WSR 02-11-032

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)

[ Filed May 7, 2002, 4:19 p.m. ]

Supplemental Notice to WSR 01-23-073.

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

Title of Rule: New WAC 388-112-0001 through 388-112-0195, 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 388-110-110 Caregiver education and training requirements.

Purpose: Implementing SSB 6502 and SHB 2707 on training for adult family homes and boarding homes; and combining training requirements for these settings into one WAC. Significant revisions have been made based on public comment to the proposal published in WSR 01-23-073. This document compares proposed WAC 388-112-0001 through 388-112-0195 with the earlier version WAC 388-112-0001 through 388-112-0175, published in WSR 01-23-073.

Amendments: The proposed amendments to WAC 388-78A-060 are withdrawn.

Changes in WAC numbering, including added and deleted sections:
Earlier version of WAC 388-112- published as WSR 01-23-073 New version of WAC 388-112-
0001 same
0005 same
Added new 0010
0010 0015
0015 0020
0020 0025
0025 0030
0030 0035
0035 0040
0040 0045
0045 0050
0050 0055
0055 0060
0060 0065
0065 0070
0070 0075
0075 0080
0080 0085
0085 0090
0090 0095
0095 0100
0100 0105
0105 0110
0110 0115
0115 0120
0120 0125
-- Added new 0130
0125 0135
--- Added new 0140
0130 0145
0135 0150
0140 0155
0145 (1) - (5) 0160
0145(6) 0165
0150 0170
0155 0175
0160 0180
0165 0185
0170 0190
0175 0195

Statutory Authority for Adoption: RCW 18.20.090 Boarding homes, 70.128.040 Adult family homes, 34.05.020.

Statute Being Implemented: Chapter 121, Laws of 2000 and chapter 233, Laws of 2002.

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. The rule has been revised based on public comment on the rule as proposed in WSR 01-23-074.

Proposal Changes the Following Existing Rules: This proposal moves existing rules for residential care settings from two separate chapters into new chapter 388-112 WAC.

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

Small Business Economic Impact Statement

SUMMARY OF PROPOSED RULES: The Department of Social and Health Services' Aging and Adult Services Administration (AASA) is proposing to create new chapter 388-112 WAC, Home and community long-term care services -- Training. The new chapter contains the training rules for adult family homes, and boarding homes. The proposed rules have been changed in response to public comments.

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: Define minimum training requirements; define the types of training; clarify curriculum requirements and instructor requirements; and 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.) This steering committee has advised the department for two years on the development of these rules.

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 2,084 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 twenty-two 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. Public comment on the earlier proposed chapter 388-112 WAC included comments from small businesses, and was considered and incorporated into the proposed rules.

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, specialty training for some, 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, and should reduce the overall costs of training.

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 generally used for cost estimates. Facilities may well be able to reduce these costs by making different choices. The assumptions 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 specialty, which is required only if the boarding home has residents with special needs, assuming the administrator (or designee) will attend the specialty training and then train their own caregivers 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.

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; Specialty training is a new requirement for all boarding homes that serve residents with special needs in dementia, mental health, or developmental disabilities.
&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.
Tables 1 and 2 below show estimated training costs for each type of provider. Based on public comments, a number of assumptions were changed, including:

&sqbul; The number of hours of orientation was increased from two to three hours.
&sqbul; Specialty training costs were added.
&sqbul; One hour of travel time was added to basic and specialty training.
&sqbul; Continuing education tuition was increased from $5 to $8 per hour.


Table 1 Boarding Homes

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 3 N/A $91.14
Trainee $9.15 $2.32 $11.48 3 N/A $34.44
Materials $10.00
Total per trainee $135.58
Basic Trainee $9.15 $2.32 $11.47 28 $129.00 $450.16
Travel 1 $11.47
Total $461.63
Specialty

(Administrator)

Trainee $28.13 $7.16 $35.29 20 $200 $905.80
Travel 1 $35.29
Total $941.09
Specialty

(Caregiver)

Trainee $9.15 $2.32 $11.47 20 N/A $229.40
Continuing Education Trainee $9.15 $2.32 $11.47 10 $80.00 $194.70

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.


Table 2 Adult Family Homes


Training Personnel, other costs Wages Benefits & Taxes Total per hour Hours Tuition Total Cost
Orientation Trainer (RN) $24.24 $6.14 $30.38 3 $91.14
Trainee $9.15 $2.32 $11.47 3 $0.00 $34.44
Materials $10.00
Total $135.58

Disproportionate Economic Impact Analysis: When there are more than minor costs to small businesses as a result of proposed rule changes, the Regulatory Fairness Act requires an analysis to be done, comparing these costs between small businesses and 10% of the largest businesses.

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). The organization has a choice of who to use in conducting the orientation training. 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.
&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. The instructor minimum qualifications have been reduced in the proposed rules. 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; The revised rules allow the board home administrator or designee, or the adult family home provider or resident manager, to train their caregivers in specialty areas, resulting in tuition and travel savings for every caregiver.
&sqbul; Specialty instructor qualifications have been lowered based on public comment.
&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; Specialty training may be completed up to ninety days after basic training is completed, spreading the costs over a longer period of time.
&sqbul; Continuing education costs may be mitigated by holding this training at the facility rather than sending staff out to training, saving the costs of each person's tuition and travel. No pre-approval of curriculum 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 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.

Hearing Location: Office Building 2 Auditorium (DSHS Headquarters) (parking at 12th and Washington), 1115 Washington, Olympia, WA 98504, on June 25, 2002, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by June 21, 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, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., June 25, 2002.

Date of Intended Adoption: Not earlier than June 26, 2002.

May 2, 2002

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3010.10
Chapter 388-112 WAC

RESIDENTIAL LONG-TERM CARE SERVICES

TRAININGSECTION I -- PURPOSE AND DEFINITIONS
NEW SECTION
WAC 388-112-0001   What is the purpose of this chapter?   The residential long-term care training requirements under this chapter apply to:

(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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NEW SECTION
WAC 388-112-0005   What definitions apply to this chapter?   "Caregiver" means anyone providing hands-on personal care to another person including but not limited to cuing, reminding, or supervision of residents, on behalf of an adult family home or boarding home, except volunteers who are directly supervised.

"Challenge test" means a competency test taken without first taking the class for which the test is designed.

"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" 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.

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

"Indirect supervision" 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 a single class or an entire course. Learning outcomes are generally identified with a specific lesson plan or curriculum.

"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 regularly.

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NEW SECTION
WAC 388-112-0010   When do the training requirements go into effect?   The training requirements of this chapter begin September 1, 2002, or one hundred twenty days from the date of employment, whichever is later, and apply to:

(1) Adult family home providers, resident managers, and caregivers, and boarding home administrators, designees, and caregivers, who are hired or begin to provide hands-on personal care to residents subsequent to September 1, 2002; and

(2) Existing adult family home providers, resident managers, and caregivers, and boarding home administrators, designees, and caregivers, who on September 1, 2002, have not successfully completed the training requirements under RCW 74.39A.010, 74.39A.020, 70.128.120, or 70.128.130 and this chapter. Existing adult family home providers, resident managers, and caregivers, and boarding home administrators, designees, and caregivers, who have not successfully completed the training requirements under RCW 74.39A.010, 74.39A.020, 70.128.120, or 70.128.130 are subject to all applicable requirements of this chapter. However, until September 1, 2002, nothing in this chapter affects the current training requirements under RCW 74.39A.010, 74.39A.020, 70.128.120, or 70.128.130.

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SECTION II -- ORIENTATION
NEW SECTION
WAC 388-112-0015   What is orientation?   Orientation provides basic introductory information appropriate to the residential care setting and population served. The department does not approve specific orientation programs, materials, or trainers for homes. No test is required for orientation.

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NEW SECTION
WAC 388-112-0020   What content must be included in an orientation?   Orientation may include the use of videotapes, audiotapes, and other media if the person overseeing the orientation is available to answer questions or concerns for the person(s) receiving the orientation. Orientation must include introductory information in the following areas:

(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 home policies and procedures.

(4) Communication skills and information, including:

(a) Methods for supporting effective communication among the resident/guardian, 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 home 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 protect and promote the rights of each resident, and assist the resident to exercise 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.

[]


NEW SECTION
WAC 388-112-0025   Is competency testing required for orientation?   There is no competency testing required for orientation.

[]


NEW SECTION
WAC 388-112-0030   Is there a challenge test for orientation?   There is no challenge test for orientation.

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NEW SECTION
WAC 388-112-0035   What documentation is required for orientation?   The home must maintain documentation of completion of orientation, issued by the home, that includes:

(1) The trainee's name;

(2) A list of the specific information taught;

(3) Signature of the person overseeing orientation, indicating completion of the required information;

(4) The trainee's date of employment;

(5) The location of the orientation; and

(6) The date(s) of orientation.

[]


NEW SECTION
WAC 388-112-0040   Who is required to complete orientation, and when must it be completed?   Adult Family Home

(1) Adult family home providers (including entity representatives as defined under chapter 388-76 WAC), resident managers, and all paid or volunteer staff who begin work September 1, 2002 or later must complete orientation before having routine interaction with residents. Orientation must be provided by appropriate adult family home staff.

Boarding Home

(2) Boarding home administrators (or their designees), caregivers, and all paid or volunteer staff who begin work September 1, 2002 or later must complete orientation before having routine interaction with residents. Orientation must be provided by appropriate boarding home staff.

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SECTION III -- BASIC TRAINING
NEW SECTION
WAC 388-112-0045   What is basic training?   Basic training includes the core knowledge and skills that caregivers need in order to provide personal care services effectively and safely. DSHS must approve basic training curricula.

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NEW SECTION
WAC 388-112-0050   Is there an alternative to the basic training for some health care workers?   Certain health care workers may complete the modified basic training instead of basic training if they meet the requirements in WAC 388-112-0105.

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NEW SECTION
WAC 388-112-0055   What knowledge and skills must be taught in basic training?   (1) The basic training knowledge and skills must include all of the learning outcomes and competencies published by the department for the following core knowledge and skills:

(a) Understanding and using effective interpersonal and problem solving skills with the resident, family members, and other care team members;

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

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

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

(e) Adhering to basic job standards and expectations.

(2) The basic training learning outcomes and competencies may be obtained from the DSHS aging and adult services administration.

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NEW SECTION
WAC 388-112-0060   Is competency testing required for basic training?   Passing the DSHS competency test is required for successful completion of basic training as provided under WAC 388-112-0290 through 388-112-0315.

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NEW SECTION
WAC 388-112-0065   Is there a challenge test for basic training?   Individuals may take the DSHS challenge test instead of the required training. If a person does not pass a challenge test on the first attempt, they may not re-take the challenge test and must attend a class.

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NEW SECTION
WAC 388-112-0070   What documentation is required for successful completion of basic training?   (1) Basic training must be documented by a certificate of successful completion of training, issued by the instructor or training entity, that includes:

(a) The name of the trainee;

(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.

(2) The trainee must be given an original certificate. A home must keep a copy of the certificate on file.

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NEW SECTION
WAC 388-112-0075   Who is required to complete basic training, and when?   Adult Family Homes

(1) Adult family home providers (including entity representatives as defined under chapter 388-76 WAC) must complete basic training and demonstrate competency before operating 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 September 1, 2002, whichever is later. Until competency in the basic training has been demonstrated, caregivers may not provide hands-on personal care without 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 September 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 September 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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SECTION IV -- MODIFIED BASIC TRAINING
NEW SECTION
WAC 388-112-0080   What is modified basic training?   Modified basic training is a subset of the basic training curriculum designed for certain health care workers defined in WAC 388-112-0105, whose previous training includes many of the outcomes taught in the full basic training. DSHS must approve modified basic training curricula.

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NEW SECTION
WAC 388-112-0085   What knowledge and skills must be included in modified basic training?   (1) Modified basic training must include all of the learning outcomes and competencies published by DSHS for the following core knowledge and skills:

(a) Resident rights, including mandatory reporting requirements;

(b) Medication assistance regulations;

(c) Nurse delegation regulations;

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

(e) Documentation in home and community settings;

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

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

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

(2) The modified basic training learning outcomes and competencies may be obtained from the DSHS aging and adult services administration.

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NEW SECTION
WAC 388-112-0090   Is competency testing required for modified basic training?   Passing the DSHS competency test is required for successful completion of modified basic training as provided in WAC 388-112-0290 through 388-112-0315.

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NEW SECTION
WAC 388-112-0095   Is there a challenge test for modified basic training?   Individuals may take the department's challenge test instead of the required training. If a person does not pass a challenge test on the first attempt, they may not re-take the challenge test and must attend the class.

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NEW SECTION
WAC 388-112-0100   What documentation is required for successful completion of modified basic training?   (1) Modified basic training must be documented by a certificate of successful completion of training, issued by the instructor or training entity, that includes:

(a) The name of the trainee;

(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.

(2) The trainee must be given an original certificate. A home must keep a copy of the certificate on file.

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NEW SECTION
WAC 388-112-0105   Who may take modified basic training instead of the full basic training?   Modified basic training may be taken, instead of the full basic training, by a person who can document that they have successfully completed training as a registered or licensed practical nurse, certified nursing assistant, physical therapist, occupational therapist, or Medicare-certified home health aide.

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SECTION V -- SPECIALTY TRAINING
NEW SECTION
WAC 388-112-0110   What is specialty training?   Specialty or "special needs" training, including caregiver specialty training, provides instruction in caregiving skills that meet the special needs of people living with mental illness, dementia, or developmental disabilities. Specialty trainings are different for each population served and are not interchangeable. Specialty training may be integrated with basic training if the complete content of each training is included. DSHS must approve specialty training curricula, except for caregiver dementia and caregiver mental health training.

(1) Boarding home administrator (or designee), adult family home provider and resident manager specialty training:

(a) Developmental disabilities specialty training, under WAC 388-112-0120, is the required training on that specialty for adult family home providers and resident managers, and for boarding home administrators (or designees.)

(b) Dementia specialty training, under WAC 388-112-0135, and mental health specialty training, under WAC 388-112-0140, are the required trainings on those specialties for adult family home providers and resident managers, and for boarding home administrators (or designees).

(2) Boarding home caregiver specialty training:

After successfully completing the specialty training, the boarding home administrator (or designee) may train his or her own caregiver staff as follows:

(a) Developmental disabilities specialty training, under WAC 388-112-0120, is the required training on that specialty for boarding home caregivers.

(b) Caregiver dementia training, under WAC 388-112-0135, and caregiver mental health training, under WAC 388-112-0140, are the required trainings on those specialties for boarding home caregivers.

(3) Adult family home caregiver specialty training:

The provider or a person knowledgeable about the specialty area trains adult family home caregivers in the specialty needs of the individual residents in the adult family home, and there is no required curriculum.

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NEW SECTION
WAC 388-112-0115   What specialty training, including caregiver specialty training, is required if a resident has more than one special need?   If an individual resident has needs in more than one of the special needs areas, the home must determine which of the specialty trainings will most appropriately address the overall needs of the person and ensure that the specialty training that addresses the overall needs is completed as required. If additional training beyond the specialty training is needed to meet all of the resident's needs, the home must ensure that additional training is completed.

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NEW SECTION
WAC 388-112-0120   What knowledge and skills must developmental disabilities specialty training include?   (1) Developmental disabilities specialty training must include all of the learning outcomes and competencies published by DSHS for the following core knowledge and skills:

(a) Overview of developmental disabilities;

(b) Values of service delivery;

(c) Effective communication;

(d) Introduction to interactive planning;

(e) Understanding behavior;

(f) Crisis prevention and intervention; and

(g) Overview of legal issues and individual rights.

(2) 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.

(3) The developmental disabilities specialty training learning outcomes and competencies may be obtained from the DSHS division of developmental disabilities.

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NEW SECTION
WAC 388-112-0125   What knowledge and skills must dementia specialty training include?   (1) Dementia specialty training must include all the learning outcomes and competencies published by DSHS for the following core knowledge and skills:

(a) Introduction to the dementias;

(b) Differentiating dementia, depression, and delirium;

(c) Caregiving goals, values, attitudes and behaviors;

(d) Caregiving principles and dementia problem solving;

(e) Effects of cognitive losses on communication;

(f) Communicating with people who have dementia;

(g) Sexuality and dementia;

(h) Rethinking "problem" behaviors;

(i) Hallucinations and delusions;

(j) Helping with activities of daily living (ADLs);

(k) Drugs and dementia;

(l) Working with families;

(m) Getting help from others; and

(n) Self-care for caregivers.

(2) The dementia specialty training learning outcomes and competencies may be obtained from the DSHS aging and adult services administration.

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NEW SECTION
WAC 388-112-0130   What knowledge and skills must caregiver dementia training include?   (1) Caregiver dementia training must include all the learning outcomes and competencies published by DSHS for the following core knowledge and skills:

(a) Introduction to the dementias;

(b) Dementia, depression, and delirium;

(c) Resident-based caregiving;

(d) Dementia caregiving principles;

(e) Communicating with people who have dementia;

(f) Sexuality and dementia;

(g) Re-thinking "problem" behaviors;

(h) Hallucinations and delusions;

(i) Helping with activities of daily living (ADLs); and

(j) Working with family and friends.

(2) The learning outcomes and competencies for caregiver dementia training may be obtained from the DSHS aging and adult services administration.

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NEW SECTION
WAC 388-112-0135   What knowledge and skills must mental health specialty training include?   (1) Mental health specialty training must include all the learning outcomes and competencies published by DSHS for the following core knowledge and skills:

(a) Introduction to mental illness;

(b) Culturally compassionate care;

(c) Respectful communications;

(d) Understanding mental illness - major mental disorders;

(e) Understanding mental illness - baseline, decompensation, and relapse planning; responses to hallucinations and delusions;

(f) Understanding and interventions for behaviors perceived as problems;

(g) Aggression;

(h) Suicide;

(i) Medications;

(j) Getting help from others; and

(k) Self-care for caregivers.

(2) The mental health specialty training learning outcomes and competencies may be obtained from the DSHS aging and adult services administration.

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NEW SECTION
WAC 388-112-0140   What knowledge and skills must caregiver mental health training include?   (1) Caregiver mental health training must include all the learning outcomes and competencies published by DSHS for the following core knowledge and skills:

(a) Understanding major mental disorders;

(b) Individual background, experiences and beliefs;

(c) Responding to decompensation, relapse, hallucinations and delusions;

(d) Interventions for behaviors perceived as problems;

(e) Aggression; and

(f) Suicide.

(2) The learning outcomes and competencies for caregiver mental health training may be obtained from the DSHS aging and adult services administration.

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NEW SECTION
WAC 388-112-0145   Is competency testing required for specialty training, including caregiver specialty training?   Passing the DSHS competency test is required for successful completion of specialty training for adult family home providers and resident managers, and for boarding home administrators (or designees) and caregivers, as provided under WAC 388-112-0290 through 388-112-0315. Competency testing is not required for adult family home caregivers.

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NEW SECTION
WAC 388-112-0150   Is there a challenge test for specialty training, including caregiver specialty training?   There is a challenge test for all the specialty trainings, including caregiver specialty trainings, except the adult family home caregiver training. Individuals may take the DSHS challenge test instead of required specialty training. A person who does not pass a challenge test on the first attempt must attend the class.

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NEW SECTION
WAC 388-112-0155   What documentation is required for successful completion of specialty training, including caregiver specialty training?   Specialty training, including caregiver specialty training, as applicable, must be documented by a certificate of successful completion of training, issued by the instructor or training entity, that includes:

(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 be given an original certificate. The home must keep a copy of the certificate on file.

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NEW SECTION
WAC 388-112-0160   Who is required to complete specialty training, and when?    Adult Family Homes

(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

(3) 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 employment or within one hundred twenty days of September 1, 2002, whichever is later.

(4) 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.

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NEW SECTION
WAC 388-112-0165   Who is required to complete caregiver specialty training, and when?   Adult family homes

If an adult family home serves one or more residents with special needs, all caregivers must receive training regarding the specialty needs of individual residents in the home. The provider or resident manager knowledgeable about the specialty area may provide this training.

Boarding homes

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

(1) If the caregiver specialty training is integrated with basic training, caregivers must complete the caregiver 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 September 1, 2002, whichever is later.

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

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

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SECTION VI -- NURSE DELEGATION CORE TRAINING
NEW SECTION
WAC 388-112-0170   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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NEW SECTION
WAC 388-112-0175   What knowledge and skills must nurse delegation core training include?   Only the curriculum developed by DSHS may be used for nurse delegation core training.

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NEW SECTION
WAC 388-112-0180   Is competency testing required for nurse delegation core training?   Passing the DSHS competency test is required for successful completion of nurse delegation core training, as provided under WAC 388-112-0265 through 388-112-0295.

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NEW SECTION
WAC 388-112-0185   Is there a challenge test for nurse delegation core training?   There is no challenge test for nurse delegation core training.

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NEW SECTION
WAC 388-112-0190   What documentation is required for successful completion of nurse delegation core training?   (1) Nurse delegation core training must be documented by a certificate of successful completion of training, issued by the instructor or training entity, that includes:

(a) The name of the trainee;

(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.

(2) The trainee must be given an original certificate. Homes must keep a copy of the certificate on file.

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NEW SECTION
WAC 388-112-0195   Who is required to complete nurse delegation core training, and when?   Adult Family Homes

(1) Before performing any delegated nursing task, adult family home staff must successfully complete DSHS-designated nurse delegation core training, and be a nursing assistant registered or certified under chapter 18.88A RCW.

Boarding Homes

(2) Before performing any delegated nursing task, boarding home staff must successfully complete DSHS-designated nurse delegation core training, and be a nursing assistant registered or certified under chapter 18.88A RCW.

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3007.6
AMENDATORY SECTION(Amending WSR 98-11-095, filed 5/20/98, effective 7/1/98)

WAC 388-76-570   Additional license requirements--Multiple facility providers.   (1) The department shall not issue a license to a provider to operate more than one adult family home unless:

(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 388-112-0265 through 388-112-0285.

[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.]


AMENDATORY SECTION(Amending WSR 98-11-095, filed 5/20/98, effective 7/1/98)

WAC 388-76-655   General management and administration.   (1) The provider shall not admit or retain any resident whose needs the provider cannot meet.

(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.

(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 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.]


AMENDATORY SECTION(Amending WSR 98-11-095, filed 5/20/98, effective 7/1/98)

WAC 388-76-660   Training.   (((1) Before operating and providing services in an)) Adult family home((,)) individual providers, entity ((representative and)) representatives, resident managers ((shall successfully complete the department's:

(a) Fundamentals of caregiving training; or

(b) Modified fundamentals of caregiving training if they meet the requirements listed in subsection (3) of this section.

(2) Providers shall ensure that:

(a) All caregivers hired in the adult family home successfully complete the department designated fundamentals of caregiving training within one hundred twenty days of employment, unless he or she meets the requirements in subsections (3) or (4) below; and

(b) All caregivers complete a minimum of ten hours of continuing education credits per calendar year, on topics relevant to caregiving:

(i) Topics include, but are not limited to residents' rights, personal care, dementia, mental illness, developmental disabilities, depression, medication assistance, communication skills, alternatives to restraints, and activities for residents;

(ii) Caregivers must receive a certificate of completion to meet the requirement for continuing education credit and each hour of completed instruction will count as one hour of continuing education credit; and

(iii) The continuing education requirement begins the calendar year after the year in which the caregiver completes the fundamentals or modified fundamentals of caregiving training.

(3) A caregiver who has successfully completed training as a registered or licensed practical nurse, a physical or occupational therapist, a nursing assistant certified, a home health aid from a Medicare certified home health agency, who has successfully completed department approved adult family home training, or department approved personal care training from an area agency on aging or their subcontractor, or who is a resident manager or provider prior to July 20, 1996, is exempt from the fundamentals of caregiving training in subsection (2) of this section if the caregiver successfully completes the department designated modified fundamentals of caregiving training in accordance with the dates specified in subsection (2) of this section.

(4) Caregivers are exempt from attending the fundamentals of caregiving or modified fundamentals of caregiving trainings if they successfully pass the department's challenge test for the class they are required to take. The caregiver has only one opportunity to successfully pass the challenge test then he/she must attend the fundamentals of caregiving or modified fundamentals of caregiving trainings as required.

(5) A provider and any of their staff who have successfully completed the division of developmental disabilities (DDD) staff training as required by chapter 275-26 WAC is exempt from the fundamentals of caregiving training in subsections (1) and (2) of this section, as long as the provider continues to work for a DDD-contracted agency. This exemption no longer applies if the provider or their staff leaves the DDD-contracted agency.

(6) Volunteers are exempt from the training requirements listed above unless they provide unsupervised direct personal care to residents.

(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.]


REPEALER

     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