Effective Date of Rule: Thirty-one days after filing.

     Purpose: Chapter 388-78A WAC was amended to make the rule clearer; to eliminate redundancies and inconsistencies with other rules and statutes; to expand options for boarding homes to provide adult day services and thereby create more options for consumers; to respond in part to chapter 505, Laws of 2005, and to create more training options for boarding home administrators.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-78A-2020, 388-78A-2050, 388-78A-2100, 388-78A-2120, 388-78A-2270, 388-78A-2280, 388-78A-2300, 388-78A-2305, 388-78A-2360, 388-78A-2380, 388-78A-2470, 388-78A-2480, 388-78A-2500, 388-78A-2510, 388-78A-2520, 388-78A-2660, 388-78A-2700, 388-78A-2910, 388-78A-2920, 388-78A-2930, 388-78A-2940, 388-78A-2960, 388-78A-2990, 388-78A-3010, 388-78A-3030, 388-78A-3040, 388-78A-3090, 388-78A-3190, and 388-78A-3220.

     Statutory Authority for Adoption: RCW 18.20.090.

      Adopted under notice filed as WSR 05-20-079 on October 4, 2005.

     Changes Other than Editing from Proposed to Adopted Version: "Resident" was deleted from WAC 388-78A-2360 (2)(i). The final rule for WAC 388-78A-2360 (2)(i) reads: "Maintain a record for each adult day services client."

     "Or resident" was deleted from the proposed wording of WAC 388-78A-2660(7). The final rule for WAC 388-78A-2660(7) reads: The boarding home must: (7) "Not allow any staff person to abuse or neglect any resident."

     A final cost-benefit analysis is available by contacting Denny McKee, ADSA Residential Care Services, P.O. Box 45600, Olympia, WA 98504-5600, phone (360) 725-2590, fax (360) 438-7903, e-mail mckeedd@dshs.wa.gov. There are no changes to the preliminary cost-benefit analysis.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 29, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 29, Repealed 0.

     Date Adopted: December 12, 2005.

Andy Fernando, Manager

Rules and Policies Assistance Unit

     "Abuse" means the willful action or inaction that inflicts injury, unreasonable confinement, intimidation, or punishment on a resident. In instances of abuse of a resident who is unable to express or demonstrate physical harm, pain, or mental anguish, the abuse is presumed to cause physical harm, pain, or mental anguish. Abuse includes sexual abuse, mental abuse, physical abuse, and exploitation of a resident, which have the following meanings:

     (1) "Mental abuse" means any willful action or inaction of mental or verbal abuse. Mental abuse includes, but is not limited to, coercion, harassment, inappropriately isolating a resident from family, friends, or regular activity, and verbal assault that includes ridiculing, intimidating, yelling, or swearing;

     (2) "Physical abuse" means the willful action of inflicting bodily injury or physical mistreatment. Physical abuse includes, but is not limited to, striking with or without an object, slapping, pinching, choking, kicking, shoving, prodding, or the use of chemical restraints or physical restraints;

     (3) "Sexual abuse" means any form of nonconsensual sexual contact, including, but not limited to, unwanted or inappropriate touching, rape, sodomy, sexual coercion, sexually explicit photographing, and sexual harassment. Sexual abuse includes any sexual contact between a staff person and a resident, whether or not it is consensual;

     (4) "Exploitation" means an act of forcing, compelling, or exerting undue influence over a resident causing the resident to act in a way that is inconsistent with relevant past behavior, or causing the resident to perform services for the benefit of another;

     (5) "Financial exploitation" means the illegal or improper use of the property, income, resources, or trust funds of the ((resident)) vulnerable adult by any person for any person's profit or advantage.

     "Activities of daily living" means the following tasks related to basic personal care: Bathing; toileting; dressing; personal hygiene; mobility; transferring; and eating.

     "Adult day ((care)) services" means care and services provided to individuals on the boarding home premises for a period of less than twenty-four continuous hours and does not involve an overnight stay.

     "Ambulatory" means capable of walking or traversing a normal path to safety without the physical assistance of another individual:

     (1) "Nonambulatory" means unable to walk or traverse a normal path to safety without the physical assistance of another individual;

     (2) "Semiambulatory" means physically and mentally capable of traversing a normal path to safety with the use of mobility aids, but unable to ascend or descend stairs without the physical assistance of another individual.

     "Applicant" means the person, as defined in this section, that has submitted, or is in the process of submitting, an application for a boarding home license.

     "Basic services" means housekeeping services, meals, nutritious snacks, laundry, and activities.

     "Bathing fixture" means a bathtub, shower or sit-down shower.

     "Bathroom" means a room containing at least one bathing fixture.

     "Boarding home" means any home or other institution, however named, which is advertised, announced, or maintained for the express or implied purpose of providing housing, basic services, and assuming general responsibility for the safety and well-being of the residents, and may also provide domiciliary care, consistent with this chapter to seven or more residents after July 1, 2000. However, a boarding home that is licensed for three to six residents prior to or on July 1, 2000, may maintain its boarding home license as long as it is continually licensed as a boarding home. "Boarding home" does not include facilities certified as group training homes pursuant to RCW 71A.22.040, nor any home, institution or section thereof which is otherwise licensed and regulated under the provisions of state law providing specifically for the licensing and regulation of such home, institution or section thereof. Nor shall it include any independent senior housing, independent living units in continuing care retirement communities, or other similar living situations including those subsidized by the Department of Housing and Urban Development. "Boarding home" may also include persons associated with the boarding home to carry out its duties under this chapter.

     "Building code" means the building codes and standards adopted by the Washington state building code council.

     "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 a boarding home, except volunteers who are directly supervised. 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.

     "Construction review services" means the office of construction review services within the Washington state department of health.

     "Continuing care contract" means, as stated in RCW 70.38.025, a contract providing a person, for the duration of that person's life or for a term in excess of one year, shelter along with nursing, medical, health-related, or personal care services, which is conditioned upon the transfer of property, the payment of an entrance fee to the provider of such services, or the payment of periodic charges for the care and services involved. A continuing care contract is not excluded from this definition because the contract is mutually terminable or because shelter and services are not provided at the same location.

     "Continuing care retirement community" means, as stated in RCW 70.38.025, an entity which provides shelter and services under continuing care contracts with its members and which sponsors or includes a health care facility or a health service.

     "Contractor" means an agency or person who contracts with a licensee to provide resident care, services or equipment.

     "Crimes relating to financial exploitation" means the same as "crimes relating to financial exploitation" as defined in RCW 43.43.830 or 43.43.842.

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

     "Dietitian" means an individual certified under chapter 18.138 RCW.

     "Document" means to record, with signature, title, date and time:

     (1) Information about medication administration, medication assistance or disposal, a nursing care procedure, accident, occurrence or change in resident condition that may affect the care or needs of a resident; and

     (2) Processes, events or activities that are required by law, rule or policy.

     "Domiciliary care" means:

     (1) Assistance with activities of daily living provided by the boarding home either directly or indirectly; or

     (2) Health support services, if provided directly or indirectly by the boarding home; or

     (3) Intermittent nursing services, if provided directly or indirectly by the boarding home.

     "Enforcement remedy" means one or more of the department's responses to a boarding home's noncompliance with chapter 18.20 RCW and this chapter, as authorized by RCW 18.20.190.

     "Food service worker" means according to chapter 246-217 WAC an individual who works (or intends to work) with or without pay in a food service establishment and handles unwrapped or unpackaged food or who may contribute to the transmission of infectious diseases through the nature of his/her contact with food products and/or equipment and facilities. This does not include persons who simply assist residents with meals.

     "General responsibility for the safety and well-being of the resident" means the provision of the following:

     (1) Prescribed general low sodium diets;

     (2) Prescribed general diabetic diets;

     (3) Prescribed mechanical soft foods;

     (4) Emergency assistance;

     (5) Monitoring of the resident;

     (6) Arranging health care appointments with outside health care providers and reminding residents of such appointments as necessary;

     (7) Coordinating health care services with outside health care providers consistent with WAC 388-78A-2350;

     (8) Assisting the resident to obtain and maintain glasses, hearing aids, dentures, canes, crutches, walkers, wheelchairs, and assistive communication devices;

     (9) Observation of the resident for changes in overall functioning;

     (10) Blood pressure checks as scheduled;

     (11) Responding appropriately when there are observable or reported changes in the resident's physical, mental, or emotional functioning; or

     (12) Medication assistance as permitted under RCW 69.41.085 and as described in RCW 69.41.010 and chapter 246-888 WAC.

     "Harm" means a physical or mental or emotional injury or damage to a resident including those resulting from neglect or violations of a resident's rights.

     "Health support services" means any of the following optional services:

     (1) Blood glucose testing;

     (2) Puree diets;

     (3) Calorie controlled diabetic diets;

     (4) Dementia care;

     (5) Mental health care; or

     (6) Developmental disabilities care.

     "Independent living unit" means:

     (1) Independent senior housing;

     (2) Independent living unit in a continuing care retirement community or other similar living environments;

     (3) Boarding home unit where domiciliary services are not provided; or

     (4) Boarding home unit where one or more items listed under "general responsibilities" are not provided.

     "Independent senior housing" means an independent living unit occupied by an individual or individuals sixty or more years of age.

     "Infectious" means capable of causing infection or disease by entrance of organisms into the body, which grow and multiply there, including, but not limited to, bacteria, viruses, protozoans, and fungi.

     "Licensee" means the person, as defined in this chapter, to whom the department issues the boarding home license.

     "Licensed resident bed capacity" means the resident occupancy level requested by the licensee and approved by the department. All residents receiving domiciliary care or the items or services listed under general responsibility for the safety and well-being of the resident as defined in this section count towards the licensed resident bed capacity. Adult day ((care)) services clients do not count towards the licensed resident bed capacity.

     "Majority owner" means any person that owns:

     (1) More than fifty percent interest; or

     (2) If no one person owns more than fifty percent interest, the largest interest portion; or

     (3) If more than one person owns equal largest interest portions, then all persons owning those equal largest interest portions.

     "Manager" means the person defined in this chapter, providing management services on behalf of the licensee.

     "Management agreement" means a written, executed agreement between the licensee and the manager regarding the provision of certain services on behalf of the licensee.

     "Maximum facility capacity" means the maximum number of individuals that the boarding home may serve at any one time, as determined by the department.

     (1) The maximum facility capacity includes all residents and respite care residents and adult day ((care)) services clients.

     (2) The maximum facility capacity is equal to the lesser of:

     (a) The sum of the number of approved bed spaces for all resident rooms (total number of approved bed spaces), except as specified in subsection (3); or

     (b) Twice the seating capacity of the dining area(s) consistent with WAC 388-78A-2300 (1)(h); or

     (c) The number of residents permitted by calculating the ratios of toilets, sinks, and bathing fixtures to residents consistent with WAC 388-78A-3030; or

     (d) For boarding homes licensed on or before December 31, 1988, the total day room area in square feet divided by ten square feet, consistent with WAC 388-78A-3050; or

     (e) For boarding homes licensed after December 31, 1988, the total day room area in square feet divided by twenty square feet, consistent with WAC 388-78A-3050.

     (3) For the purposes of providing adult day services consistent with WAC 388-78A-2360, one additional adult day services client may be served, beyond the total number of approved bed spaces, for each additional sixty square feet of day room area greater than the area produced by multiplying the total number of approved bed spaces by twenty square feet, provided that:

     (a) There is a least one toilet and one hand washing sink accessible to adult day services clients for every eight adult day services clients or fraction thereof;

     (b) The total number of residents and adult day services clients does not exceed twice the seating capacity of the dining area(s) consistent with WAC 388-78A-2300 (1)(h); and

     (c) The adult day services program area(s) and building do not exceed the occupancy load as determined by the local building official or state fire marshal.

     "Medication administration" means the direct application of a prescribed medication whether by injection, inhalation, ingestion, or other means, to the body of the resident by an individual legally authorized to do so.

     "Medication assistance" means assistance with self-administration of medication rendered by a nonpractitioner to a resident of a boarding home in accordance with chapter 246-888 WAC.

     "Medication organizer" means a container with separate compartments for storing oral medications organized in daily doses.

     "Medication service" means any service provided either directly or indirectly by a boarding home related to medication administration, medication administration provided through nurse delegation, medication assistance, or resident self-administration of medication.

     "Neglect" means:

     (1) A pattern of conduct or inaction resulting in the failure to provide the goods and services that maintain physical or mental health of a resident, or that fails to avoid or prevent physical or mental harm or pain to a resident; or

     (2) An act or omission that demonstrates a serious disregard of consequences of such a magnitude as to constitute a clear and present danger to the resident's health, welfare, or safety.

     "Nonresident individual" means an individual who resides in independent senior housing, independent living units in continuing care retirement communities, or in other similar living environments or in a boarding home and may receive one or more of the services listed in WAC 388-78A-2030 (2)(a) through (g), but may not receive domiciliary care as defined in this section, directly or indirectly by the facility, and may not receive the items or services listed under general responsibility for the safety and well-being of the resident as defined in this section.

     "Nonpractitioner" means any individual who is not a practitioner as defined in WAC 388-78A-2020 and chapter 69.41 RCW.

     "Nurse" means an individual currently licensed under chapter 18.79 RCW as either a:

     (1) "Licensed practical nurse" (LPN); or

     (2) "Registered nurse" (RN).

     "Over-the-counter (OTC) medication" means any medication that may be legally purchased without a prescriptive order, including, but not limited to, aspirin, antacids, vitamins, minerals, or herbal preparations.

     "Person" means any individual, firm, partnership, corporation, company, association, joint stock association or any other legal or commercial entity.

     "Physician" means an individual licensed under chapter 18.57 or 18.71 RCW.

     "Practitioner" includes a licensed physician, osteopathic physician, podiatric physician, pharmacist, licensed practical nurse, registered nurse, advanced registered nurse practitioner, dentist, and physician assistant. Refer to chapter 69.41 RCW for a complete listing of practitioners.

     "Prescribed medication" means any medication (legend drug, controlled substance, and over-the-counter) that is prescribed by an authorized practitioner.

     "Prescriber" means a health care practitioner authorized by Washington state law to prescribe drugs.

     "Problem" means a violation of any WAC or RCW applicable to the operation of a boarding home:

     (1) "Recurring problem" means, for all purposes other than those described in RCW 18.20.400, that the department has cited the boarding home for a violation of WAC or RCW and the circumstances of (a) or (b) of this subsection are present:

     (a) The department previously imposed an enforcement remedy for a violation of the same section of WAC or RCW for substantially the same problem following any type of inspection within the preceding thirty-six months; or

     (b) The department previously cited a violation under the same section of WAC or RCW for substantially the same problem following any type of inspection on two occasions within the preceding thirty-six months.

     (c) If the previous violation in (a) or (b) of this subsection was pursuant to WAC or RCW that has changed at the time of the new violation, citation to the equivalent current WAC or RCW section is sufficient.

     (d) When there is a change in licensees between the first and the second or third citations, the new licensee must accept, and the department will consider, the prior licensee's compliance and enforcement record as part of the new licensee's compliance record at that boarding home if any person affiliated with the new licensee was affiliated with the prior licensee at the same boarding home. A person is considered affiliated with the licensee if the person is an applicant for the boarding home license, or is listed on the license application as a partner, officer, director, or majority owner of the applicant.

     (2) "Serious problem" means:

     (a) There has been a violation of a WAC or RCW; and

     (b) Significant harm has actually occurred to a resident; or

     (c) It is likely that significant harm or death will occur to a resident.

     (3) "Uncorrected problem" means the department has cited a violation of WAC or RCW following any type of inspection and the violation remains uncorrected at the time the department makes a subsequent inspection for the specific purpose of verifying whether such violation has been corrected. When a change in licensees occurs, the new licensee is responsible for correcting any remaining violations that may exist, including complying with any plan of correction in effect immediately prior to the change in licensees.

     "Prospective resident" means an individual who is seeking admission to a licensed boarding home and who has completed and signed an application for admission, or such application for admission has been completed and signed in their behalf by their legal representative if any, and if not, then the designated representative if any.

     "Reasonable accommodation" and "reasonably accommodate" have the meaning given in federal and state antidiscrimination laws and regulations which include, but are not limited to, the following:

     (1) Reasonable accommodation means that the boarding home must:

     (a) Not impose admission criteria that excludes individuals unless the criteria is necessary for the provision of boarding home services;

     (b) Make reasonable modification to its policies, practices or procedures if the modifications are necessary to accommodate the needs of the resident;

     (c) Provide additional aids and services to the resident.

     (2) Reasonable accommodations are not required if:

     (a) The resident or individual applying for admission presents a significant risk to the health or safety of others that cannot be eliminated by the reasonable accommodation;

     (b) The reasonable accommodations would fundamentally alter the nature of the services provided by the boarding home; or

     (c) The reasonable accommodations would cause an undue burden, meaning a significant financial or administrative burden.

     "RCW" means Revised Code of Washington.

     "Records" means:

     (1) "Active records" means the current, relevant documentation regarding residents necessary to provide care and services to residents; or

     (2) "Inactive records" means historical documentation regarding the provision of care and services to residents that is no longer relevant to the current delivery of services and has been thinned from the active record.

     "Resident" means an individual who:

     (1) Chooses to reside in a boarding home, including an individual receiving respite care;

     (2) Is not related by blood or marriage to the operator of the boarding home;

     (3) Receives basic services; and

     (4) Receives one or more of the services listed under general responsibility for the safety and well-being of the resident, and may receive domiciliary care or respite care provided directly, or indirectly, by the boarding home.

     "Resident's representative" means:

     (1) The legal representative who is the person or persons identified in RCW 7.70.065 and who may act on behalf of the resident pursuant to the scope of their legal authority. The legal representative shall not be affiliated with the licensee, boarding home, or management company, unless the affiliated person is a family member of the resident; or

     (2) If there is no legal representative, a person designated voluntarily by a competent resident in writing, to act in the resident's behalf concerning the care and services provided by the boarding home and to receive information from the boarding home if there is no legal representative. The resident's representative may not be affiliated with the licensee, boarding home, or management company, unless the affiliated person is a family member of the resident. The resident's representative under this subsection shall not have authority to act on behalf of the resident once the resident is no longer competent. The resident's competence shall be determined using the criteria in RCW 11.88.010 (1)(e).

     "Respite care" means short-term care for any period in excess of twenty-four continuous hours for a resident to temporarily relieve the family or other caregiver of providing that care.

     "Restraint" means any method or device used to prevent or limit free body movement, including, but not limited to:

     (1) Confinement, unless agreed to as provided in WAC 388-78A-2370;

     (2) "Chemical restraint" which means a psychopharmacologic drug that is used for discipline or convenience and not required to treat the resident's medical symptoms; and

     (3) "Physical restraint" which means a manual method, obstacle, or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that restricts freedom of movement or access to his or her body, is used for discipline or convenience, and not required to treat the resident's medical symptoms.

     "Room" means a space set apart by floor to ceiling partitions on all sides with all openings provided with doors or windows.

     (1) "Sleeping room" means a room where a resident is customarily expected to sleep and contains a resident's bed.

     (2) "Resident living room" means the common space in a resident unit that is not a sleeping room, bathroom or closet.

     "Significant change" means a change in the resident's physical, mental, or psychosocial status that causes either life-threatening conditions or clinical complications.

     "Special needs" means a developmental disability, mental illness, or dementia.

     "Staff person" means any boarding home employee or temporary employee or contractor, whether employed or retained by the licensee or any management company, or volunteer.

     "State fire marshal" means the director of fire protection under the direction of the chief of the Washington state patrol.

     "Toilet" means a disposal apparatus used for urination and defecation, fitted with a seat and flushing device.

     "Volunteer" means an individual who interacts with residents without reimbursement.

     "Vulnerable adult" means "vulnerable adult" as defined in chapter 74.34 RCW. For the purposes of requesting and receiving background checks pursuant to RCW 43.43.832, it shall also include adults of any age who lack the functional, mental, or physical ability to care for themselves.

     "WAC" means Washington Administrative Code.

     "WISHA" means the Washington Industrial Safety and Health Act, chapter 49.17 RCW administered by the Washington state department of labor and industries.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2020, filed 7/30/04, effective 9/1/04.]

     (1) The boarding home can safely and appropriately serve the individual with appropriate available staff providing:

     (a) The scope of care and services described in the boarding home's disclosure information, except if the boarding home chooses to provide additional services consistent with RCW 18.20.300(4); and

     (b) The reasonable accommodations required by state or federal law, including providing any specialized training to caregivers that may be required according to WAC 388-78A-2490 through 388-78A-2510;

     (2) The individual does not require the frequent presence and frequent evaluation of a registered nurse, excluding those individuals who are receiving hospice care or individuals who have a short-term illness that is expected to be resolved within fourteen days as long as the boarding home has the capacity to meet the individual's identified needs; and

     (3) The individual is ambulatory, unless the boarding home is approved by the Washington state director of fire protection to care for semiambulatory or nonambulatory residents.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2050, filed 7/30/04, effective 9/1/04.]

     (1) Complete a full assessment addressing the elements set forth in WAC 388-78A-2090 for each resident at least annually;

     (2) Complete an assessment specifically focused on a resident's identified problems and related issues:

     (a) Consistent with the resident's change of condition as specified in WAC 388-78A-2120; ((or))

     (b) When the resident's negotiated service agreement no longer addresses the resident's current needs and preferences;

     (c) When the resident has an injury requiring the intervention of a practitioner.

     (3) Ensure the staff person performing the on-going assessments is qualified to perform them.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2100, filed 7/30/04, effective 9/1/04.]

     (1) Observe each resident consistent with his or her assessed needs and negotiated service agreement;

     (2) Identify any changes in the resident's physical, emotional, and mental functioning that are a:

     (a) Departure from the resident's customary range of functioning; or

     (b) Recurring condition in a resident's physical, emotional, or mental functioning that has previously required intervention by others.

     (3) Evaluate ((the change identified in the resident per subsection (2) of this section)), in order to determine if there is a need for further action((, including, but not limited to, assessment;)):

     (a) The changes identified in the resident per subsection (2) of this section; and

     (b) Each resident when an accident or incident that is likely to adversely affect the resident's well-being, is observed by or reported to staff persons.

     (4) ((Ensure that changes that may require further action by the boarding home are documented in the resident's record, including dates, times, and facts;

     (5) Assess a resident consistent with WAC 388-78A-2100 if assessment is identified as needed;

     (6) Update the negotiated service agreement as needed; and

     (7))) Take appropriate action in response to each resident's changing needs.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2120, filed 7/30/04, effective 9/1/04.]

     (2) The boarding home must allow a resident((s who are assessed to be capable of self-administration or self-administration with assistance)) to control and secure the medications ((they)) that he or she self-administers or self-administers with assistance if the boarding home assesses the resident to be capable of safely and appropriately storing his or her own medications and the resident desires to do so.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2270, filed 7/30/04, effective 9/1/04.]

     (2) ((A)) The boarding home must ensure that any nurse ((may)) who fills a medication organizer for a resident ((only when)) labels the medication organizer with:

     (a) ((The resident understands the use of the medications that have been prescribed for him or her; and

     (b) The resident is totally independent with self-administration of medications when using a medication organizer, except for the physical assistance required to fill the medication organizer, or the resident can safely direct others to administer his or her medications; and

     (c) Staff persons have no further responsibility for:

     (i) Storing the resident's medication; or

     (ii) Providing any additional medication assistance to the resident beyond filling the medication organizer; or

     (iii) Providing medication administration services to the resident.

     (d) The medication organizer carries a label that clearly identifies:

     (i))) The name of the resident;

     (((ii))) (b) The name of the medications in the organizer; and

     (((iii))) (c) The frequency of the dosage.

     (((3) The boarding home must ensure a licensed pharmacy has filled the medication organizer any time the boarding home is:

     (a) Involved in storing the resident's medications;

     (b) Providing medication assistance to the resident; or

     (c) Providing medication administration services to the resident.))

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2280, filed 7/30/04, effective 9/1/04.]

     (a) Provide a minimum of three meals a day:

     (i) At regular intervals;

     (ii) With no more than fourteen hours between the evening meal and breakfast, unless the boarding home provides a nutritious snack after the evening meal and before breakfast.

     (b) Provide sufficient time and staff support for residents to consume meals;

     (c) Ensure all menus:

     (i) Are written at least one week in advance and delivered to residents' rooms or posted where residents can see them, except as specified in (f) of this subsection;

     (ii) Indicate the date, day of week, month and year;

     (iii) Include all food and snacks served that contribute to nutritional requirements;

     (iv) Are ((retained)) kept at least six months;

     (v) Provide a variety of foods; and

     (vi) Are not repeated for at least three weeks, except that breakfast menus in boarding homes that provide a variety of daily choices of hot and cold foods are not required to have a minimum three-week cycle.

     (d) Prepare on-site, or provide through a contract with a food service establishment located in the vicinity and that meets the requirements of chapter 246-215 WAC, palatable, attractively served meals and nourishments that meet the current recommended dietary allowances established by the Food and Nutrition Board, National Research Council, adjusted for:

     (i) Age, gender and activities, unless medically contraindicated; and

     (ii) Individual preferences to the extent reasonably possible.

     (e) Substitute foods, when changes in the current day's menu are necessary, of equal nutrient value and record changes on the original menu;

     (f) Make available and known to residents alternate choices in entrees for midday and evening meals that are of comparable quality and nutritional value. The boarding home is not required to post alternate choices in entrees on the menu one week in advance, but must record on the menus the alternate choices in entrees that are served;

     (g) Develop, make known to residents, and implement a process for residents to express their views and comment on the food services; and

     (h) Maintain a dining area or areas approved by the department with a seating capacity for fifty percent or more of the residents per meal setting, or ten square feet times the licensed resident bed capacity, whichever is greater.

     (2) The boarding home must plan in writing, prepare on-site or provide through a contract with a food service establishment located in the vicinity that meets the requirements of chapter 246-215 WAC, and serve to each resident as ordered:

     (a) Prescribed general low sodium, general diabetic, and mechanical soft food diets according to a diet manual. The boarding home must ensure the diet manual is:

     (i) Available to and used by staff persons responsible for food preparation;

     (ii) Approved by a dietitian; and

     (iii) Reviewed and updated as necessary or at least every five years.

     (b) Prescribed nutrient concentrates and supplements when prescribed in writing by a health care practitioner.

     (3) The boarding home may provide to a resident at his or her request and as agreed upon in the resident's negotiated service agreement, nonprescribed:

     (a) Modified or therapeutic diets;

     (b) Nutritional concentrates or supplements.

     (((4) The boarding home must manage food, and maintain any on-site food service facilities in compliance with chapter 246-215 WAC, Food service sanitation, except that boarding homes licensed for sixteen or fewer beds may use domestic or home-type kitchen appliances, provided that:

     (a) If a home-type mechanical dishwasher was installed before September 1, 2004, the boarding home must:

     (i) Operate it according to manufacturer directions; and

     (ii) Ensure the dishwasher is supplied with water heated to 155°F or more.

     (b) If a home-type mechanical dishwasher is installed after September 1, 2004, the boarding home must ensure the dishwasher has:

     (i) A high temperature final rinse water at a minimum of 180°F measured by the gauge;

     (ii) A high temperature final rinse resulting in a minimum of 160°F measured at the surface of the utensil;

     (iii) A continuous supply of water heated to 155°F throughout its operating cycle; or

     (iv) An automatically dispensed approved concentration of chemical sanitizer as described in 21 C.F.R. Part 178.

     (5) The boarding home must ensure employees working as food service workers obtain a food worker card according to chapter 246-217 WAC.

     (6) The boarding home must ensure a resident obtains a food worker card according to chapter 246-217 WAC whenever:

     (a) The resident is routinely or regularly involved in the preparation of food to be served to other residents;

     (b) The resident is paid for helping to prepare food; or

     (c) The resident is preparing food to be served to other residents as part of an employment-training program.))

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2300, filed 7/30/04, effective 9/1/04.]

     (1) Manage food, and maintain any on-site food service facilities in compliance with chapter 246-215 WAC, Food service;

     (2) Ensure employees working as food service workers obtain a food worker card according to chapter 246-217 WAC; and

     (3) Ensure a resident obtains a food worker card according to chapter 246-217 WAC whenever:

     (a) The resident is routinely or regularly involved in the preparation of food to be served to other residents;

     (b) The resident is paid for helping to prepare food; or

     (c) The resident is preparing food to be served to other residents as part of an employment-training program.

[]

     (2) If adult day ((care is)) services are provided, the boarding home must:

     (a) Ensure each adult day ((care)) services client receives appropriate supervision and agreed upon care and services during the time spent in the day ((care)) services program;

     (b) Ensure the care and services provided to adult day ((care)) services clients do not compromise the care and services provided to boarding home residents;

     (c) Ensure the total number of residents plus adult day ((care)) services clients does not exceed the boarding home's maximum facility capacity;

     (d) Only accept adult day ((care)) services clients who are appropriate for boarding home care and services, consistent with WAC 388-78A-2050;

     (e) Provide sufficient furniture for the comfort of day ((care adults)) services clients, in addition to furniture provided for residents;

     (f) Notify appropriate individuals specified in the client's record and consistent with WAC 388-78A-2640 when there is a significant change in the condition of an adult day ((care)) services client;

     (g) Investigate and document incidents and accidents involving adult day ((care)) services clients consistent with WAC 388-78A-2700;

     (h) Maintain a separate register of adult day ((care)) services clients; and

     (i) Maintain a ((resident)) record for each adult day ((care)) services client.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2360, filed 7/30/04, effective 9/1/04.]

     (1) Each resident, or a person authorized under RCW 7.70.065 to provide consent on behalf of the resident, consents to living in such unit or building.

     (2) Each resident assessed as being cognitively and physically able to safely leave the boarding home is able to do so independently without restriction.

     (3) Each resident, assessed as being cognitively able to safely leave the boarding home and who has physical challenges that make exiting difficult, is able to leave the boarding home when the resident desires and in a manner consistent with the resident's negotiated service agreement.

     (4) Each resident who is assessed as being unsafe to leave the boarding home unescorted is able to leave the boarding home consistent with his or her negotiated service agreement.

     (5) Areas from which egress is restricted are equipped throughout with an approved automatic fire detection system and automatic fire sprinkler system electrically interconnected with a fire alarm system that transmits an alarm off site to a twenty-four hour monitoring station.

     (6) Installation of special egress control devices in all proposed construction issued a project number by construction review services on or after September 1, 2004 for construction related to this section, must conform to standards adopted by the state building code council.

     (7) Installation of special egress control devices in all construction issued a project number by construction review services ((prior to)) before September 1, 2004 for construction related to this section, must conform to the following:

     (a) The egress control device must automatically deactivate upon activation of either the sprinkler system or the smoke detection system.

     (b) The egress control device must automatically deactivate upon loss of electrical power to any one of the following:

     (i) The egress control device itself;

     (ii) The smoke detection system; or

     (iii) The means of egress illumination.

     (c) The egress control device must be capable of being deactivated by a signal from a switch located in an approved location.

     (d) An irreversible process which will deactivate the egress control device must be initiated whenever a manual force of not more than fifteen pounds is applied for two seconds to the panic bar or other door-latching hardware. The egress control device must deactivate within an approved time period not to exceed a total of fifteen seconds. The time delay must not be field adjustable.

     (e) Actuation of the panic bar or other door-latching hardware must activate an audible signal at the door.

     (f) The unlatching must not require more than one operation.

     (g) A sign must be provided on the door located above and within twelve inches of the panic bar or other door-latching hardware reading:

     "Keep pushing. The door will open in fifteen seconds. Alarm will sound."

     The sign lettering must be at least one inch in height and must have a stroke of not less than one-eighth inch.

     (h) Regardless of the means of deactivation, relocking of the egress control device must be by manual means only at the door.

     (8) The boarding home must have a system in place to inform and permit visitors, staff persons and appropriate residents how they can exit without sounding the alarm.

     (9) Units or buildings from which egress is restricted are equipped with a secured outdoor space for walking which:

     (a) Is accessible to residents without staff assistance;

     (b) Is surrounded by walls or fences at least seventy-two inches high;

     (c) Has areas protected from direct sunshine and rain throughout the day;

     (d) Has walking surfaces that are firm, stable, slip-resistant and free from abrupt changes and are suitable for individuals using wheelchairs and walkers; and

     (e) Has suitable outdoor furniture.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2380, filed 7/30/04, effective 9/1/04.]

     (2) The boarding home must:

     (a) Ensure any individual associated with the licensee or boarding home who may have unsupervised access to residents has had a background check of conviction records, pending charges and disciplinary board decisions completed within the past two years, and is repeated every two years thereafter, and that individual has not been:

     (i) Convicted of a crime against children or other persons as defined in RCW 43.43.830 or 43.43.842;

     (ii) Convicted of ((a)) crimes relating to financial exploitation as defined in RCW 43.43.830 or 43.43.842;

     (iii) Found in any disciplinary board final decision to have abused a vulnerable adult as defined in RCW 43.43.830;

     (iv) The subject in a protective proceeding under chapter 74.34 RCW;

     (v) Convicted of criminal mistreatment; or

     (vi) Found by the department to have abused, neglected, or exploited a minor or vulnerable person, provided the individual was offered an administrative hearing to contest the finding, and the finding was upheld, or the individual failed to timely appeal the finding.

     (b) Not hire or retain, directly or by contract, or accept as a volunteer, any individual prohibited from having unsupervised access to residents((,)) under (a) of this subsection, except as provided in subsection (6) of this section and RCW 43.43.842.

     (((c) Not hire, directly or by contract, or accept as a volunteer, any individual who may have unsupervised access to residents, prior to receiving favorable results of the background check except as specified in subsection (2) of this section.

     (d))) (3) Prior to first starting his or her duties, the boarding home must:

     (a) Require each prospective employee, manager, volunteer, contractor and student associated with the licensee or boarding home who may have unsupervised access to residents to disclose, consistent with RCW 43.43.834(2), whether he or she:

     (i) Has been convicted of a crime, including any of the following as defined in RCW 43.43.830:

     (A) All crimes against children or ther persons;

     (B) All crimes relating to financial exploitation; and

     (C) All crimes relating to drugs;

     (ii) Has had findings made against him or her in any civil adjudicative proceeding as defined in RCW 43.43.830; or

     (iii) Has both convictions for (i) and findings made against him or her under (ii).

     (b) Require each individual making the disclosures required in subsection (3)(a) of this section:

     (i) To make the disclosures in writing;

     (ii) To swear under penalty of perjury that the contents of the disclosure are accurate; and

     (iii) To sign the disclosure statement.

     (4) Prior to first starting his or her duties, the boarding home must take one or more of the following three actions for each prospective employee, manager, volunteer, contractor and student associated with the licensee or boarding home who may have unsupervised access to residents:

     (a) Initiate a background check on the individual through the department, which includes taking the following actions:

     (i) Informing ((every)) the individual ((who is associated with the boarding home and who will have unsupervised access to residents in the boarding home,)) that a background check is required. ((This requirement includes, but is not limited to, the following:

     (i) Employees;

     (ii) Managers;

     (iii) Volunteers who are not residents;

     (iv) Contractors; and

     (v) Students.

     (e) Require)) (ii) Requiring the individual((s identified in (d) of this subsection)) to complete and sign a DSHS background authorization form prior to the individual having unsupervised access to residents;

     (((f))) (iii) Submitting all background check authorization forms to the department's:

     (((i))) (A) Aging and disability services administration with the initial application for licensure; and

     (((ii))) (B) Background check central unit ((every two years for each individual identified in (d) of this subsection. A background check result is only valid for two years from the date it is conducted)) for currently licensed boarding homes.

     (((g))) (iv) Verbally informing the named individual of his/her individual background check results and offering to provide him or her a copy of the background check results within ten days of receipt((;)).

     (b) Obtain from the individual's prior employer a copy of the completed criminal background inquiry information for the individual, subject to the following conditions:

     (i) The prior employer was a nursing home licensed under chapter 18.51 RCW, a boarding home licensed under chapter 18.20 RCW, or an adult family home licensed under chapter 70.128 RCW;

     (ii) The nursing home, boarding home or adult family home providing completed criminal background inquiry information for the individual is reasonably known to be the individual's most recent employer;

     (iii) No more than twelve months has elapsed from the date the individual was employed by the nursing home, boarding home or adult family home and the date of the individual's current application;

     (iv) The background inquiry for the individual is no more than two years old; and

     (v) The boarding home has no reason to believe the individual has or may have a disqualifying conviction or finding as described in RCW 43.43.842.

     (c) When using staff persons from a home health, hospice, or home care agency licensed under chapter 70.127 RCW, or a nursing pool registered under chapter 18.52C RCW, the boarding home must establish, maintain and follow a written agreement with the agency or pool to ensure the requirements of subsection (2) of this section are met for the agency or pool staff who may work in the boarding home.

     (((h))) (5) The boarding home must ensure that all disclosure statements, and background check results obtained by the boarding home, are:

     (((i))) (a) Maintained on-site in a confidential and secure manner;

     (((ii))) (b) Used for employment purposes only;

     (((iii))) (c) Not disclosed to any individual except:

     (((A))) (i) The individual named on the background check result;

     (((B))) (ii) Authorized state and federal employees;

     (((C))) (iii) The Washington state patrol auditor; and

     (((D))) (iv) As otherwise authorized in chapter 43.43 RCW.

     (((iv))) (d) Retained and available for department review:

     (((A))) (i) During the individual's employment or association with a facility; and

     (((B))) (ii) At least two years following termination of employment or association with a facility.

     (((2))) (6) The boarding home may conditionally hire, directly or by contract, an individual having unsupervised access to residents pending a background inquiry, provided the boarding home:

     (a) Obtains a criminal history background check authorization form from the individual prior to the individual beginning work;

     (b) Submits the criminal history background check authorization form to the department no later than one business day after the individual started working; and

     (c) Has received three positive references for the individual.

     (((3))) (7) The department may require the boarding home or any other individual associated with the boarding home who has unsupervised access to residents to complete additional disclosure statements or background inquiries if the department has reason to believe that offenses specified under RCW 43.43.830 have occurred since completion of the previous disclosure statement or background inquiry.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2470, filed 7/30/04, effective 9/1/04.]

     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.
AMENDATORY SECTION(Amending WSR 04-16-065, filed 7/30/04, effective 9/1/04)

WAC 388-78A-2480   TB tests.   (1) The boarding home must ensure each staff person, except for volunteers and contactors, is screened for tuberculosis, as follows:

     (a) Except when a staff person provided the boarding home with documentation of a previous positive Mantoux skin test, a staff person hired before September 1, 2004 must have had:

     (i) A tuberculin skin test by the Mantoux method within six months preceding the date of employment in the boarding home; and

     (ii) A second tuberculin skin test within one to three weeks after a negative Mantoux test if the staff person was thirty-five years of age or older at the time of hiring.

     (b) A staff person hired on or after September 1, 2004 must have a baseline two-step skin test initiated within three days of being hired unless the staff person meets the requirements in (((b))) (c) or (((c))) (d) of this subsection. The skin tests must be:

     (i) Given no less than one and no more than three weeks apart;

     (ii) By intradermal (Mantoux) administration of purified protein derivative (PPD);

     (iii) Read between forty-eight and seventy-two hours following administration, by trained personnel; and

     (iv) Recorded in millimeters of induration.

     (((b))) (c) A staff person needs to have only a one-step skin test within three days of being hired if:

     (i) There is documented history of a negative result from previous two-step testing; or

     (ii) There was a documented negative result from one-step skin testing in the previous twelve months.

     (((c))) (d) A staff person does not need to be skin tested for tuberculosis if he/she has:

     (i) Documented history of a previous positive skin test consisting of ten or more millimeters of induration; or

     (ii) Documented evidence of adequate therapy for active disease; or

     (iii) Documented evidence of adequate preventive therapy for infection.

     (d) If a skin test results in a positive reaction, the boarding home must:

     (i) Ensure that the staff person has a chest X ray within seven days;

     (ii) Report positive chest X rays to the appropriate public health authority; and

     (iii) Follow precautions ordered by a physician or public health authority.

     (2) The boarding home must:

     (a) ((Retain)) Keep in the boarding home for the duration of the staff person's employment, and at least two years following termination of employment, records of:

     (i) Tuberculin test results;

     (ii) Reports of X-ray findings; and

     (iii) Physician or public health official orders.

     (b) Provide staff persons with a copy of the records specified in (a) of this subsection:

     (i) During the time the staff person is employed in the boarding home, limited to one copy per report; and

     (ii) When requested by the staff person.

     (3) The boarding home must ensure that caregivers caring for a resident with suspected tuberculosis comply with the WISHA standard for respiratory protection.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2480, filed 7/30/04, effective 9/1/04.]

     Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
AMENDATORY SECTION(Amending WSR 04-16-065, filed 7/30/04, effective 9/1/04)

WAC 388-78A-2490   Specialized training for developmental disabilities.   (1) The boarding home must provide caregivers with specialized training, consistent with chapter 388-112 WAC, to serve residents with developmental disabilities, whenever at least one of the residents in the boarding home ((is:

     (1) A person who meets the eligibility criteria for services defined in chapter 388-825 WAC; or

     (2) A person with a severe, chronic disability which is attributable to cerebral palsy or epilepsy, or any other condition, other than mental illness, found to be closely related to mental retardation which results in impairment of general intellectual functioning or adaptive behavior similar to that of a person with mental retardation, and requires treatment or services similar to those required for these persons (i.e., autism), and:

     (a) The condition was manifested before the person reached eighteen;

     (b) The condition is likely to continue indefinitely; and

     (c) The condition results in substantial functional limitations in three or more of the following areas of major life activities:

     (i) Self-care;

     (ii) Understanding and use of language;

     (iii) Learning;

     (iv) Mobility;

     (v) Self-direction; and

     (vi) Capacity for independent living)) has a developmental disability as defined in WAC 388-823-0040, that is the resident's primary special need.

     (2) Nothing in this section is intended to require additional specialty training beyond that required by WAC 388-112-0115.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2490, filed 7/30/04, effective 9/1/04.]

     (((1))) (a) Who has received the diagnosis or treatment within the previous two years; and

     (((2))) (b) Whose diagnosis was made by, or treatment provided by, one of the following:

     (((a))) (i) A licensed physician;

     (((b))) (ii) A mental health professional;

     (((c))) (iii) A psychiatric advanced registered nurse practitioner; or

     (((d))) (iv) A licensed psychologist.

     (2) Nothing in this section is intended to require additional specialty training beyond that required by WAC 388-112-0115.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2500, filed 7/30/04, effective 9/1/04.]

     (2) Nothing in this section is intended to require additional specialty training beyond that required by WAC 388-112-0115.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2510, filed 7/30/04, effective 9/1/04.]

     (2) The licensee must only appoint as a boarding home administrator an individual who meets at least one of the following qualifications listed in (a) through (f) of this subsection:

     (a) The individual was actively employed as a boarding home administrator and met existing qualifications on September 1, 2004;

     (b) The individual holds a current Washington state nursing home administrator license in good standing;

     (c) Prior to assuming duties as a boarding home administrator, the individual has met the qualifications listed in both (c)(i) and (ii) of this subsection:

     (i) Obtained certification of completing a recognized administrator training course consisting of a minimum of twenty-four hours of instruction or equivalent on-line training or certification of passing an administrator examination, from or endorsed by a department-recognized national accreditation health or personal care organization such as:

     (A) The American Association of Homes and Services for the Aging; or

     (B) The American College of Health Care Administrators; or

     (C) The American Health Care Association; or

     (((C))) (D) The Assisted Living Federation of America; or

     (((D))) (E) The National Association of Board of Examiners of Long Term Care Administrators.

     (ii) Three years paid experience:

     (A) Providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living; and/or

     (B) Managing persons providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living.

     (d) The individual holds an associate degree in a related field of study such as health, social work, or business administration and meets the qualifications listed in either (d)(i), (ii) or (iii) of this subsection:

     (i) Obtains certification of completing a recognized administrator training course consisting of a minimum of twenty-four hours of instruction or equivalent on-line training, or certification of passing an administrator examination, within six months of beginning duties as the administrator, from or endorsed by a department-recognized national accreditation health or personal care organization such as:

     (A) The American Association of Homes and Services for the Aging; or

     (B) The American College of Health Care Administrators; or

     (C) The American Health Care Association; or

     (((C))) (D) The Assisted Living Federation of America; or

     (((D))) (E) The National Association of Board of Examiners of Long Term Care Administrators.

     (ii) Has two years paid experience:

     (A) Providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living; and/or

     (B) Managing persons providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living.

     (iii) Has completed a qualifying administrator training program supervised by a qualified administrator according to WAC 388-78A-2530.

     (e) The individual holds a bachelor's degree in a related field of study such as health, social work, or business administration and meets the qualifications listed in either (e)(i), (ii) or (iii) of this subsection:

     (i) Obtains certification of completing a recognized administrator training course consisting of a minimum of twenty-four hours of instruction or equivalent on-line training, or certification of passing an administrator examination, within six months of beginning duties as the administrator, from or endorsed by a department-recognized national accreditation health or personal care organization such as:

     (A) The American Association of Homes and Services for the Aging; or

     (B) The American College of Health Care Administrators; or

     (C) The American Health Care Association; or

     (((C))) (D) The Assisted Living Federation of America; or

     (((D))) (E) The National Association of Board of Examiners of Long Term Care Administrators.

     (ii) Has one year paid experience:

     (A) Providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living; and/or

     (B) Managing persons providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living.

     (iii) Has completed a qualifying administrator training program supervised by a qualified administrator according to WAC 388-78A-2530.

     (f) ((Prior to)) Before assuming duties as an administrator, the individual has five years of paid experience:

     (i) Providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living; and/or

     (ii) Managing persons providing direct care to vulnerable adults in a setting licensed by a state agency for the care of vulnerable adults, such as a nursing home, boarding home, or adult family home, or a setting having a contract with a recognized social service agency for the provision of care to vulnerable adults, such as supported living.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2520, filed 7/30/04, effective 9/1/04.]

     (1) Comply with chapter 70.129 RCW, Long-term care resident rights;

     (2) Ensure all staff persons provide care and services to each resident consistent with chapter 70.129 RCW;

     (3) Not use restraints on any resident;

     (4) Promote and protect the residents' exercise of all rights granted under chapter 70.129 RCW;

     (5) Provide care and services to each resident in compliance with applicable state statutes related to substitute health care decision making, including chapters 7.70, 70.122, 11.88, 11.92, and 11.94 RCW; ((and))

     (6) Reasonably accommodate residents consistent with applicable state and/or federal law; and

     (7) Not allow any staff person to abuse or neglect any resident.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2660, filed 7/30/04, effective 9/1/04.]

     (2) The boarding home must:

     (a) Maintain the premises free of hazards;

     (b) Maintain any vehicles used for transporting residents in a safe condition;

     (c) Investigate and document investigative actions and findings for any alleged or suspected neglect or abuse or exploitation, accident or incident jeopardizing or affecting a resident's health or life. The boarding home must:

     (i) Determine the circumstances of the event;

     (ii) When necessary, institute and document appropriate measures to prevent similar future situations if the alleged incident is substantiated; and

     (iii) Protect other residents during the course of the investigation.

     (d) Provide appropriate hardware on doors of storage rooms, closets and other rooms to prevent residents from being accidentally locked in;

     (e) Provide, and ((advise)) tell staff persons of, a means of emergency access to resident-occupied bedrooms, toilet rooms, bathing rooms, and other rooms;

     (f) Provide emergency lighting or flashlights in all areas of the boarding home. For all boarding homes first issued a project number by construction review services on or after September 1, 2004 for construction related to this section, the boarding home must provide emergency lighting in all areas of the boarding home;

     (g) Make sure first-aid supplies are:

     (i) Readily available and not locked;

     (ii) Clearly marked;

     (iii) Able to be moved to the location where needed; and

     (iv) Stored in containers that protect them from damage, deterioration, or contamination.

     (h) Make sure first-aid supplies are appropriate for:

     (i) The size of the boarding home;

     (ii) The services provided;

     (iii) The residents served; and

     (iv) The response time of emergency medical services.

     (i) Develop and maintain a current disaster plan describing measures to take in the event of internal or external disasters, including, but not limited to:

     (i) On-duty staff persons' responsibilities;

     (ii) Provisions for summoning emergency assistance;

     (iii) Plans for evacuating residents from area or building;

     (iv) Alternative resident accommodations;

     (v) Provisions for essential resident needs, supplies and equipment including water, food, and medications; and

     (vi) Emergency communication plan.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2700, filed 7/30/04, effective 9/1/04.]

     (2) Existing licensed boarding homes must continue to meet the building codes in force at the time of their initial licensing.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2910, filed 7/30/04, effective 9/1/04.]

     (a) Storage and handling of clean and sterile nursing equipment and supplies; and

     (b) Cleaning and disinfecting of soiled nursing equipment.

     (2) For all boarding homes first issued a project number by construction review services on or after September 1, 2004 for construction related to this section, in which intermittent nursing services are provided, or upon initiating intermittent nursing services within an existing boarding home, the boarding home must provide the following two separate rooms in each boarding home building, accessible only by staff persons:

     (a) A "clean" utility room for the purposes of storing and preparing clean and sterile nursing supplies, equipped with:

     (i) A work counter or table;

     (ii) A handwashing sink, with soap and paper towels or other approved hand-drying device; and

     (iii) Locked medication storage, if medications are stored in this area, that is separate from all other stored items consistent with WAC 388-78A-2260.

     (b) A "soiled" utility room for the purposes of storing soiled linen, cleaning and disinfecting soiled nursing care equipment, and disposing of refuse and infectious waste, equipped with:

     (i) A work counter or table;

     (ii) A two-compartment sink for handwashing and equipment cleaning and sanitizing;

     (iii) A clinical service sink or equivalent for rinsing and disposing of waste material;

     (iv) Soap and paper towels or other approved hand-drying device; and

     (v) Locked storage for cleaning supplies, if stored in the area.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2920, filed 7/30/04, effective 9/1/04.]

     (a) Provide residents and staff persons with the means to summon on-duty staff assistance ((from)):

     (i) From resident units;

     (ii) From common areas accessible to residents;

     (iii) From corridors accessible to residents; and

     (iv) For boarding homes issued a project number by construction review services on or after September 1, 2004 for construction related to this section, all bathrooms ((and)), all toilet rooms ((in boarding homes issued a project number by construction review services on or after September 1, 2004)), resident living rooms and sleeping rooms.

     (b) Provide residents, families, and other visitors with a means to contact a staff person inside the building from outside the building after hours.

     (2) The boarding home must provide one or more nonpay telephones:

     (a) In each building located for ready access by staff persons; and

     (b) On the premises ((for)) with reasonable access and privacy by residents.

     (3) In boarding homes issued a project number by construction review services on or after September 1, 2004 for construction related to this section, the boarding home must equip each resident room with((:

     (a) An)) two telephone lines.

     (4) If a boarding home that is issued a project number by construction services on or after September 1, 2004 chooses to install an intercom system, the intercom system must be equipped with a mechanism that allows a resident to control:

     (((i))) (a) Whether or not announcements are broadcast into the resident's room; and

     (((ii))) (b) Whether or not voices or conversations within the resident's room can be monitored or listened to by persons outside the resident's room.

     (((b) Two telephone lines.))

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2930, filed 7/30/04, effective 9/1/04.]

     (1) A resident initiates the contact; or

     (2) Staff persons announce to the resident that the intercom has been activated at the time it is activated, and:

     (a) The resident and any others in the room agree to continue the contact;

     (b) ((A visible signal is activated in the resident's room at all times the intercom is in operation; and

     (c))) The boarding home deactivates the intercom when the conversation is complete; and

     (c) The boarding home ensures each resident is aware the intercom is operating at all times the intercom is in use in the resident's room.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2940, filed 7/30/04, effective 9/1/04.]

     (1) Ensure that all sewage and waste water drain into a municipal sewage disposal system ((in accordance with)) according to chapter 246-271 WAC, if available; or

     (2) Provide on-site sewage disposal systems designed, constructed, and maintained as required by chapters 246-272 and 173-240 WAC, and local ordinances((; and

     (3) Provide a grease interceptor when the boarding home has an on-site commercial kitchen or septic system in accordance with chapter 246-272 WAC)).

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2960, filed 7/30/04, effective 9/1/04.]

     (1) Equip each resident-occupied building with an approved heating system capable of maintaining a minimum temperature of 70°F per the building code. The boarding home must:

     (a) Maintain the boarding home at a minimum temperature of 60°F during sleeping hours; and

     (b) Maintain the boarding home at a minimum of 68°F during waking hours, except in rooms:

     (i) Designated for activities requiring physical exertion; or

     (ii) Where residents can individually control the temperature in their own living units, independent from other areas.

     (2) Equip each resident-occupied building with a mechanical air cooling system or equivalent capable of maintaining a temperature of 75°F in communities where the design dry bulb temperature exceeds 85°F for one hundred seventy-five hours per year or two percent of the time, as specified in the latest edition of "Recommended Outdoor Design Temperatures -- Washington State," published by the Puget Sound chapter of the American Society of Heating, Refrigeration, and Air-Conditioning Engineers;

     (3) Equip each boarding home issued a project number by construction review services on or after September 1, 2004 for construction related to this section, with a backup source of heat in enough common areas to keep all residents adequately warm during interruptions of normal heating operations;

     (4) Prohibit the use of portable space heaters unless approved in writing by the Washington state director of fire protection; and

     (5) Equip each resident sleeping room and resident living room in boarding homes issued a project number by construction review services on or after September 1, 2004 for construction related to this section, with individual temperature controls located between thirty and forty-eight inches above the floor capable of maintaining room temperature plus or minus 3°F from setting, within a range of minimum 60°F to maximum 85°F.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2990, filed 7/30/04, effective 9/1/04.]

     (a) Eighty or more square feet of usable floor space in a one-person sleeping room;

     (b) Seventy or more square feet of usable floor space per individual in a sleeping room occupied by two or more individuals, except:

     (i) When a resident sleeping room is located within a private apartment; and

     (ii) The private apartment includes a resident sleeping room, a resident living room, and a private bathroom; and

     (iii) The total square footage in the private apartment equals or exceeds two hundred twenty square feet excluding the bathroom; and

     (iv) There are no more than two residents living in the apartment; and

     (v) Both residents mutually agree to share the resident sleeping room; and

     (vi) All other requirements of this section are met, then the two residents may share a sleeping room with less than one hundred forty square feet.

     (c) A maximum sleeping room occupancy of:

     (i) Four individuals if the boarding home was licensed before July 1, 1989, and licensed continuously thereafter; and

     (ii) Two individuals if the boarding home, after June 30, 1989:

     (A) Applied for initial licensure; or

     (B) Applied to increase the number of resident sleeping rooms; or

     (C) Applied to change the use of rooms into sleeping rooms.

     (d) Unrestricted direct access to a hallway, living room, outside, or other common-use area;

     (e) One or more outside windows with:

     (i) Window sills at or above grade, with grade extending horizontally ten or more feet from the building; and

     (ii) Adjustable curtains, shades, blinds, or equivalent for visual privacy.

     (f) One or more duplex electrical outlets per bed if the boarding home was initially licensed after July 1, 1983;

     (g) A light control switch located by the entrance for a light fixture in the room;

     (h) An individual towel and washcloth rack or equivalent, except when there is a private bathroom attached to the resident sleeping or living room, the individual towel and washcloth rack may be located in the attached private bathroom;

     (i) In all boarding homes issued a project number by construction review services on or after September 1, 2004 for construction related to this section, and when requested by a resident in a boarding home licensed on or ((prior to)) before September 1, 2004, provide a lockable drawer, cupboard or other secure space measuring at least one-half cubic foot with a minimum dimension of four inches;

     (j) Separate storage facilities for each resident in or immediately adjacent to the resident's sleeping room to adequately store a reasonable quantity of clothing and personal possessions;

     (k) A configuration to permit all beds in the resident sleeping room to be spaced at least three feet from other beds unless otherwise requested by all affected residents.

     (2) The boarding home must ensure each resident sleeping room contains:

     (a) A comfortable bed for each resident, except when two residents mutually agree to share a bed. The bed must be thirty-six or more inches wide for a single resident and fifty-four or more inches wide for two residents, appropriate for size, age and physical condition of the resident and room dimensions, including, but not limited to:

     (i) Standard household bed;

     (ii) Studio couch;

     (iii) Hide-a-bed;

     (iv) Day bed; or

     (v) Water bed, if structurally and electrically safe.

     (b) A mattress for each bed which:

     (i) Fits the bed frame;

     (ii) Is in good condition; and

     (iii) Is at least four inches thick unless otherwise requested or necessary for resident health or safety.

     (c) One or more comfortable pillows for each resident;

     (d) Bedding for each bed, in good repair; and

     (e) Lighting at the resident's bedside when requested by the resident.

     (3) The boarding home must not allow a resident sleeping room to be used as a passageway or corridor.

     (4) The boarding home may use or allow use of carpets and other floor coverings only when the carpet is:

     (a) Securely fastened to the floor or provided with nonskid backing; and

     (b) Kept clean and free of hazards, such as curling edges or tattered sections.

     (5) The boarding home must ensure each resident has either a sleeping room or resident living room that contains a sturdy, comfortable chair appropriate for the age and physical condition of the resident. This requirement does not mean a boarding home is responsible for supplying specially designed orthotic or therapeutic chairs, including those with mechanical lifts or adjustments.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-3010, filed 7/30/04, effective 9/1/04.]

     (2) The boarding home must provide each toilet room and bathroom with:

     (a) Water resistant, smooth, low gloss, nonslip and easily cleanable materials;

     (b) Washable walls to the height of splash or spray;

     (c) Grab bars installed and located to minimize accidental falls including one or more grab bars at each:

     (i) Bathing fixture; and

     (ii) Toilet.

     (d) Plumbing fixtures designed for easy use and cleaning and kept in good repair; and

     (e) Adequate ventilation to the outside of the boarding home. For boarding homes issued a project number by construction review services on or after September 1, 2004 for construction related to this section, must provide mechanical ventilation to the outside.

     (3) The boarding home must provide each toilet room with a:

     (a) Toilet with a clean, nonabsorbent seat free of cracks;

     (b) Handwashing sink in or adjacent to the toilet room. For boarding homes issued a project number by construction review services on or after September 1, 2004 for construction related to this section, the handwashing sink must be in the toilet room or in an adjacent private area that is not part of a common use area of the boarding home; and

     (c) Suitable mirror with adequate lighting for general illumination.

     (4) For boarding homes approved for construction or initially licensed after August 1, 1994, the boarding home must provide a toilet and handwashing sink in, or adjoining, each bathroom.

     (5) When providing common-use toilet rooms and bathrooms, the boarding home must provide toilets and handwashing sinks for residents in the ratios of one toilet and one handwashing sink for every eight residents or fraction as listed in the following table:

Number of Residents	Number of Toilets*	Number of Handwashing Sinks
1-8	1	1
9-16	2	2
17-24	3	3
25-32	4	4
33-40	5	5
41-48	6	6
49-56	7	7
57-64	8	8
65-72	9	9
73-80	10	10
81-88	11	11
89-96	12	12
97-104	13	13
105-112	14	14
113-120	15	15
121-128	16	16
129-136	17	17
137-144	18	18
145-152	19	19
153-160	20	20
161-168	21	21
169-176	22	22
177-184	23	23

*When two or more toilets are contained in a single bathroom, they are counted as one toilet.

     (6) When providing common-use toilet rooms and bathrooms, the boarding home must provide bathing fixtures for residents in the ratio of one bathing fixture for every twelve residents or fraction thereof as listed in the following table:

Number of Residents	Number of Bathing Fixtures
1-12	1
13-24	2
25-36	3
37-48	4
49-60	5
61-72	6
73-84	7
85-96	8
97-108	9
109-120	10
121-132	11
133-144	12
145-160	13
161-172	14
173-184	15
185-196	16

     (7) When providing common-use toilet rooms and bathrooms, the boarding home must:

     (a) Designate toilet rooms containing more than one toilet for use by men or women;

     (b) Designate bathrooms containing more than one bathing fixture for use by men or women;

     (c) Equip each toilet room and bathroom designed for use by, or used by, more than one person at a time, in a manner to ensure visual privacy for each person using the room. The boarding home is not required to provide additional privacy features in private bathrooms with a single toilet and a single bathing fixture located within a private apartment;

     (d) Provide a handwashing sink with soap and single use or disposable towels, blower or equivalent hand-drying device in each toilet room, except that single-use or disposable towels or blowers are not required in toilet rooms or bathrooms that are located within a private apartment;

     (e) Provide reasonable access to bathrooms and toilet rooms for each resident by:

     (i) Locating a toilet room on the same floor or level as the sleeping room of the resident served;

     (ii) Locating a bathroom on the same floor or level, or adjacent floor or level, as the sleeping room of the resident served; ((and))

     (iii) Providing access without passage through any kitchen, pantry, food preparation, food storage, or dishwashing area, or from one bedroom through another bedroom; and

     (f) Provide and ensure toilet paper is available at each common-use toilet.

     (8) In boarding homes issued a project number by construction review services on or after September 1, 2004 for construction related to this section, the boarding home must ensure fifty percent of all the bathing fixtures in the boarding home are roll-in type showers that have:

     (a) One-half inch or less threshold;

     (b) A minimum size of thirty-six inches by forty-eight inches; and

     (c) Single lever faucets located within thirty-six inches of the seat so the faucets are within reach of persons seated in the shower.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-3030, filed 7/30/04, effective 9/1/04.]

     (2) The boarding home must handle, clean, and store linen according to acceptable methods of infection control. The boarding home must:

     (a) Provide separate areas for handling clean laundry and soiled laundry;

     (b) Ensure clean laundry is not processed in, and does not pass through, areas where soiled laundry is handled;

     (c) Ensure areas where clean laundry is stored are not exposed to contamination from other sources; and

     (d) Ensure all staff persons wear((s)) gloves and uses other appropriate infection control practices when handling soiled laundry.

     (3) The boarding home must use washing machines that have a continuous supply of hot water with a temperature of 140°F measured at the washing machine intake, or that automatically dispense a chemical sanitizer as specified by the manufacturer, whenever the boarding home washes:

     (a) Boarding home laundry;

     (b) Boarding home laundry combined with residents' laundry into a single load; or

     (c) More than one resident's laundry combined into a single load.

     (4) The boarding home or a resident washing an individual resident's personal laundry, separate from other laundry, may wash the laundry at temperatures below 140°F and without the use of a chemical sanitizer.

     (5) The boarding home must ventilate laundry rooms and areas to the outside of the boarding home, including areas or rooms where soiled laundry is held for processing by off site commercial laundry services.

     (6) The boarding home must locate laundry equipment in rooms other than those used for open food storage, food preparation or food service.

     (7) For all boarding homes issued a project number by construction review services on or after September 1, 2004 for construction related to this section, the boarding home must provide a laundry area where residents' may do their personal laundry that is:

     (a) Equipped with:

     (i) A utility sink;

     (ii) A table or counter for folding clean laundry;

     (iii) At least one washing machine and one clothes dryer; and

     (iv) Mechanical ventilation to the outside of the boarding home.

     (b) Is arranged to reduce the chances of soiled laundry contaminating clean laundry.

     (8) The boarding home may combine areas for soiled laundry with other areas when consistent with WAC 388-78A-3110.

     (9) The boarding home may combine areas for handling and storing clean laundry with other areas when consistent with WAC 388-78A-3120.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-3040, filed 7/30/04, effective 9/1/04.]

     (a) Provide a safe, sanitary and well-maintained environment for residents;

     (b) Keep exterior grounds, boarding home structure, and component parts safe, sanitary and in good repair;

     (c) Keep facilities, equipment and furnishings clean and in good repair;

     (d) Ensure each resident or staff person maintains the resident's quarters in a safe and sanitary condition; and

     (e) Equip a housekeeping supply area on the premises with:

     (i) A utility sink or equivalent means of obtaining and disposing of mop water, separate from food preparation and service areas;

     (ii) Storage for wet mops, ventilated to the outside of the boarding home; and

     (iii) Locked storage for cleaning supplies.

     (2) For boarding homes issued a project number by construction review services on or after September 1, 2004 for construction related to this section, the boarding home must provide housekeeping supply room(s):

     (a) Located on each floor of the boarding home, except only one housekeeping supply room is required for boarding homes licensed for sixteen or fewer beds when there is a means other than using a stairway, for transporting mop buckets between floors;

     (b) In proximity to laundry and kitchen areas; and

     (c) Equipped with:

     (i) A utility sink or equivalent means of obtaining and disposing of mop water, away from food preparation and service areas;

     (ii) Storage for wet mops;

     (iii) Locked storage for cleaning supplies; and

     (iv) Mechanical ventilation to the outside of the boarding home.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-3090, filed 7/30/04, effective 9/1/04.]

     (a) Convicted of a crime against ((a)) children or other persons or ((a)) crimes ((related)) relating to financial exploitation as defined under RCW 43.43.830 or 43.43.842; or

     (b) Found by a court in a protection proceeding or in a civil damages lawsuit under chapter 74.34 RCW to have abused, neglected, abandoned or exploited a vulnerable adult; or

     (c) Found in any dependency action under chapter 13.34 RCW to have sexually assaulted, neglected, exploited, or physically abused any minor; or

     (d) Found by a court in a domestic relations proceeding under Title 26 RCW to have sexually abused, exploited, or physically abused any minor; or

     (e) Found in any final decision issued by a disciplinary board to have sexually or physically abused or neglected or exploited any minor or any vulnerable adult, or has a stipulated finding of fact, conclusion of law, an agreed order, or finding of fact, conclusion of law, or final order issued by a disciplining authority, a court of law, or entered into a state registry finding him or her guilty of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW.

     (2) This section applies to any boarding home:

     (a) Applicant;

     (b) Partner, officer or director;

     (c) Manager or managerial employee; or

     (d) Owner of five percent or more of the applicant:

     (i) Who is involved in the operation of the boarding home; or

     (ii) Who may have direct access to the boarding home residents; or

     (iii) Who controls or supervises the provision of care or services to the boarding home residents; or

     (iv) Who exercises control over daily operations.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-3190, filed 7/30/04, effective 9/1/04.]

     (a) May contest an enforcement remedy imposed by the department pursuant to RCW 18.20.190 according to the provisions of chapter 34.05 RCW and chapters 10-08 and 388-02 WAC;

     (b) Must file any request for an adjudicative proceeding with the Office of Administrative Hearings at the mailing address specified in the notice of imposition of an enforcement remedy within twenty-eight days of receiving the notice.

     (2) Orders of the department imposing licensing suspension, stop-placement, or conditions for continuation of a license are effective immediately upon notice and shall continue pending any hearing.

[Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-3220, filed 7/30/04, effective 9/1/04.]