WSR 02-15-065

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)

[ Filed July 11, 2002, 4:31 p.m. ]

Date of Adoption: July 10, 2002.

Purpose: Adopting new WAC 388-112-0001 through 388-112-0195. These rules implement 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.

Citation of Existing Rules Affected by this Order: Repealing WAC 388-76-59100, 388-76-59110, 388-76-59120 and 388-110-110; and amending WAC 388-76-570, 388-76-655, and 388-76-660.

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

Other Authority: Chapter 121, Laws of 2000, and chapter 233, Laws of 2002.

Adopted under notice filed as WSR 01-23-073 on November 20, 2001, and supplemental notice filed as WSR 02-11-032 on May 7, 2002.

Changes Other than Editing from Proposed to Adopted Version: These rules were originally filed as WSR 01-23-073. As a result of public comments and statutory directives, the rules were revised, renumbered, and reproposed.


Rules as Proposed Changes (additions underlined, deletions struck through) Explanation of changes
WAC 388-112-0005 What definitions apply to this chapter?
"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. A boarding home administrator may have more than one designee. Clarification.
WAC 388-112-0010 When do the training requirements go into effect?

(1) 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:

(2) 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

(3) 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.

New WAC section, added from statute per chapter 233, Laws of 2002 for clarification.
WAC 388-112-0035 (5) The location of name of the home giving the orientation; and Clarify meaning of "location" based on comments.
WAC 388-112-0040 Who is required to complete orientation, and when must it be completed?

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

Clarify that AFH providers do not have to have this orientation, but all other staff do.

WAC 388-112-0070 What documentation is required for successful completion of basic training?

(1)(c) The location of name of the home or training entity giving the training; ...

Clarify what was meant by location, based on public comment.
WAC 388-112-0075 Who is required to complete basic training, and when?

(4) Boarding home administrators (or their designees), except administrators with a current nursing home administrator license, 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.

Change based on public comment.
WAC 388-112-0100 What documentation is required for successful completion of modified basic training?

(1)(c) The location of name of the home or training entity giving the training. ...

Clarification based on public comment.
WAC 388-112-0110 What is specialty training?

(1) 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 for managers and caregivers, except for adult family home caregiver dementia and mental health specialty training.

(1) (2) Manager specialty training for boarding home administrators (or designees), adult family home providers and resident managers specialty training:

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

(2) (3) Boarding home c Caregiver specialty training for boarding homes:

(3) (4) Caregiver specialty training for adult family homes caregiver specialty training:

The provider or resident manager who has successfully completed the manager specialty training, 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.

(1) Clarify that DSHS does not need to approve AFH caregiver specialty training curricula.

(2) Differentiate between manager and caregiver specialty trainings.

Information on administrators and designees training their own caregivers in specialty without meeting the instructor qualifications has been moved to the instructor qualifications for each specialty, sections 0385, 0390, and 0395.

(3) Editing.

(4) Clarification.

WAC 288-112-0120 What knowledge and skills must manager and caregiver developmental disabilities specialty training include?

(1) Manager and caregiver developmental disabilities specialty training must include all of the learning outcomes and competencies published by DSHS for the following core knowledge and skills:

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

Clarify that this training content is for both managers and caregivers.
WAC 388-112-0125 What knowledge and skills must manager dementia specialty include? (1) Manager dementia specialty training must include all the learning outcomes and competencies published by DSHS for the following core knowledge and skills:...

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

Clarify that this training is for managers, not caregivers.
WAC 388-112-0135 What knowledge and skills must manager mental health specialty training include? Manager mental health specialty training must include all the learning outcomes and competencies published by DSHS for the following core knowledge and skills:

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

Clarify that this training is for managers, not caregivers.
WAC 388-112-0155 What documentation is required for successful completion of specialty training, including caregiver specialty training?

(3) The location of name of the home or training entity giving the training. ...

Clarify "location" based on public comment.
WAC 388-112-0160 Who is required to complete manager 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 manager 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 manager specialty training and demonstrate competency.

Clarify type of specialty training required.
Boarding Homes

(3) If a boarding home serves one or more residents with special needs, the boarding home administrator (or designee) must complete manager 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. home. A boarding home administrator with a current nursing home administrator license is exempt from this requirement, unless the administrator will train their facility caregivers in a caregiver specialty.

(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 manager specialty training and demonstrate competency. .A boarding home administrator with a current nursing home administrator license is exempt from this requirement, unless the administrator will train their facility caregivers in a caregiver specialty.

Clarify type of specialty training required.

Changed based on public comment.

WAC 388-112-0190 (1)(c) The location of name of the training entity giving the training,; Clarification.
WAC 388-112-0195 Who is required to complete nurse delegation core training, and when?

(1) Before performing any delegated nursing task, adult family home staff must:

(a) Successfully complete DSHS-designated nurse delegation core training; and

(b) Be a nursing assistant registered or certified under chapter 18.88A RCW; and

(c) If a nursing assistant registered, successfully complete basic training..

(2) Before performing any delegated nursing task, boarding home staff must:

(a) Successfully complete DSHS-designated nurse delegation core training; and

(b) Be a nursing assistant registered or certified under chapter 18.88A RCW; and

(c) If a nursing assistant registered, successfully complete basic training..

Add more complete information about nurse delegation requirements; editing.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 40, Amended 3, Repealed 4.

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

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

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

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 40, Amended 3, Repealed 4.
Effective Date of Rule: Thirty-one days after filing.

July 10, 2002

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3010.12
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. A boarding home administrator may have more than one designee.

"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.

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

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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 name of the home giving the orientation; and

(6) The date(s) of orientation.

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

(1) All paid or volunteer staff in adult family homes 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 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 name of the home or training entity giving 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), except administrators with a current nursing home administrator license, 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 name of the home or training entity giving 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?   (1) 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 for managers and caregivers, except for adult family home caregiver specialty training.

(2) Manager specialty training for boarding home administrators (or designees), adult family home providers and resident managers:

(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).

(3) Caregiver specialty training for boarding homes:

(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.

(4) Caregiver specialty training for adult family homes:

The provider or resident manager who has successfully completed the manager specialty training, 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 manager and caregiver developmental disabilities specialty trainings include?   (1) Manager and caregiver developmental disabilities specialty trainings 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 manager and caergiver developmental disabilities specialty training learning outcomes and competencies may be obtained from the DSHS division of developmental disabilities.

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Reviser's note: The spelling error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-112-0125   What knowledge and skills must manager dementia specialty training include?   (1) Manager 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 manager 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 manager mental health specialty training include?   (1) Manager 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 manager 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 name of the home or training entity giving 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 manager 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 manager 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 manager 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 manager 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. A boarding home administrator with a current nursing home administrator license is exempt from this requirement, unless the administrator will train their facility caregivers in a caregiver specialty.

(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 manager specialty training and demonstrate competency. A boarding home administrator with a current nursing home administrator license is exempt from this requirement, unless the administrator will train their facility caregivers in a caregiver specialty.

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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 name of the training entity giving 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:

(a) Successfully complete DSHS-designated nurse delegation core training;

(b) Be a nursing assistant registered or certified under chapter 18.88A RCW; and

(c) If a nursing assistant registered, successfully complete basic training.

Boarding Homes

(2) Before performing any delegated nursing task, boarding home staff must:

(a) Successfully complete DSHS-designated nurse delegation core training;

(b) Be a nursing assistant registered or certified under chapter 18.88A RCW; and

(c) If a nursing assistant registered, successfully complete basic training.

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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