Original Notice.

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

Title of Rule: New WAC 388-112-0180 through 388-112-0375, Residential long-term care services -- Training; and amending WAC 388-78A-050 and 388-78A-060, boarding homes.

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 licensed boarding home administrators and caregivers to have continuing education, moves all training requirements for these two settings into one training WAC, and implement processes for approval of alternative curricula and instructors.

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. The rules also set the processes for approval of instructors and alternative curricula for certain trainings. New requirements in the RCW include requirements for licensed boarding homes for administrators, or their designees, and caregivers to have continuing education.

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

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(1) Resident rights;

(2) Personal care (such as transfers or skin care);

(3) Mental illness;

(4) Dementia;

(5) Developmental disabilities;

(6) Depression;

(7) Medication assistance;

(8) Communication skills;

(9) Positive resident behavior support;

(10) Developing or improving resident centered activities;

(11) Dealing with wandering or aggressive resident behaviors; and

(12) Medical conditions.

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(1) If one or more specialty trainings are completed in the same year as basic or modified basic training, the specialty training applies toward the continuing education requirement for the two calendar years following the year of completion of the basic and specialty trainings.

(2) If one or more specialty trainings are completed in a different year than the year when basic or modified basic training was taken, the specialty training may be applied toward the continuing education requirement for the calendar year in which the specialty training is taken and the following calendar year.

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(1) The trainee's name;

(2) The title or content of the training;

(3) The instructor's name or the name of the video, on-line class, professional journal, or equivalent instruction materials completed;

(4) The number of hours of training; and

(5) The date(s) of training.

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(1) Adult family home providers (including entity representatives as defined under chapter 388-76 WAC), resident managers, and caregivers must complete ten hours of continuing education each calendar year.

(2) Continuing education must be on a topic relevant to the care setting and care needs of residents in adult family homes.

Boarding Homes

(3) Boarding home administrators (or their designees) and caregivers must complete ten hours of continuing education each calendar year.

(4) Continuing education must be on a topic relevant to the care setting and care needs of residents in boarding homes.

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(1) Adult family home providers, resident managers, and caregivers must take CPR and first aid within thirty days of employment and maintain valid cards or certificates.

Boarding Homes

(2) Boarding home administrators and caregivers must take CPR and first aid within thirty days of employment and must maintain valid cards or certificates.

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(1) Business planning and marketing;

(2) Fiscal planning and management;

(3) Human resource planning;

(4) Resident health services;

(5) Nutrition and food service;

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

(7) The licensing process;

(8) Social and recreational activities;

(9) Resident rights;

(10) Legal issues;

(11) Physical maintenance and fire safety; and

(12) Housekeeping.

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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. A copy of the certificate must be in the adult family homes' files.

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(1) Skills demonstration of ability to perform and/or implement specific caregiving approaches, and/or activities as appropriate for the training;

(2) Written evaluation to show level of comprehension and knowledge of the learning outcomes for the training; and

(3) A scoring guide for the tester with clearly stated criteria and minimum proficiency standards.

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(1) An instructor for the course who meets all minimum instructor qualifications for the course he or she teaches must oversee all testing; and

(2) The tester must follow DSHS guidelines for:

(a) The maximum length of time allowed for testing;

(b) The amount and nature of instruction given to students before beginning a test;

(c) The amount of assistance to students allowed during testing;

(d) The accommodation guidelines for students with disabilities; and

(e) Accessibility guidelines for students with limited English proficiency.

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(1) All the learning outcomes and competencies in the DSHS-developed curriculum for the course;

(2) Printed student materials that support the curriculum, a teacher's guide or manual, and learning resource materials such as learning activities, audio-visual materials, handouts, and books;

(3) The expected learning outcomes for the curriculum;

(4) The recommended sequence and delivery of the material;

(5) The teaching methods or approaches that will be used for different sections of the course, including for each lesson:

(a) The expected learning outcomes;

(b) Learning activities that incorporate adult learning principles and address the learning readiness of the student population;

(c) Practice of skills to increase competency;

(d) Feedback to the student on knowledge and skills;

(e) An emphasis on facilitation by the teacher; and

(f) An integration of knowledge and skills from previous lessons to build skills.

(6) For the teacher, a complete guide to the implementation of the curriculum;

(7) A list of the sources or references used to develop the curriculum;

(8) Methods of teaching and student evaluation for students with limited English proficiency and/or learning disabilities; and

(9) A plan for updating material. All changes to a previously approved curriculum must be approved before they are used.

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(1) A curriculum is submitted to DSHS for approval;

(2) DSHS may use DSHS-selected volunteer reviewers, if available, to assist in reviewing alternative curriculum and making recommendations to DSHS;

(3) DSHS must review and determine, using the criteria in WAC 388-112-0305, that the alternative curriculum is substantially similar to or better than the DSHS curriculum for it to be approved;

(4) DSHS sends a written response to the person or organization that submitted the curriculum, indicating approval or disapproval of the curriculum;

(5) If a curriculum does not include all the required components, the curriculum is disapproved, and returned with missing or incomplete parts noted;

(6) The curriculum with the additional components incorporated into the curriculum design may be re-submitted to DSHS for another review.

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(1) Verifies and documents that all instructors meet each of the minimum instructor qualifications for the course they plan to teach;

(2) Teaches using a complete DSHS-approved curriculum.

(a) A facility may request the use of a curriculum developed by DSHS;

(b) If a facility wishes to use an alternate curriculum that is not already approved, the facility must submit that curriculum and receive approval from DSHS before using it to teach.

(3) To assist DSHS in providing access to training, notifies DSHS in writing of the facility's intent to conduct staff training prior to providing training, and in the future, notify DSHS when changes occur. The notification must include:

(a) Facility name;

(b) Name of training(s) the facility will conduct;

(c) Name of curriculum(s) the facility will use; and

(d) If the facility will train only the facility's staff, or will also train staff from other facilities.

(4) Ensures that DSHS competency tests are administered as provided in WAC 388-112-0265 through 388-112-0295;

(5) Provides a certificate of completion of training to all staff that successfully complete the entire course. The certificate must include:

(a) The trainee's name,

(b) The name of the training,

(c) The location of the training,

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

(e) The date(s) of training.

(6) Keeps a copy of student certificates on file for six years, and gives the original certificate to the trainee.

(7) Keeps attendance records and testing records of students trained and tested on file for six years.

(8) Reports training data to DSHS in DSHS-identified time frames.

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(1) Coordinating and teaching classes,

(2) Assuring that the curriculum used is taught as designed,

(3) Selecting qualified guest speakers where applicable,

(4) Administering or overseeing the administration of DSHS competency and challenge tests,

(5) Maintaining training records including student tests and attendance records for a minimum of six years,

(6) Reporting training data to DSHS in DSHS-identified time frames, and

(7) Issuing or re-issuing training certificates to students.

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(2) DSHS may select contracted instructors through a purchased services contract procurement pursuant to chapter 236-48 WAC or through other applicable contracting procedures. Contractors must meet the minimum qualifications for instructors under this chapter and any additional qualifications established through a request for qualifications and quotations (RFQQ) or other applicable contracting procedure.

(3) Facilities conducting their own training programs using the training curricula developed by DSHS or alternative curricula approved by DSHS must ensure that their instructors meet the minimum qualifications for instructors under this chapter.

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(2) DSHS may terminate any training contract in accordance with the terms of the contract. The contractor's administrative remedies shall be limited to those specified in the contract.

(3) DSHS may prohibit a facility from providing its own basic, modified basic, or specialty training when:

(a) DSHS determines that the training fails to meet the standards under this chapter;

(b) The facility's instructor has been a licensee, boarding home administrator, or adult family home resident manager, as applicable, of any facility while it was under temporary management or subject to a revocation or summary suspension of the facility's license, a stop placement of admissions order, a condition on the license related to resident care, or a civil fine of five thousand dollars or more; or

(c) The facility has been operated under temporary management or has been subject to a revocation or suspension of the facility's license, a stop placement of admissions order, a condition on the license related to resident care, or a civil fine of five thousand dollars or more.

(d) Nothing in this section shall be construed to limit DSHS' authority under chapters 388-76 or 388-78A WAC to require the immediate enforcement, pending any appeal, of a condition on the facility's license prohibiting the facility from conducting its own training programs.

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(1) If the person currently holds a health care or social services license or certification in Washington state, it must be in good standing. However, no license or certification is required;

(2) The instructor must meet the requirements in (a) or (b) of this subsection. The instructor:

(a) Must have at least one hundred hours experience teaching adults within the last ten years in a classroom setting, with at least fifty of those hours teaching content comparable to topics included in basic training, and with documented practice in principles of adult education theory and practice including:

(i) Classroom facilitation skills and techniques;

(ii) Facilitating adult learning activities; and

(iii) Administering competency testing for both skills and written testing.

(b) Must, if the person does not meet the requirements in (a) of this subsection:

(i) Have at least thirty-two hours of classroom instruction in principles of adult education theory and practice that meets the requirements of WAC 388-112-0350; and

(ii) Observe an instructor meeting minimum instructor requirements under this section teaching the entire basic training class.

(3) Upon initial approval or hire, the instructor must have at least five hundred twenty hours (three months full time equivalent) professional work experience within the last five years in an adult family home, boarding home, supported living residential services contracted and certified through DDD per chapter 388-820 WAC, or home care setting;

(4) The instructor must be experienced in caregiving practices and capable of demonstrating competency with respect to the course content or units being taught;

(5) Instructors who will administer tests must have experience or training in assessment and competency testing; and

(6) Instructors must successfully complete basic or modified basic training prior to beginning teaching, if required under WAC 388-112-0075 or 388-112-0100.

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(1) Adult education theory and practice principles;

(2) Instructor facilitation techniques;

(3) Facilitating learning activities for adults;

(4) Administering competency testing; and

(5) Working with adults with special training needs (for example, English as a second language or learning and literacy issues).

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(1) The trainer must be experienced in mental health caregiving practices and capable of demonstrating competency in the entire course content;

(2) Education - Bachelor's degree and at least one year of education in psychology, mental health, education, or closely related subjects (one year of education equals twenty-four semester hours, forty-five quarter hours, or one hundred ninety-two hours of continuing education and other documented training such as seminars). Education must include:

(a) Adult mental health caregiving theories, current research, adult mental health caregiving skills development, best practices;

(b) Adult learning theory and teaching community-based adult vocational education;

(c) Written and skills performance testing procedures; and

(d) Successful completion of the mental health specialty training, prior to beginning to train, if required under WAC 388-112-0145.

(3) Work experience - Minimum of four thousand one hundred sixty hours (two years full-time equivalent) direct work experience with people who have a mental illness. This may include relevant caregiving experience; and

(4) Teaching experience - Minimum of four hundred hours experience in community-based adult education, with two hundred of the four hundred hours teaching specific course work in mental health or closely related subjects. Teaching experience must include:

(a) Using interactive learning activities to explain mental health concepts, disorders, and treatments;

(b) Teaching clinical concepts and skills to nonclinically trained people;

(c) Administering written and skills performance evaluations using standardized scoring tools and supervision of testing procedures to ensure the integrity, and confidentiality of all evaluation processes and materials (the evaluations and scoring guide/answers); and

(d) Interactive learning facilitation to actively engage student participation in brainstorming, role playing, large and small group process, brief talks, written exercises, skills demonstrations, and practice to develop problem solving, critical thinking, and caregiving skills.

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(1) The trainer must be experienced in dementia caregiving practices and capable of demonstrating competency in the entire course content;

(2) Education - Bachelor's degree and at least one year of education in psychology, dementia, education, or closely related subjects (one year of education equals twenty-four semester hours, forty-five quarter hours, or at least one hundred ninety-two hours of continuing education and other documented training such as seminars). Education must include:

(a) Dementia caregiving theories, current research, dementia caregiving skills development, best practices;

(b) Adult learning theory and teaching community-based adult vocational education;

(c) Written and skills performance testing procedures; and

(d) Successful completion of the dementia specialty training, prior to beginning to train, if required under WAC 388-112-0145.

(3) Work experience - Minimum of four thousand one hundred sixty hours (two years full-time equivalent) direct work experience with people who have dementia. This may include relevant caregiving experience; and

(4) Teaching experience - Minimum of four hundred hours experience in community-based adult education, with two hundred of the four hundred hours teaching specific course work in dementia or closely related subjects. Teaching experience must include:

(a) Using interactive learning activities to explain dementia-related diseases, concepts, types, stages, treatment, and culturally-based variants of the dementias;

(b) Teaching clinical concepts and skills to nonclinically trained people;

(c) Administering written and skills performance evaluations using standardized scoring tools and supervision of testing procedures to ensure the integrity and confidentiality of all evaluation processes and materials (the evaluations and scoring guide/answers); and

(d) Interactive learning facilitation to actively engage student participation in brainstorming, role playing, large and small group process, brief talks, written exercises, skills demonstrations, and practice to develop problem solving, critical thinking, and caregiving skills.

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(1) Education:

(a) Bachelor degree or at least four years of full-time work experience in the field of disabilities; and

(b) Successful completion of developmental disabilities specialty training;

(2) Experience - At least two years full-time direct work experience with persons who have a developmental disability; and

(3) Teaching experience - Either:

(a) Four hundred hours teaching experience; or

(b) Two hundred hours of teaching experience plus successful completion of the division of developmental disabilities' specialty train the trainer course.

(4) Instructors who will administer tests must have experience in assessment and competency testing.

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(2) Testing sites must provide adequate space for testing, comfort, lighting, and lack of disturbance appropriate for the written or skills test being conducted. Appropriate supplies and equipment necessary for the particular test must be provided.

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(1) Training must not exceed eight hours within a twenty-four hour period;

(2) Training provided in short time segments must include an entire unit, skill or concept;

(3) Training must include regular breaks; and

(4) Students attending a classroom training must not be expected to leave the class to attend to job duties, except in an emergency.

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(a) Develop and maintain written job descriptions for the administrator and each staff position;

(b) Verify work references;

(c) Verify required credentialling is current and in good standing for licensed and certified staff;

(d) Document and retain weekly staffing schedules, as planned and worked, for the last twelve months;

(e) Provide sufficient, trained staff in each boarding home to:

(i) Furnish the services and care needed by residents;

(ii) Maintain the boarding home free of safety hazards; and

(iii) Implement fire and disaster plans;

(f) Assure one or more resident-care staff eighteen years of age or older, with current cardiopulmonary resuscitation and first-aid cards, is present to assist residents at all times:

(i) On the boarding home premises when one or more residents are present;

(ii) Off the boarding home premises during boarding home activities; and

(iii) When staff transport a resident;

(g) Assure staff provide "on-premises" supervision when any resident is working for, or employed by, the boarding home; and

(h) Provide staff orientation and appropriate training for expected duties, including:

(i) Organization of boarding home;

(ii) Physical boarding home layout;

(iii) Specific duties and responsibilities; and

(iv) Policies, procedures, and equipment necessary to perform duties.

(2) The licensee shall ensure that the administrator and staff complete any training required under chapter 388-112 WAC.

(3) The licensee shall, in addition to following WISHA requirements, protect residents from tuberculosis by requiring each staff person to have, upon employment:

(a) A tuberculin skin test by the Mantoux method, unless the staff person:

(i) Documents a previous positive Mantoux skin test, which is ten or more millimeters of induration read at forty-eight to seventy-two hours;

(ii) Documents meeting the requirements of this subsection within the six months preceding the date of employment; or

(iii) Provides a written waiver from the department or authorized local health department stating the Mantoux skin test presents a hazard to the staff person's health;

(b) A second test one to three weeks after a negative Mantoux skin test for staff thirty-five years of age or older;

(c) A chest x-ray within seven days of any positive Mantoux skin test.

(((3))) (4) The licensee shall report positive chest x-rays to the appropriate public health authority, and follow precautions ordered by a physician or public health authority.

(((4))) (5) The licensee shall retain records of tuberculin test results, reports of x-ray findings, exceptions, physician or public health official orders, and waivers in the boarding home.

(((5) The licensee shall assure that all resident-care staff including those transporting residents and supervising resident activities, except licensed staff whose professional training exceeds first-responder training, have within thirty days of employment:

(a) Current cardiopulmonary resuscitation cards from instructors certified by:

(i) American Red Cross;

(ii) American Heart Association;

(iii) United States Bureau of Mines; or

(iv) Washington state department of labor and industries; and

(b) Current first-aid cards from instructors certified as in (a) of this subsection, except nurses do not need first-aid cards.))

(6) The licensee shall restrict a staff person's contact with residents when the staff person has a known communicable disease in the infectious stage which is likely to be spread in the boarding home setting or by casual contact.

(7) The licensee shall assure any staff person suspected or accused of abuse does not have access to any resident until the licensee investigates and takes action to assure resident safety to the satisfaction of the department.

(8) The licensee shall not interfere with the investigation of a complaint, coerce a resident, or conceal evidence of alleged improprieties occurring within the boarding home.

(9) The licensee shall prohibit an employee from being directly employed by a resident or a resident's family during the hours the employee is working for the boarding home.

(10) The licensee shall maintain the following documentation on the boarding home premises, during employment, and at least two years following termination of employment:

(a) Staff orientation and training pertinent to duties, including but not limited to cardiopulmonary resuscitation, first-aid, tuberculin skin testing and HIV/AIDS training;

(b) Criminal history disclosure and background checks as required in WAC 388-78A-045; and

(c) Verification of contacting work references and professional licensing and certification boards as required by subsection (1) of this section.

[Statutory Authority: RCW 18.20.240. 99-15-067, 388-78A-050, filed 7/19/99, effective 8/19/99; 98-20-021, recodified as 388-78A-050, filed 9/25/98, effective 9/25/98. Statutory Authority: RCW 18.20.090. 94-13-180, 246-316-050, filed 6/21/94, effective 7/22/94. Statutory Authority: RCW 43.43.830 through 43.43.842. 93-16-030 (Order 381), 246-316-050, filed 7/26/93, effective 8/26/93. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as 246-316-050, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.20.090. 89-09-034 (Order 2786), 248-16-046, filed 4/14/89.]

(1) Verify or arrange appropriate education and training of staff within thirty days of employment on the prevention, transmission, and treatment of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) consistent with RCW 70.24.310; and

(2) Use infection control standards and educational material consistent with:

(a) The approved curriculum manual KNOW - HIV/AIDS Prevention Education for Health Care Facility Employees, January 1991, or subsequent editions published by the department; and

(b) WAC 296-62-08001, Bloodborne pathogens implementing WISHA.

(3) Staff who successfully complete the basic training in WAC 388-112-0040 through 388-112-0070 are considered to have met the training requirement under this section.

[Statutory Authority: RCW 18.20.240. 98-20-021, recodified as 388-78A-060, filed 9/25/98, effective 9/25/98. Statutory Authority: RCW 18.20.090. 94-13-180, 246-316-060, filed 6/21/94, effective 7/22/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as 246-316-060, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 70.24.310. 89-21-038 (Order 3), 248-16-048, filed 10/12/89, effective 11/12/89.]

Washington State Code Reviser's Office