions include:

(a) Monthly bank statements and reconciliation;

(b) Checkbook registers and bankbooks;

(c) Deposit receipts;

(d) Receipts for purchases over twenty-five dollars, or as specified in the financial plan;

(e) Any itemized subsidiary ledgers showing deposits, withdrawals, and interest payments to individual clients; and

(f) A control journal for trust accounts.

(3) Other documentation that a service provider must keep for client cash transactions include:

(a) A detailed ledger signed by the person who withdrew any of the client's money;

(b) Monthly reconciliation to the cash amount;

(c) Detailed accounting of the money received on behalf of the client, such as cash received from writing checks over the purchase amount, and a list of where the money was spent; and

(d) Receipts for purchases over twenty-five dollars where service provider staff withdrew the money.

(4) Service providers must notify DSHS when the client:

(a) Receives services under a CAP (community alternative program) waiver; and

(b) Has an account that reaches three hundred dollars less than the maximum amount allowed by federal or state law.

Note: CAP-waiver is defined under WAC 388-825-170.

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NEW SECTION
WAC 388-820-660   How are a client's funds transferred when they are managed by a service provider?   When a service provider manages a client's funds, transferring those funds must follow specific procedures.

(1) When a client transfers from one service provider to another, the previous service provider must transfer client funds within thirty days. To transfer funds, the previous service provider must:

(a) Give the client, the client's guardian, and/or the legal representative a written accounting of all known client funds;

(b) When applicable, give the new service provider a written accounting of all transferred client funds;

(c) Obtain a written receipt from the client, client's guardian and/or legal representative for all transferred funds; and

(d) When applicable, obtain the new service provider's written receipt for the transferred funds.

(2) When a client becomes incapacitated or a client's whereabouts are unknown, the client's service provider must transfer the client's funds within one hundred and eighty days to the client's legal guardian, to DSHS, or to the requesting governmental entity.

(3) When a client dies, the service provider must transfer the client's funds within ninety days to:

(a) The client's guardian;

(b) The legal representative;

(c) The requesting governmental entity; or

(d) DSHS if the client does not have a legal heir.

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NEW SECTION
WAC 388-820-670   How does a service provider handle loans to a client?   (1) A service provider may loan money to a client from the service provider's funds and collect the debt from the client by installments.

(2) The client's service provider must not:

(a) Charge a client interest for money loaned; or

(b) Borrow funds from the client.

(3) A service provider must retain a signed agreement with the client.

(4) Documentation must be kept for:

(a) The amount loaned;

(b) Payments; and

(c) The balance owed.

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NEW SECTION
WAC 388-820-680   When must a service provider pay a client?   A service provider must pay a client when:

(1) A service provider or staff has stolen, misplaced, or mismanaged client funds.

(2) There are service charges incurred on a trust account that the service provider operates for a client.

(3) A client performs work for the service provider.

(a) The service provider must pay the client at least the current minimum wage.

(b) Clients who work for a service provider must be paid according to federal and state law requirements.

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CLIENT HEALTH SERVICES
NEW SECTION
WAC 388-820-690   What must service providers do to support a client's health?   (1) The service provider must give necessary assistance to the client in accessing health, mental health, and dental services.

(2) For clients who receive an average of thirty hours or more of service per month, the service provider must:

(a) Maintain health records;

(b) Assist the client in arranging appointments with health professionals;

(c) Monitor medical treatment prescribed by health professionals;

(d) Communicate directly with health professionals when needed; and

(e) Ensure that the client receives an annual physical and dental examination unless the appropriate medical professional gives a written exception.

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NEW SECTION
WAC 388-820-700   May a client refuse health care services?   A client may refuse to participate in health care services. Service providers must document these situations, according to WAC 388-820-100.

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NEW SECTION
WAC 388-820-710   When may client funds be used for health services?   (1) Client funds for health services may be used when no other funding is available.

(2) A service provider must document all denials from:

(a) DSHS' medical assistance administration; and/or

(b) Private insurance companies or other carriers of primary medical insurance.

(3) The written documentation must be given to the client's DDD case resource manager and kept in the client's files.

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CLIENT TRANSPORTATION
NEW SECTION
WAC 388-820-720   How must the service provider be involved with a client's transportation needs?   (1) The service provider must provide transportation or ensure that clients have a way to get to:

(a) Emergency medical care;

(b) Medical appointments; and

(c) Therapies.

(2) Within available resources, the service provider must provide necessary assistance with transportation to and from:

(a) Work, school or other publicly funded services;

(b) Leisure or recreation activities;

(c) Client-requested activities; and

(d) ISP- or IISP-related activities.

(3) A vehicle that the service provider uses to transport clients must be:

(a) In safe operating condition; and

(b) Properly insured for its usage.

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NURSE DELEGATION
NEW SECTION
WAC 388-820-730   Who may delegate nursing care tasks?   (1) Any registered nurse (RN) may delegate specified nursing care tasks to staff who become qualified nursing assistants. Qualified nursing assistants may perform nursing care tasks only for the client who is specified by the RN to receive care.

(2) One nursing assistant must not transfer delegated authority to perform nursing care tasks to another nursing assistant.

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NEW SECTION
WAC 388-820-740   What training is required before staff are qualified to perform delegated tasks?   (1) Before performing delegated tasks, staff must:

(a) Be registered or certified as a nursing assistant (NAR or NAC, respectively);

(b) Complete nurse delegation core training approved by DSHS and receive a certificate; and

(c) Receive client-specific training from the delegating registered nurse.

(2) In addition, registered nursing assistants must complete thirty-two hours of staff training required by WAC 388-820-330 before doing nursing care tasks. Certified nursing assistants may perform delegated tasks before completing the required thirty-two hours of staff training.

(3) After the staff member completes the required training, the service provider must keep:

(a) Written instructions provided by the delegating registered nurse; and

(b) A copy of the current registration or certification for each employee.

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NEW SECTION
WAC 388-820-750   Do nursing assistants need to comply with department of health requirements?   Nursing assistants must comply with department of health (DOH) requirements under chapter 246-840 WAC.

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NEW SECTION
WAC 388-820-760   Who is authorized to provide consent for a client's receiving health care?   (1) Before nursing assistants perform nursing care tasks for a client, the registered nurse must obtain consent from the client or person authorized to give consent.

(2) Under RCW 7.70.065, if a client is unable to give consent or is incapacitated, certain people are authorized to provide consent for a client's receiving health care. These people must be one of the following in this priority order:

(a) The legal guardian, if any;

(b) An individual who holds a durable power of attorney for health care decisions;

(c) The client's spouse;

(d) The client's children who are at least eighteen years of age;

(e) The client's parents; and

(f) The client's adult siblings.

(3) Proof of consent must be kept in the client's files.

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NEW SECTION
WAC 388-820-770   What rights do nursing assistants have concerning the delegation of nursing care tasks?   Nursing assistants have certain rights when nursing care tasks are delegated by the registered nurse.

(1) The nursing assistant:

(a) May consent or refuse to consent to perform a delegated nursing care task; and

(b) Must not receive employer reprisal for refusing to accept the delegation of a nursing care task if the refusal is based on client safety issues.

(2) The service provider must post the toll-free telephone number (1-800-562-6078), established by DSHS' aging and adult services administration, for complaints about the delegation of nursing tasks to nursing assistants. This phone number is on DSHS forms: 13-678B, 13-680 and 13-681.

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NEW SECTION
WAC 388-820-780   Are nursing assistants liable for errors while doing nursing care tasks?   If nursing assistants are following written directions from the delegating nurse, they are not liable for errors in doing nursing care tasks.

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NEW SECTION
WAC 388-820-790   What happens if unqualified staff do a nursing task?   (1) DSHS must impose a civil fine on any service provider who knowingly performs or permits an employee to perform a nursing task without proper delegation. (See chapter 18.88A RCW and chapter 246-840 WAC.) The minimum amount of this fine is two hundred fifty dollars. The maximum fine allowed is one thousand dollars.

(2) When assessing civil fines, DSHS must consider:

(a) Severity of occurrence;

(b) Frequency of occurrence; and

(c) Other relevant factors relating to the occurrence.

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NEW SECTION
WAC 388-820-800   What technical assistance may service providers get from DSHS for nurse delegation requirements?   (1) DSHS must offer technical assistance to service providers for purposes of education and assistance to help service providers comply with nurse delegation requirements and protocols.

(2) The DSHS technical assistance program must include:

(a) Technical assistance visits where DSHS informs the service provider of violation of law or service provider rules;

(b) Information about how to get technical assistance;

(c) Printed information;

(d) Information and assistance by phone;

(e) Training meetings;

(f) Other appropriate methods to provide technical assistance; and

(g) A list of organizations that provide technical assistance.

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NEW SECTION
WAC 388-820-810   What happens when DSHS finds a service provider in violation of nurse delegation requirements?   (1) Before imposing a civil fine, DSHS may take the following steps after discovering that a service provider is in violation of rules:

(a) Notify the service provider in writing about the concerns;

(b) Give the service provider an opportunity to explain circumstances or present additional information that may clarify concerns; and

(c) Request the service provider to provide additional information, if necessary.

(2) DSHS must inform the service provider in writing about the outcome of findings and any required actions.

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NEW SECTION
WAC 388-820-820   May a service provider have a chance to correct violations before being fined?   The service provider must be given a reasonable period of time to correct violations of nurse delegation requirements before any civil penalty is imposed.

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NEW SECTION
WAC 388-820-830   May civil fines be imposed during technical assistance visits?   A civil fine may be issued during a technical assistance visit if:

(1) The service provider has previously been found out of compliance for the same statute or rule; or

(2) The service provider's violation is likely to place a person in danger of death or bodily harm.

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NEW SECTION
WAC 388-820-840   How does DSHS impose a civil fine?   DSHS gives a service provider written notice of any civil fines. This notice must:

(1) State the amount and reasons for the fine and the applicable law under which the fine is imposed; and

(2) Inform the service provider of the right to request a hearing.

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NEW SECTION
WAC 388-820-850   When is payment due for a civil fine?   (1) A civil fine becomes due twenty-eight days after the receipt of the written notice of the fine.

(2) Exception: If a service provider requests a hearing under chapter 34.05 RCW and RCW 43.20A.215, DSHS must stop the fine while waiting for a final decision on the matter.

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NEW SECTION
WAC 388-820-860   May a service provider disagree with DSHS findings of a violation?   (1) When a service provider disagrees with DSHS' finding of a violation under this chapter, the service provider has the right to have the violation reviewed under the department's dispute resolution process.

(2) No service provider may discriminate or retaliate in any manner against a person who makes a complaint or has cooperated in the complaint investigation.

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NEW SECTION
WAC 388-820-870   May a service provider contest a civil fine?   (1) A service provider may contest DSHS' decision to impose a civil fine.

(2) Within twenty-eight days of receiving the decision, the service provider must file a written application for a hearing, showing proof of receipt with the Board of Appeals, P.O. Box 42489, Olympia, WA 98504-2489. The application must include:

(a) The grounds for contesting the department decision; and

(b) A copy of the contested department decision.

(3) Hearings are governed by chapter 34.05 RCW and RCW 43.20A.215, and chapter 388-02 WAC. If any provision in this section conflicts with chapter 388-02 WAC, the provision in this section governs.

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DISPUTE RIGHTS
NEW SECTION
WAC 388-820-880   May an agency or service provider contest a DSHS decision?   (1) An agency or service provider may contest a DSHS decision about certification within twenty-eight days of being notified of the decision.

(2) Within this twenty-eight day period, the agency or service provider must request in writing that the DDD director or designee review the decision. The agency or service provider must:

(a) Sign the request;

(b) Identify the challenged decision and the date it was made;

(c) State specifically the issues and regulations involved and the grounds for the service provider's disagreement; and

(d) Include with the request copies of any supporting documentation for the service provider's position.

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NEW SECTION
WAC 388-820-890   When does an administrative review conference occur?   (1) After receiving the agency or service provider's timely written request to review a decision, DSHS has twenty-eight days to contact the service provider to schedule an administrative review conference at a mutually convenient time.

(2) Exception: The agency or service provider and DSHS may agree in writing to a specific later date for the conference.

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NEW SECTION
WAC 388-820-900   May an administrative review conference be conducted by telephone?   (1) The administrative review conference between DSHS and an agency or service provider may be conducted by telephone.

(2) Exception: If either the department, or the agency or service provider requests in writing that the conference be held in person, the conference may not be conducted by telephone.

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NEW SECTION
WAC 388-820-910   What happens during the administrative review conference?   (1) The agency or service provider requesting an administrative review conference and appropriate DSHS representatives must attend the conference.

(2) The agency or service provider must bring to the conference, or give to DSHS before the conference, any supporting documentation for the service provider's position.

(3) The parties must clarify and attempt to resolve the issues at the conference.

(4) If additional documentation is needed to resolve issues, a second session of the conference must be scheduled. The second conference must be scheduled no later than twenty-eight days after the initial session unless both parties agree in writing to a specific later date.

(5) The director of the division of developmental disabilities must give a written decision to the service provider after the end of the conference.

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NEW SECTION
WAC 388-820-920   May an agency or service provider contest the decision from the administrative review conference?   At the administrative review conference, an agency or service provider may contest a decision made by the director of the division of developmental disabilities. To contest a decision, the agency or service provider may request a hearing. The hearing procedure follows the requirements under chapter 388-02 WAC.

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REQUESTS FOR EXCEPTIONS
NEW SECTION
WAC 388-820-930   Does DSHS make exceptions to the requirements in this chapter?   DSHS may grant service providers exceptions to the requirements specified in this chapter as long as the following conditions are met:

(1) The service provider must submit a written request for an exception to the DDD regional administrator of the region where the contract is held.

(2) DSHS must evaluate requests for exceptions, considering:

(a) The health and safety of the clients;

(b) The quality of the services;

(c) Supervision; and

(d) The impact on client services.

(3) DSHS must send a copy of those requests that have significant impacts on client services to the client(s) involved. DSHS must then give the client an opportunity to comment before granting an exception.

(4) The DDD director or designee must approve or deny the request in writing within sixty calendar days after receiving the request from the service provider.

(5) Any exception granted must be in line with the legislative intent of Title 71A RCW.

(6) Service providers must retain a copy of each DSHS-approved exception.

(7) Service providers do not have hearing rights when they receive a denial from DSHS for an exception to the rules in this chapter.

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Washington State Code Reviser's Office