Original Notice.

Preproposal statement of inquiry was filed as WSR 00-23-049.

Title of Rule: New WAC 388-112-0001 through 388-112-0175, Residential long-term care services -- Training; amending WAC 388-76-570, 388-76-655 and 388-76-660, adult family home minimum licensing requirements; and repealing WAC 388-76-59100, 388-76-59110, and 388-76-59120, adult family home minimum licensing requirements, and WAC 388-110-110 Caregiver education and training requirements.

Purpose: To implement SSB 6502 (chapter 121, Laws of 2000) on training for adult family homes and boarding homes; combine training requirements for these settings into one WAC.

Statutory Authority for Adoption: RCW 18.20.090, 70.128.040, 74.39A.050, and 34.05.020.

Statute Being Implemented: Chapter 121, Laws of 2000.

Summary: Implements requirements for staff orientation in adult family homes and boarding homes; implements requirements for licensed boarding home administrators and caregivers to have basic training and specialty training; moves all training requirements for these two settings into one training WAC.

Reasons Supporting Proposal: Implementing statutes referenced above.

Name of Agency Personnel Responsible for Drafting: Dotti Wilke, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2539; Implementation and Enforcement: Marta Acedo, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2549.

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

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

Explanation of Rule, its Purpose, and Anticipated Effects: This rule implements RCWs on training for adult family homes and boarding homes, and consolidates the current training rules for those settings into one place. New requirements in the RCW include an orientation for all staff with significant interaction with residents in adult family homes and boarding homes; requirements for licensed boarding homes for administrators or their designees, and caregivers to have basic training and specialty training.

Proposal Changes the Following Existing Rules: This proposal moves existing rules into one new rule.

A small business economic impact statement has been prepared under chapter 19.85 RCW.

&sqbul;	Adult family homes, and
&sqbul;	Boarding homes.

The new chapter 388-112 WAC consolidates training rules by including rules moved from:

&sqbul;	Chapter 388-76 WAC, Adult family homes;
&sqbul;	Chapter 388-78A WAC, Boarding homes; and
&sqbul;	Chapter 388-110 WAC, Contracted residential services.

The chapter also contains new rules implementing changes mandated by the following RCWs:

&sqbul;	Chapter 18.20 RCW, Boarding homes, and
&sqbul;	Chapter 70.128 RCW, Adult family homes.

The purpose of this chapter is to:

&sqbul;	Define minimum training requirements;
&sqbul;	Define the types of training;
&sqbul;	Clarify curriculum requirements and instructor requirements; and
&sqbul;	Establish department procedures for approval of curricula and instructors.

The statutory authority for these chapters includes RCW 18.20.270 Boarding homes and 70.128.230 Adult family homes.

The major proposed changes are:

&sqbul;	Incorporating a new requirement for orientation training for new staff in both settings, as required in chapters 18.20 and 70.128 RCW.
&sqbul;	Incorporating new training requirements for licensed boarding homes that do not contract with DSHS, including orientation, basic training, special needs (specialty) training, and continuing education, as required in RCW 18.20.270.
&sqbul;	Creating an approval system for alternative curricula for basic and specialty training, as required by RCW 18.20.270 Boarding homes and 70.128.230 Adult family homes.
&sqbul;	Creating an approval system for trainers as required by the RCWs.

Background of the proposed rule: In 1995, as part of long-term care reform, the legislature allocated funds for training during the following year. Providers and caregivers who were trained included:

&sqbul;	Caregivers in boarding homes that contract with DSHS; and
&sqbul;	All licensed adult family home providers and caregivers.

In 1997, two task forces were created under the auspices of the legislature, to review caregiver training:

&sqbul;	The Joint Executive-Legislative Long Term Care Task Force's subcommittee on training. This task force reported to the legislature in December 1998 and January 2000.
&sqbul;	The training task force, which DSHS, the Department of Health, and the Nursing Care Quality Assurance Commission created, under legislative directives, to review caregiver training. This task force reported to the legislature in December 1998.

Recommendations from both task forces were key in establishing new training requirements created by legislation in the 2000 session. This same legislation created the Community Long Term Care Education and Training Steering Committee to advise the department on the development of rules to implement the new law. (See RCW 74.39A.190.)

Goals for the proposed rules:

&sqbul;	Increase the number of caregivers who will be trained;
&sqbul;	Ensure that all caregivers have an orientation when they begin to work with residents; and
&sqbul;	Allow more boarding homes and adult family homes to teach their own staff and use their own curricula.

Training improves caregiving skills and the quality of care delivered to more than 7,000 adults receiving care through these programs.

SMALL BUSINESS ECONOMIC IMPACT STATEMENT: Chapter 19.85 RCW, the Regulatory Fairness Act, requires that the economic impact of proposed regulations be analyzed in relation to small businesses. This statute outlines information that must be included in a small business economic impact statement (SBEIS). Preparation of an SBEIS is required when a proposed rule has the potential of placing a disproportionate economic impact on small businesses.

Aging and Adult Services Administration has analyzed the proposed amendments to their rules and has determined that small businesses will be impacted by these changes, with some costs considered "more than minor."

INDUSTRY ANALYSIS: Aging and Adult Services Administration is responsible for boarding home and adult family home licensing. As part of licensing, this state agency keeps current internal databases that identify all licensed facilities and agencies. Since internal industry information can be obtained at a more accurate level than is required by chapter 19.85 RCW, it is unnecessary to conduct an industry analysis using the four-digit standard industrial classification (SIC) codes.

INVOLVEMENT OF SMALL BUSINESSES: The data used in this analysis was gathered from several sources:

&sqbul;	The statewide organizations that represent the 2084 adult family homes, and 513 boarding homes affected by these proposed rules.
&sqbul;	The residential care services and management services divisions of the Aging and Adult Services Administration.

The organizations that contributed current data on wages, benefits, and cost estimates for the businesses they represent, most of which are small businesses, include: Washington State Residential Care Council (AFH), the Adult Family Home Association (AFH), Washington Health Care Association (BH), Washington Association of Housing and Services for the Aging (BH), and Northwest Assisted Living Facilities Association (BH).

This proposed chapter has been developed with the advice of the training steering committee, which has been meeting monthly for fifteen months to consider and recommend the rules to implement these laws. Represented in this committee are small business members from the statewide provider organizations mentioned above.

In addition, four public forums were held during the summer in (Bellevue, Lacey, Spokane, and Yakima) to discuss the rule development and take public comment on the proposed rules as recommended by the steering committee. Approximately 2,000 interested parties were invited; seventy-seven people attended and commented. Small businesses were represented at these forums, as well.

AASA staff have also regularly attended meetings with adult family home and boarding home providers for the past year to update them on the rule development and take their comments and suggestions. To reach those who could not attend meetings, the proposed rules as recommended by the steering committee have been posted on the AASA Internet web site, with contact person information for anyone wishing to comment or make suggestions on the rule. All the input from these various groups and meetings has helped shape the development of this rule.

COST OF COMPLIANCE: Costs related to record keeping: Each business must keep on file copies of certificates showing successful completion of required trainings for each of their employees. The only new record-keeping requirement for boarding homes that contract with DSHS and adult family homes is orientation. The new requirements for boarding homes that do not contract with DSHS include orientation, basic training, and continuing education. Boarding homes that contract with DSHS already meet these requirements under contracting rules, so they will incur no additional costs. Training costs are included in the DSHS rates paid to both boarding homes and adult family homes. Keeping these certificates on file will result in a minor cost to the business.

Costs related to professional services: In estimating costs, AASA has chosen to assume that staff are trained on-site for orientation, and sent off-site for other trainings, with the intent that these are probably the highest cost scenarios. However, if a boarding home or adult family home chooses to contract with a trainer to come in and provide training in their own facility, this will result in costs for the professional services of a trainer. This training strategy, however, eliminates the costs of paying tuition and paying for travel time to and from training, for each trainee.

Estimated training costs: Expected costs include:

&sqbul;	The trainer's wages and benefits (if an on-staff trainer is used, as for orientation);
&sqbul;	The trainee's wages and benefits; and
&sqbul;	Costs for training materials (if training is on site) or for tuition, if off-site.

See Tables 1 and 2 below for estimated costs for each type of provider.

To fairly consider costs of compliance, AASA has elected to look at costs per trainee. This is because there is no reliable data on the number of employees that will be required to have this training, or the rate of turnover, both of which affect total training costs.

In each setting, the most costly wage scenarios were used for cost estimates. These include:

&sqbul;	For orientation, using a registered nurse as the orientation trainer, and assuming a one-on-one training, rather than in a group;
&sqbul;	For basic training, assuming the facility will pay tuition rather than providing training at the facility.
&sqbul;	For continuing education, assuming the facility will pay tuition rather than providing training at the facility.

Circumstances that may be used to mitigate these costs are noted in the section on mitigating expenses, which follows the cost estimates.

Specialty training has not been included in this analysis, because the boarding home rules specifying who has to take this training are not yet developed. The Residential Care Services Division of AASA is in the process of developing these rules with the input of stakeholder workgroups.

Costs of Compliance for Boarding Homes:

&sqbul;	Orientation is a new requirement for all boarding homes. It is always provided at the facility, by facility staff.
&sqbul;	Basic training is a new requirement for boarding homes that do not contract with DSHS. It may be provided by the facility or staff may be sent to another educator for training.
&sqbul;	Continuing education is a new requirement for boarding homes that do not contract with DSHS. It includes ten hours of training on caregiving issues, per calendar year. The requirement begins the second year after the basic training is completed. It may be provided by the facility, or staff may be sent to another educator for training.

Training	Personnel & other costs	Wages	Benefits & Taxes	Total per hour	Hours	Tuition (if applies)	Total Cost
Orientation	Trainer (RN)	$24.24	$6.14	$30.38	2	N/A	$60.76
	Trainee	$9.15	$2.32	$11.475 43.86	2	N/A	$22.94
	Materials						$10.00
	Total per trainee						$93.70
Basic	Trainee	$9.15	$2.32	$11.47	28	$129.00	$450.16
	Total per trainee, first year						$543.86
Continuing Education
	Trainee	$9.15	$2.32	$11.47	10	$50.00	$164.70
	CE total per trainee per year						$164.70

Costs of Compliance for Adult Family Homes: Orientation is a new requirement for all adult family homes. It is always provided at the facility, by facility staff.

All for-profit adult family homes are by nature small businesses; an adult family home can serve a maximum of six residents at a time, and so has a small number of employees. No data is available on the actual numbers of employees in boarding homes, but many or most boarding homes are small businesses with fewer than fifty employees. While the per-trainee costs do not differ between small and large businesses, the costs may be a higher proportion of overall costs for a small business. AASA elected to focus on mitigating expenses regardless of results of comparing large and small businesses; therefore AASA considered this type of comparative analysis unnecessary. Therefore, AASA proposes several measures that will mitigate the impact of costs for small businesses.

Mitigating Expenses: Aging and Adult Services Administration has included the following to help mitigate training costs for small businesses:

&sqbul;	Orientation training costs can be significantly reduced if the person doing the orientation is not an RN (high wage rate), for instance, if an LPN does the orientation, the median hourly wage is estimated to be $15.72, and a social worker's median hourly wage is $18.74 (compared to an RN at $24.24). for instance, an RN's median hourly wage is estimated to be $24.24. If an LPN does the orientation, the hourly wage drops to $15.72; if a social worker does the orientation, the hourly wage is $18.74. Both are qualified to do this training. The organization has a choice of who to use in conducting the orientation training.
&sqbul;	Orientation training costs are further reduced if the facility orients more than one person at a time. This can be done any time the facility hires several new caregivers and has them start working at the same time.
&sqbul;	Individuals who have already been oriented at another facility can have a much briefer orientation at a new facility, which is a savings for the second business. The orientation can be shorter because basic information on the required topics will be consistent across facilities. The facility will be able to spend less time on basic information, and focus primarily on information specific to the facility.
&sqbul;	Basic training costs may be mitigated if the training is done on-site. The rules allow for facilities to train their own staff if the instructor(s) meet minimum qualifications. This means the facility does not have to pay tuition for each student, nor pay for travel time and expenses to the training.
&sqbul;	Individuals who take basic, specialty training, or continuing education will not be required to take it again if hired at another business where training is required, which is a savings for the second business.
&sqbul;	Boarding homes with a new requirement for basic training for caregivers will have up to one hundred twenty days following the effective date of the rule to meet the requirement.
&sqbul;	The continuing education requirement does not start until January of the second year after an employee takes the basic training.
&sqbul;	Continuing education costs may be mitigated by holding this training at the facility rather than sending staff to an educator, paying for each student's tuition and travel. No pre-approval of trainer or instructor is required.

Additional cost savings:

&sqbul;	The orientation reduces the time it takes new employees to begin to provide quality care to residents, which translates into higher satisfaction for the clients, and better word-of-mouth publicity for the agency, which may increase income.
&sqbul;	Well-trained employees generally have higher job satisfaction and this leads to a lower turnover rate, significantly reducing overall costs. Turnover rates have been estimated as 50% or higher per year, for caregivers. Village Green, a Washington state boarding home, determined that monthly turnover for caregivers dropped from 21% to under 5% after implementing a thorough orientation program.

CONCLUSION: Aging and Adult Services Administration has given careful consideration to the impact of proposed rules in chapter 388-112 WAC, Home and community long-term care services -- Training, on small businesses. In accordance with the Regulatory Fairness Act, chapter 19.85 RCW, Aging and Adult Services Administration has analyzed impacts on small businesses and proposed ways to mitigate those costs associated with implementing the training requirements in these rules. Training staff adequately to care for adult residents is a benefit to both the resident and the provider.

A copy of the statement may be obtained by writing to Tresa Harambasic, Aging and Adult Services Administration, P.O. Box 45600, Olympia, WA 98504-5600, phone (360) 725-2548, fax (360) 725-2646.

RCW 34.05.328 applies to this rule adoption. A cost-benefit analysis has been prepared concerning these proposed rules, and may be obtained by contacting Tresa Harambasic, Aging and Adult Services Administration, P.O. Box 45600, Olympia, WA 98504-5600, phone (360) 725-2548, fax (360) 725-2646.

Hearing Location: Office Building-2 Auditorium, DSHS Headquarters, 1115 Washington, 14th and Jefferson, Olympia, WA 98504, on January 8, 2002, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by January 4, 2002, phone (360) 664-6094, TTY (360) 664-6178, e-mail fernaax@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by 5:00 p.m., January 8, 2002.

Date of Intended Adoption: Not earlier than January 9, 2002.

November 14, 2001

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

(1) All adult family homes licensed under chapter 70.128 RCW; and

(2) All boarding homes licensed under chapter 18.20 RCW.

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"Competency" means the minimum level of information and skill trainees are required to know and be able to demonstrate.

"Designee" means a person in a boarding home who supervises caregivers and who is designated by a boarding home administrator to take the trainings in this chapter required of the boarding home administrator.

"Direct supervision" (of facility caregivers) means oversight by a person who has demonstrated competency in the basic training (and specialty training if required), or who has been exempted from the basic training requirements, is on the premises, and is quickly and easily available to the caregiver.

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

"Facility" refers to adult family homes and boarding homes.

"Indirect supervision" (of facility caregivers) means oversight by a person who has demonstrated competency in the basic training (and specialty training if required), or who has been exempted from the basic training requirements, and who is quickly and easily available to the caregiver, but not necessarily on-site.

"Learning outcomes" means the specific information, skills and behaviors desired of the learner as a result of a specific unit of instruction, such as what they would learn by the end of single class or an entire course. Learning outcomes are generally identified with a specific lesson plan or curriculum.

"Outcome based training" means training that bases the curriculum design, content, instructional methods, and assessment on the specific knowledge, skills, and behaviors needed to demonstrate competency.

"Resident" means a person residing and receiving long-term care services at a boarding home or adult family home. As applicable, the term resident also means the resident's legal guardian or other surrogate decision maker.

"Routine interaction" means contact with residents that happens more than infrequently.

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(1) The care setting;

(2) The characteristics and special needs of the population served;

(3) Fire and life safety, including:

(a) Emergency communication (including phone system if one exists);

(b) Evacuation planning (including fire alarms and fire extinguishers where they exist);

(c) Ways to handle resident injuries and falls or other accidents;

(d) Potential risks to residents or staff (for instance, aggressive resident behaviors and how to handle them); and

(e) The location of facility policies and procedures.

(4) Communication skills and information, including:

(a) Methods for supporting effective communication among the resident, staff, and family members;

(b) Use of verbal and non-verbal communication;

(c) Review of written communications and/or documentation required for the job, including the resident's service plan;

(d) Expectations about communication with other facility staff; and

(e) Whom to contact about problems and concerns.

(5) Universal precautions and infection control, including:

(a) Proper hand washing techniques;

(b) Protection from exposure to blood and other body fluids;

(c) Appropriate disposal of contaminated/hazardous articles;

(d) Reporting exposure to contaminated articles, blood, or other body fluids; and

(e) What staff should do if they are ill.

(6) Resident rights, including:

(a) The resident's right to confidentiality of information about the resident;

(b) The resident's right to participate in making decisions about the resident's care, and to refuse care;

(c) Staff's duty to refrain from interfering with the resident's exercise of his or her rights;

(d) How and to whom staff should report any concerns they may have about a resident's decision concerning the resident's care;

(e) Staff's duty to report any suspected abuse, abandonment, neglect, or exploitation of a resident;

(f) Advocates that are available to help residents (LTC ombudsmen, organizations); and

(g) Complaint lines, hot lines, and resident grievance procedures.

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(1) A list of the specific information and skills taught;

(2) Signatures of the trainer and trainee indicating completion of the required information and skills;

(3) The trainee's date of employment or other service;

(4) The location of the training; and

(5) The date(s) of training.

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(1) Adult family home providers, resident managers, and all paid or volunteer staff must complete orientation before having routine interaction with residents. Orientation must be provided at the adult family home by appropriate facility staff.

Boarding Home

(2) Boarding home administrators (or their designees), caregivers, and all paid or volunteer staff must complete orientation before having routine interaction with residents. Orientation must be provided at the boarding home by appropriate facility staff.

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(1) Understanding and using effective interpersonal and problem solving skills with residents, family members, and other care team members;

(2) Taking appropriate action to promote and protect resident rights, dignity, and independence;

(3) Taking appropriate action to promote and protect the health and safety of the resident and the caregiver;

(4) Correctly performing required personal care tasks while incorporating resident preferences, maintaining the resident's privacy and dignity, and creating opportunities that encourage resident independence;

(5) Adhering to basic job standards and expectations.

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(1) The name of the trainee,

(2) The name of the training,

(3) The location of the training,

(4) The instructor's name and signature, and

(5) The date(s) of training.

The trainee must retain the original certificate. A facility must keep a copy of the certificate on file.

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(1) Adult family home providers must complete basic training and demonstrate competency before operating and providing services in an adult family home.

(2) Adult family home resident managers must complete basic training and demonstrate competency before providing services in an adult family home.

(3) Caregivers in adult family homes must complete basic training within one hundred twenty days of when they begin providing hands-on personal care or within one hundred twenty days of March 1, 2002, whichever is later. Until competency in the basic training has been demonstrated, caregivers may not provide hands-on personal care without direct or indirect supervision.

Boarding Homes

(4) Boarding home administrators (or their designees) must complete basic training and demonstrate competency within one hundred twenty days of employment or within one hundred twenty days of March 1, 2002, whichever is later.

(5) Caregivers must complete basic training within one hundred twenty days of when they begin providing hands-on personal care or within one hundred twenty days of March 1, 2002, whichever is later. Until competency in the basic training has been demonstrated, caregivers may not provide hands-on personal care without direct supervision.

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(1) Resident rights, including mandatory reporting requirements;

(2) Medication assistance regulations;

(3) Nurse delegation regulations;

(4) Assessment and observations in home and community settings;

(5) Documentation in home and community settings;

(6) Service planning in home and community care settings;

(7) Resource information, including information on continuing education; and

(8) Self-directed care regulations for home care.

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(1) The name of the trainee,

(2) The name of the training,

(3) The location of the training,

(4) The instructor's name and signature, and

(5) The date(s) of training.

The trainee must retain the original certificate. A facility must keep a copy of their employees' certificates on file.

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(1) Introduction to developmental disabilities;

(2) Principles and values for providing services, including residential guidelines;

(3) Interactive planning;

(4) Understanding behavior;

(5) Effective communication;

(6) Crisis intervention and prevention; and

(7) Resident rights and other legal issues.

(8) For adult family homes, the division of developmental disabilities (DDD) will provide in-home technical assistance to the adult family home upon admission of the first resident eligible for services from DDD and, thereafter, as determined necessary by DSHS.

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Reviser's note: The above new section was filed by the agency as WAC 288-112-0115. This section is placed among sections forming new chapter 388-112 WAC, and therefore should be numbered WAC 388-112-0115. Pursuant to the requirements of RCW 34.08.040, the section is published in the same form as filed by the agency.
NEW SECTION
WAC 388-112-0120   What knowledge and skills must dementia specialty training include?   Dementia Specialty Training must include the following minimum knowledge and skills:

(1) Overview of the definitions, types, stages, and culturally based variations of the dementias;

(2) Ways to identify and provide specific caregiving for each type and stage of dementia;

(3) Explanation of ways dementing diseases affect residents' needs and behaviors (including sexuality), and ways to facilitate residents' rights, uphold their dignity, meet current needs, and provide safety;

(4) Ways to differentiate, by observation of the residents, between dementia, depression, and delirium, and how to get medical assistance when needed;

(5) The causes of unwanted behaviors (such as aggression, catastrophic reactions, wandering, inappropriate sexual behavior) and ways to identify and respond using the new principles taught and practiced in the training (i.e., changing caregiver's behavior to change unwanted resident behaviors, programming to fit residents' individual needs, supporting residents' strengths, providing meaningful relationships and a caring, positive, validating environment);

(6) Dementia problem solving method, and ways to implement it correctly;

(7) Ways to respectfully use appropriate communications with people with dementia (including multi-cultural applications);

(8) Recognition of dementia-caused hallucinations and delusions and ways to correctly use intervention strategies that include culturally accurate symptom identification and responses;

(9) Ways to perceive and transform the resident's stage-related activities of daily living caregiving needs into therapeutic daily programming activities;

(10) Introduction to frequently used psychotropic medical terms and "dementia" medications, dementia contraindications, and when and how to get medical help;

(11) Ways to facilitate a resident's right to no chemical restraints, to informed consent, and to refuse medications;

(12) Understanding what community resources are available, how to interact with residents' families, and when and how to get help; and

(13) Practical self-care for caregivers.

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(1) Overview of mental illnesses, including definitions, symptom identification, decompensation, relapse, hallucinations, and delusions with special focus on thought and mood disorders and mental illness issues for older adults, and the appropriate caregiving responses;

(2) Community resources and how to effectively get the appropriate help from others;

(3) The importance of cultural identity for mental health residents and clients, and causes and meanings of mental illness from several different cultures' perspectives, and the ability to be culturally inclusive;

(4) The origin of behaviors perceived as problems and appropriate caregiving responses;

(5) Recognition of aggressive and suicidal behaviors, ways to de-escalate aggression, and provide beginning suicide crisis intervention (who to contact and how to provide safety to resident, caregiver, and other staff);

(6) Introduction to psychotropic medical terms and medications, recognition of side effects and other medication problems, and what to do if these occur, including who to contact;

(7) Respectful, nonjudgmental communications, how to appropriately initiate and conduct conversations for specific mental health conditions, and monitor and change caregiver's affect for resident's well-being;

(8) Ways to facilitate residents' rights including the right to no chemical restraints, informed consent, and to refuse medications; and

(9) Practical self-care for caregivers.

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(1) The trainee's name,

(2) The name of the training,

(3) The location of the training,

(4) The instructor's name and signature, and

(5) The date(s) of training.

(6) The trainee must retain the original certificate. The facility must keep a copy of their employees' certificates on file.

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(1) Adult family home providers (including entity representatives as defined under chapter 388-76 WAC) and resident managers must complete specialty training and demonstrate competency before admitting and serving residents who have special needs related to mental illness, dementia, or a developmental disability.

(2) If a resident develops special needs while living in a home without a specialty designation, the provider and resident manager have one hundred twenty days to complete specialty training and demonstrate competency.

Boarding Homes

(4) If a boarding home serves one or more residents with special needs, the boarding home administrator (or designee) must complete specialty training and demonstrate competency within one hundred twenty days of March 1, 2002. A boarding home administrator (or designee) hired after March 1, 2002, in a facility serving one or more residents with special needs, must complete specialty training before beginning work.

(5) If a resident develops special needs while living in a boarding home, the boarding home administrator (or designee) has one hundred twenty days to complete specialty training and demonstrate competency.

(6) If a boarding home serves one or more residents with special needs, caregivers must complete specialty training and demonstrate competency.

(a) If specialty training is integrated with basic training, caregivers must complete specialty training within one hundred twenty days of when they begin providing hands-on personal care to a resident having special needs or within one hundred twenty days of March 1, 2002, whichever is later.

(b) If specialty training is not integrated with basic training, caregivers must complete specialty training within ninety days of completing basic training.

(c) Until competency in the core specialty areas has been demonstrated, caregivers may not provide hands-on personal care to a resident with special needs without direct supervision.

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Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.SECTION VI -- NURSE DELEGATION CORE TRAINING
NEW SECTION
WAC 388-112-0150   What is nurse delegation core training?   Nurse delegation core training is required before a nursing assistant may be delegated a nursing task. DSHS approves instructors for nurse delegation core training.

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(1) The name of the trainee,

(2) The name of the training,

(3) The location of the training,

(4) The instructor's name and signature, and

(5) The date(s) of training.

The trainee must retain the original certificate. Facilities must keep copies of employees' certificates on file.

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(1) Before performing any delegated nursing task, adult family home staff must successfully complete DSHS-designated nurse delegation core training.

Boarding Homes

(2) Before performing any delegated nursing task, boarding home staff must successfully complete DSHS-designated nurse delegation core training.

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(a) The applicant has operated an adult family home for at least one year in this state without any significant violation of the rules of this chapter; or

(b) The applicant has submitted evidence demonstrating that it has the capability to operate multiple adult family homes.

(2) An applicant that is applying to be licensed for more than one adult family home shall submit to the department for each adult family home:

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

(b) A plan for covering administrative responsibilities.

(3) Multiple facility providers shall have on-site at each adult family home a plan that addresses visitor parking, deliveries, and staff parking.

(4) The department may consider the applicant's credit history in determining whether to license the applicant for more than two adult family homes, when the department determines the credit history relates to an applicant's ability to provide care and services to vulnerable adults.

(5) Prior to operating two or more adult family homes, the individual provider or entity representative shall successfully complete forty-eight hours of residential care administrator's training, ((including training in at least the following areas:

(a) Business planning and marketing;

(b) Fiscal planning and management;

(c) Human resource planning;

(d) Resident health services;

(e) Nutrition and food service;

(f) Working with people who are elderly, chronically mentally ill, or developmentally disabled;

(g) The licensing process;

(h) Social and recreational activities;

(i) Resident rights;

(j) Legal issues;

(k) Physical maintenance and fire safety; and

(l) Housekeeping)) as specified in WAC 388-112-0245 through 388-112-0260.

[Statutory Authority: RCW 70.128.040, chapters 70.128 and 70.129 RCW. 98-11-095, 388-76-570, filed 5/20/98, effective 7/1/98. Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-570, filed 6/19/96, effective 7/20/96.]

(2) The provider shall ensure all of the following:

(a) That staff are competent((,)) and receive necessary training, including but not limited to any training required under chapter 388-112 WAC to perform assigned tasks;

(b) The adult family home is in compliance with the requirements of this chapter and other applicable state laws;

(c) The home employs sufficient staff to meet the needs of the residents; and

(d) That he/she is available to respond to resident needs and caregiver inquiries within a reasonable time frame. In the event a provider is unavailable (including but not limited to being on vacation), a person must be designated to respond on behalf of the provider.

(3) The provider shall maintain liability insurance of at least one hundred thousand dollars per occurrence to cover:

(a) Damage or loss of the resident's property if due to negligence of the insured; and

(b) Injury or harm to the resident resulting from:

(i) The provision of services or failure to provide needed services; or

(ii) Incidents occurring in the adult family home or on the home's premises.

(4) The provider shall ensure that all caregivers are at least eighteen years of age or older.

(5) The provider shall ensure that the provider, entity representative, resident manager and all caregivers:

(a) Are able to communicate or make provisions for communicating with the resident in his or her primary language;

(b) Have a clear understanding of job responsibilities and knowledge of residents' negotiated care plans in order to be able to provide care specific to each resident's needs; and

(c) Not engage in the illegal use of drugs or the excessive use of alcohol when providing care to residents; and

(d) Possess ((a)) valid first aid and CPR ((card prior to providing care for residents unless such care is directly supervised by a fully qualified caregiver who has a valid first aid and CPR card)) cards as required under WAC 388-112-0240.

(6) The provider shall ensure that:

(a) There is at least one caregiver present in the home whenever one or more residents are on the premises;

(b) The caregiver referred to in (a) of this subsection has valid first aid and CPR cards and is capable of understanding and speaking English well enough to be able to respond appropriately to emergency situations; and

(c) At least one caregiver is accessible by phone or beeper for emergencies when there are no residents on the ((homes')) home's premises.

(7) An adult family home shall be exempt from subsection (6)(a) of this section if:

(a) The home provides care to residents whose primary disabilities are developmental disabilities as defined by WAC 388-76-590; and

(b) It is determined and documented in a resident's current negotiated care plan that the resident is capable and willing to be left alone unsupervised in the adult family home during normal awake hours. The maximum period of time a resident can be left alone must be documented in the negotiated care plan.

[Statutory Authority: RCW 70.128.040, chapters 70.128 and 70.129 RCW. 98-11-095, 388-76-655, filed 5/20/98, effective 7/1/98. Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-655, filed 6/19/96, effective 7/20/96.]

(7) The provider shall document that caregivers have met the education and training requirements)), and caregivers must meet the training requirements under chapter 388-112 WAC.

[Statutory Authority: RCW 70.128.040, chapters 70.128 and 70.129 RCW. 98-11-095, 388-76-660, filed 5/20/98, effective 7/1/98. Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-660, filed 6/19/96, effective 7/20/96.]

     The following sections of the Washington Administrative Code are repealed:

WAC 388-76-59100	Does completion of this training substitute for any other required trainings?
WAC 388-76-59110	For the dementia and mental health specialties can providers take a test instead of attending the training?
WAC 388-76-59120	Are there any different training requirements for adult family homes providing services to persons with developmental disabilities?
WAC 388-110-110	Caregiver education and training requirements.

Washington State Code Reviser's Office