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

     Purpose: The purpose of the new language in chapters 388-71 and 388-112 WAC is to implement and clarify the training requirements and the criminal history background check requirements as directed in chapter 74.39A RCW and to revise the implementation effective dates as directed by Initiative 1163 and subsequently ESHB 2314. Chapter 74.39A RCW requires training for long-term care workers which includes seventy-five hours of entry-level training and also requires federal and state criminal history background checks for all long-term care workers. This law increases the basic training hour requirements for long-term care workers from thirty-two hours to seventy-five hours and increases their continuing education hour requirement from ten to twelve hours annually. ESHB 2314 also allows for certified home care aides to be delegated nursing tasks and this was also added to these WACs.

     Initiative 1163, enacted by the people in November 2011, requires implementation of these rules effective beginning January 7, 2012 (unless otherwise specified). Emergency rules were filed to implement the effective dates as WSR 12-05-100 and an emergency rule extension was filed as WSR 12-21-068 on October 17, 2012. This CR-103P supersedes the CR-103Es filed to implement this rule amendment.

     Citation of Existing Rules Affected by this Order: Repealing WAC 388-71-05665, 388-71-05670, 388-71-05675, 388-71-05680, 388-71-05685, 388-71-05690, 388-71-05695, 388-71-05700, 388-71-05705, 388-71-05710, 388-71-05715, 388-71-05720, 388-71-05725, 388-71-05730, 388-71-05735, 388-71-05740, 388-71-05745, 388-71-05750, 388-71-05755, 388-71-05760, 388-71-05765, 388-71-05770, 388-71-05775, 388-71-05780, 388-71-05785, 388-71-05790, 388-71-05795, 388-71-05799, 388-71-05805, 388-71-05810, 388-71-05815, 388-71-05820, 388-71-05825, 388-71-05830, 388-71-05832, 388-71-05835, 388-71-05836, 388-71-05837, 388-71-05840, 388-71-05845, 388-71-05850, 388-71-05860, 388-71-05865, 388-71-05870, 388-71-05875, 388-71-05880, 388-71-05885, 388-71-05890, 388-71-05895, 388-71-05899, 388-71-05905, 388-71-05909, 388-71-0801, 388-71-0806, 388-71-0811, 388-71-0816, 388-71-0821, 388-71-0826, 388-71-0855, 388-112-0020, 388-112-0025, 388-112-0030, 388-112-0040, 388-112-0050, 388-112-0060, 388-112-0065, 388-112-0080, 388-112-0085, 388-112-0090, 388-112-0095, 388-112-0100, 388-112-0105, 388-112-01965, 388-112-0215, 388-112-0220, 388-112-0230, 388-112-0245, 388-112-02610, 388-112-02615, 388-112-02620, 388-112-02625, 388-112-02630, 388-112-0350 and 388-112-0375; and amending WAC 388-71-0500, 388-71-0505, 388-71-0510, 388-71-0513, 388-71-0515, 388-71-0520, 388-71-0540, 388-71-0546, 388-71-0551, 388-71-0560, 388-112-0001, 388-112-0005, 388-112-0010, 388-112-0015, 388-112-0035, 388-112-0040, 388-112-0045, 388-112-0055, 388-112-0070, 388-112-0075, 388-112-0110, 388-112-0115, 388-112-0120, 388-112-0125, 388-112-0130, 388-112-0135, 388-112-0140, 388-112-0145, 388-112-0150, 388-112-0155, 388-112-0160, 388-112-0165, 388-112-0170, 388-112-0195, 388-112-0196, 388-112-0200, 388-112-0205, 388-112-0210, 388-112-0220, 388-112-0225, 388-112-0235, 388-112-0240, 388-112-0255, 388-112-0260, 388-112-0270, 388-112-0280, 388-112-0295, 388-112-0300, 388-112-0315, 388-112-0320, 388-112-0325, 388-112-0330, 388-112-0335, 388-112-0340, 388-112-0345, 388-112-0350, 388-112-0355, 388-112-0360, 388-112-0365, 388-112-0370, 388-112-0380, 388-112-0385, 388-112-0390, 388-112-0395, 388-112-0405, and 388-112-0410.

     Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.

      Adopted under notice filed as WSR 12-16-027 on July 25, 2012.

     Changes Other than Editing from Proposed to Adopted Version: There were no major policy changes since the last filing.

     Rules were amended to coordinate training to coincide with the department of health rules which will require workers to take recertification training by their birthdays instead of by calendar year. Other clarifications were made based on comments received.

SUMMARY OF COMMENTS RECEIVED			THE DEPARTMENT CONSIDERED ALL COMMENTS SUBMITTED. THE ACTIONS TAKEN IN RESPONSE, OR THE REASONS NO ACTIONS WERE TAKEN, FOLLOW.
Proposed new WAC 388-71-0543 and 388-71-0544 permit the department, AAA, or the department designee to deny payment to individual providers and home care agencies with LTC employees for a multitude of reasons that were not previously within the department's discretion. The proposed regulations fail to provide any opportunity for the disqualified LTC worker -- whom the department declines to pay -- to challenge the decision or to be heard by an impartial body. Examples of arbitrary and inappropriate employment disqualifications allowed by the proposed rules include the following: Proposed WAC 388-71-0543 permits unreviewable department action denying payment to LTC workers even though more than three or five years have passed since the listed criminal conviction. Previously, the worker had an opportunity to establish, after the requisite time period, that they possessed the character, competence, and suitability to care for the vulnerable adult. Without basis in law, that opportunity is removed. Proposed WAC 388-71-0543 permits unreviewable department action denying payment to LTC workers based on any conviction the department agent deems related to the person's competency to provide care to a client. The proposed rule does not address whether the conviction is recent or remote in time and does not identify which convictions are related to the worker's competency to provide care. As a result, a person convicted of driving with a suspended license, for example, could be denied payment if one department agent deemed that related to the worker's competency to provide care. WAC 388-71-0543 (1)(a)-(b) and 388-71-0544 (1)(a)-(b) are also concerning. We'd like to know why the department feels these addition[al] categories of crimes should be considered disqualifying; what the magnitude of the effect of enacting these new exclusions will be on the current and future long-term care workforce, and what if any process there will be for transitioning any individuals currently in the long-term care workforce who were previously convicted of what will now be considered a disqualifying crime.			One of the purposes of chapter 388-71 WAC is to describe requirements that apply to individual providers (IPs) and home care agency employees in order for them to be qualified to have unsupervised access to vulnerable adults. The rules address training requirements and requirements related to the health, safety, and well-being of vulnerable adults who will be receiving services Changes were made to WAC 388-71-0540 and 388-71-0543 to clarify which actions require a denial of payment (WAC 388-71-0540) and which actions may result in a denial of payment (WAC 388-71-0543). WAC 388-71-0540 has been changed to more clearly state the disqualifying crimes that are in statute, including a few that have a disqualification period of three or five years from the date of conviction. For crimes with a disqualification period, character, competence, and suitability review will be conducted on a case-by-case basis after the disqualification period has passed. WAC 388-71-0543 includes those actions that may result in a denial of payment. A decision to deny payment under WAC 388-71-0543 is made on a case-by-case basis, through a character, competence, and suitability review. As required by chapter 74.39A RCW, the applicant/provider is given a right to appeal denial of payment actions related to training and certification requirements, and overpayments. The client is the employer of the IP. Therefore, the client is the individual who is given the right to appeal the department's decision not to pay for the provision of services by a specific IP. The client is afforded due process.
			As stated above, the rule related to crimes that are disqualifying for three or five years from the date of conviction were moved into WAC 388-71-0540, so that the reader will know that convictions for Theft 2 and Forgery are disqualifying for five years, and Theft 3, Prostitution, and Assault 4 are disqualifying for three years. A conviction for any of these five crimes beyond these periods of disqualification requires a character, competence, and suitability review on a case-by-case basis. The department provides training and consultation on character, competence, and suitability to department staff, AAAs, and home care agencies. There are no new crimes in rule. WAC 388-71-0540 clarifies actions that will result in denial of payment and WAC 388-71-0543 clarifies actions that may result in denial of payment.
Proposed WAC 388-71-0543 permits unreviewable department action denying payment to an LTC worker if a department agent determines the worker "has engaged in the illegal use of drugs or excessive use of alcohol or drugs without evidence of rehabilitation. ..." The proposed rule does not address whether the alleged conduct is recent or remote in time and the term "excessive" is subjective. The proposed rule provides no guidance on assessing the reliability of the information the agent is using and no requirement that it bears on the worker's current ability to do the job. It is also unclear what would constitute sufficient evidence of rehabilitation. Finally, this section of the rule seems to violate the ADA's prohibition of discrimination against recovering alcoholics and drug addicts. Proposed WAC 388-71-0543 permits unreviewable department action denying payment to an LTC worker if a department agent determines that the worker had a license to care for children or vulnerable adults denied, revoked, suspended, terminated, or not renewed, without regard to the basis for the loss or denial of the license, or the passage of time since the license ended. For instance, a person who decided not to renew a license because the cost of a new plumbing system in her/his facility was too great, could be denied payment as a LTC worker with no opportunity for review. Proposed WAC 388-71-0543 permits unreviewable department action denying payment to an LTC worker if a department agent determines that the worker voluntarily relinquished, or had any health care provider license, certification or contract denied, suspended, revoked, or terminated, even though the license was later reinstated after satisfactory completion of conditions or requirements. For instance, a young applicant for a registered nursing assistant license who was denied because s/he had not yet completed a prerequisite, but then completed the prerequisite and obtained the license, could be denied payment as a LTC worker with no opportunity for review.			WAC 388-71-0543(2) has been changed and clarifies that an IP may be denied payment if he or she is engaged in the misuse of alcohol, controlled substances, or legend drugs. Character, competence, and suitability reviews are client and IP-specific, and they may include the individual's age at the time of conviction(s), the number of years since the conviction(s), the nature of the conviction(s), and other objective information, in relation to the specific client and his or her assessed needs/tasks/service plan. The individual was provided an opportunity to appeal the licensing action, such as a revocation or suspension, at the time the action was taken. An individual who decides not to renew a license will not be denied payment, if the nonrenewal was initiated solely by the individual, as in the example given here. In contrast, an [a] decision by an agency to "not renew" the license is an action that will be considered and would fall under either WAC 388-71-0540 or 388-71-0543, depending upon the reasons for the nonrenewal. For providers who have had a license or contract for the care of children or vulnerable adults denied, revoked, suspended or terminated for failure to comply with state and federal regulations WAC 388-71-0540 and 388-71-0543 describe when the department will deny payment or when the department may deny payment. In either of the scenarios presented, the applicants voluntarily left the workforce; their actions did not result from any type of agency decision or action, consequently they would not be denied payment if they are otherwise qualified. If, the fact that their license was suspended or not renewed happened to appear on their background check, the department would ascertain the reasons for the action during the character competency and suitability review.
Proposed WAC 388-71-0543 permits unreviewable department action denying payment to an LTC worker if a department agent determines that the worker voluntarily relinquished or had a residential or health care facility license, certification or contract denied, revoked, suspended, terminated, or not renewed, without regard to the basis for the loss or denial of the license, or the passage of time since the license ended. For example, a person who left the work force for a few years to care for children or elderly parents and so relinquished his/her license, could be denied payment as a LTC worker with no opportunity for review. Proposed WAC 388-71-0543 permits unreviewable department action denying payment to an LTC worker with a pending criminal charge for a disqualifying crime, without regard to the nature of the allegations. The enabling legislation provides that the department must perform criminal background checks and to submit to fingerprints "for the purpose of investigating conviction records through both the Washington state patrol and the federal bureau of investigation." Requiring reports of pending charges before conviction, and denying payment to LTC workers who have pending charges may result in denying pay to workers who are facing false allegations and would disproportionately harm people of color.			WAC 388-71-0540 was revised to more clearly describe when the department will deny payment, and WAC 388-71-0543 was revised to more clearly describe when the department may deny payment. In the example given, an applicant who relinquished a license to care for children because he or she left the work force to care for elderly parents would not be disqualified. An applicant would be disqualified if he or she relinquished a license for the care of children because he or she had neglected children under state and federal regulations, and the license was otherwise going to be revoked or terminated. Under these circumstances, the individual would have been provided the right to appeal the underlying licensing action. That is the type of licensing action that would fall under WAC 388-71-0540. This change was made in order to make the background check requirements for IPs consistent with the department's background check requirements for other administrations and divisions. This rule does not apply to arrests, only to pending charges for crimes that would be disqualifying, if convicted. This is consistent with current practice and policy. When the court makes its determination that the person was not guilty, the charge will not be considered, nor appear on a new background check. If the person is found to be guilty of a lesser, nondisqualifying crime, the department will conduct a character, competence, and suitability review.
RECOMMENDATION: Proposed WAC 388-71-0543 and 388-71-0544 should be deleted. If any provisions remain, however, the LTC worker must be given notice and a right to appeal such determinations. RECOMMENDATION: Either the administrative hearing rights in proposed WAC 388-71-0561 and 388-71-0562 should match the expansion of DSHS discretion to deny payment described in proposed WAC 388-71-0543 and 388-71-0544, or proposed WAC 388-71-0543 and 388-71-0544 should be deleted as noted above.			The department cannot delete provider requirements for IPs (WAC 388-71-0543) and home care agency long-term care employees (WAC 388-71-0544). These rules implement rules implement[ing] new statutory requirements and clarify rules that are long standing. The department provides appeal rights for client/employers, as specified in RCW 74.39A.095. IPs have appeal rights, as specified in RCW 74.39A.056 and 43.20B.675.
The proposed amendment to WAC 388-71-0515(1) deletes the provision that the client's plan of care shall be translated or interpreted for the individual provider. COMMENT: Limited English proficient individual providers may have a solid command of conversational English, but unable to effectively read English. RECOMMENDATION: WAC 388-71-0515(1) should state "Understand the client's plan of care that is signed by the client or legal representative and which may be translated or interpreted, as necessary, for the client and the provider; ... ." Reports of large scale losses of home care workers followed the implementation of emergency rules WSR 12-05-100 and 12-13-090. The rules proposed in the latest WSR filing offer no changes. COMMENT: We received reports from regions throughout the state that home care recipients lost care providers in large numbers and shortages of available caregivers occurred because many workers could not obtain home care aide certification by the deadline. The reports included descriptions of workers who were not certified through no fault of their own, due to barriers in the application, training, testing, and evaluation process. For example, the home care application packet is twenty-three pages and offered in English only, even though many home care workers are limited English proficient. Some workers were unaware that after taking the training, the worker must fill out a second application to take the test. The effect on vulnerable adults in need of home care has been dramatic. A shortage of home care workers can cause vulnerable adults to stay at home without needed care for as long as they can to avoid institutionalization, risking falls and other injuries, malnourishment, medication mistakes, and ultimately, hospitalization. Individuals seeking to return home from nursing facilities and persons seeking to stay at home and out of care facilities are unable to do so without home care aides to help them. The individuals whom I-1163 is intended to benefit are harmed when qualified workers are not available.			Language is clarified. Translations requirements and requests apply to medicaid clients.
The effect on the state's budget is also a concern. When individuals remain in nursing facilities because there are not enough workers to provide less restrictive, less expensive options, the state's long-term care budget increases. We also understand that the AAAs are sharing their regional information with the department and that SEIU and the department are collaborating to address these problems. RECOMMENDATION: The implementation of I-1163 introduced a complex change to the long-term care system. We urge all entities involved to work promptly for solutions to reduce the barriers that potential home care workers face in getting the training and certification needed. In particular, we urge that language access accommodations be provided for limited English proficient workers throughout the entire training and certification process.
WAC 388-71-0836 definition of "functionally disabled person" or "person who is functionally disabled" should be changed to "person who has a functional disability." Please consider involving clients who receive these services in the competency training process.			The term "functionally disabled" was removed from chapter 388-71 WAC. Client advocacy groups have been involved in the development of the competencies and learning objectives of the training.
WAC 388-112-0002 - Unclear as to why this section is necessary; would recommend eliminating the phrase "long-term care worker" from the first sentence since the training described in the WAC applies to all adult family home/assisted living workers, not just "long-term care workers."			WAC 388-112-0002 delineates who the chapter applies to. The term "long-term care worker" was removed from the first sentence.
WAC 388-112-0003:
•	Reorganize the table so that the credential is in a column to the left, with all required education/training provided across in a row. This decreases confusion while including "one stop shopping" for all requirements.		Modifications were made to the table in an effort to simplify and clarify. However, major changes were not made due to formatting restrictions imposed by the office of the code reviser.
•	Ensure continuity in language regarding continuing education column: Include "12 hours" in each column in order to ensure consistency.		The suggested change was made.
•	Include ALL training requirements covered in the chapter 388-112 WAC on the table.		In order to keep the table "simple" and because of restrictions noted above, other trainings (not all of which are required) were listed below the table with reference to appropriate WAC section.
WAC 388-112-0004:
•	There is no need to "call out" the department's abilities to take action against facilities in noncompliance; this is duplication since language already exists in chapters 18.20 and 70.128 RCW.		No change was made.
•	RCW 74.39A.086 is very specific regarding enforcement action related to those providers who knowingly employ a long-term care worker who is not a certified home care aid, and is directed to promulgate the rules to implement. These rules fail to address the "appropriate enforcement action."		RCW 74.39A.086 refers specifically to employment of uncertified long-term care workers. The intention of WAC 388-112-0004 is to inform regarding actions possible for violations of other parts of this chapter.
WAC 388-112-0005:
•	Under the definition of "long-term care worker" there is a section that calls out "the following persons are not long-term care workers." Add contracted nurse/RN to this section, as they work, oftentimes, for their own company.		The definition of "long-term care worker" clearly states that "all persons providing paid, personal care services... in state-licensed facilities" are considered as long-term care workers.
•	Why is "care team" included in the definitions section? In adult family homes and assisted living facilities, residents do not direct the service plan - this appears to be relevant for the home care sector.		A change was made to allow resident to direct care "when able." The department does not wish to preclude the possibility of a resident to exercise their right to self-determine care.
•	The "direct supervision" definition is incomplete: RCW 18.20.270 [(1)](b) "direct supervision" means oversight by a person who has demonstrated competency in the core areas or has been fully exempted from the training requirements pursuant to this section, is on the premises, and is quickly and easily available to the caregiver.		Changes were made to more clearly define "direct supervision."
•	Why is the definition of "functionally disabled person" necessary in the WAC?		Term was removed from chapter 388-112 WAC.
WAC 388-112-0015, 388-112-0016, 388-112-0018, 388-112-0035: To alleviate confusion, distinguish orientation training from the long-term care worker orientation and safety training.			Changes were made to WAC 388-112-0015, 388-112-0016, 388-112-0018 and 388-112-0035 to more clearly define training requirements addressed in these sections.
WAC 388-112-0040: Eliminate this section as it needs to be separated out.			WAC 388-112-0040 repealed.
WAC 388-112-0045 What is basic training?
•	Subsection (4) should read "A previously approved basic training curriculum may be used to teach core basic training but it must include enhancements which must be approved by the department." This fully incorporates an individual's ability to use not only RFOC but another qualifying curriculum as well.		Changes were made to allow more flexibility for creative application of requirements, and similarly for examples of enhancements. Initiative 1163 was a mandate to create a comprehensive training program for long-term care workers. Enhancing fundamentals of caregiving is in keeping with Initiative 1163. No changes were made in response to second bullet point comment.
•	Examples of enhancements (and what are NOT considered enhancements) should be removed, as they limit the opportunity for creative application. Furthermore, the content of this section is outside the intent of the initiative.
WAC 388-112-0053 What topics must be taught in the core competencies of basic training for long-term care workers?
•	Many of the topics included in the core competencies are duplicative, as they are also found in the orientation and safety training. These include:		No change was made. Although there is some repetition of content matter, orientation and safety is a five-hour training and, as such, would not allow the level of detail expected in the seventy basic training. These duplicative items are key skills that are part of the skills testing through the department of health (DOH).
		Communication skills Resident rights Abuse, abandonment, neglect, financial exploitation and mandatory reporting Body mechanics Fall prevention Infection control, blood-borne pathogens
•	Add at the end of this section, "The core basic training learning outcomes and competencies may be obtained from the department."		The department is required to approve topics and competencies and therefore they are outlined in WAC.
WAC 388-112-0055 What are the core competencies and learning objectives for long-term care worker basic training?
•	By including the learning outcomes and competencies in WAC, it forces DSHS to "open" WACs whenever they wish to update and/or make changes to these outcomes and competencies. In order to avoid this, we recommend eliminating this entire section and include the statement at the end of WAC 388-112-0053: "The core basic training learning outcomes and competencies may be obtained from the department." This supports other sections of the draft WAC, such as WAC 388-112-0125.		No change was made. This section of the WAC relates directly to the skills portion of the training and testing and as such they are clearly stated.
•	If this is not the chosen pathway, consider the following as alternatives:
•	Learning objectives must be measureable; the words "recognize" and "understand" are included in many sections and are not measureable; they should be replaced.		A student's ability to "recognize" and "understand" are determined in the testing process and are legitimate terms of learning. Testing is based on learning outcomes.
•	Subsection (1)(c) "Listen attentively and determine that the resident understands what has been communicated." This should be limited to "listen attentively" as one cannot always determine that a resident understands what has been communicated. Medical, cultural, and/or cognitive conditions may limit a resident's ability to fully understand and therefore this learning objective is unattainable.		The term "when able" was added to the sentence. This term allows for the possibility that barriers may exist that would not allow for a resident to fully understand what is being communicated, but encourages communication to the fullest extent.
•	Subsection (4)(c) "Maintain a restraint-free environment, including physical, chemical, and environmental restraints .... This may not be possible, as there are rare occasions where a restraint is indeed the best option for the resident and must be implemented as part of his/her negotiated care. In this instance, workers should learn the legalities of restraint use and when they are indeed appropriate; monitoring for safety and proper implementation then becomes the key objective.		Any use of restraints in a facility would be rare, and under very specific circumstances and unique to a particular resident and their plan of care. In these instances specific training would occur for the long-term care worker that would address this unique situation. The training for long-term care workers is geared to the normal rather than the exceptional circumstance.
•	Subsection (5)(b) "Identify common symptoms of abuse, abandonment ...." Consider replacing the word "symptoms" with "indications" as the word "symptom" generally relates to a medical condition.		The suggested change was made.
•	Subsection (6)(a), add, "Describe a worker's role and limitations in resident directed care ...."
•	Subsection (6)(b), correct to identify that resident directed care is unique to in-home care situations only. Consider, "Describe the importance, impact, and limitations of resident directed care ....		Residential care offers different challenges for self-directed care but does not limit it to only in-home care.
•	Subsection (12)(a), the list of skills demonstrations are limited in scope and do not prepare the worker to fully operate as a member of the care team; vital signs measurements are expected as part of the job and are not reflected or mentioned as learning objectives or demonstrated during skills practice. Neither is safe use of mechanical lifts.		Taking and recording vital signs is not a requirement for all long-term care workers. There are approved continuing education courses that include taking and recording of vital signs. Use of mechanical lifts are also part of approved CE courses. Many facilities do not have mechanical lifts and those that do use a variety of devices. LTC worker would need to learn use of specific equipment in the facility where they work.
•	All sections that are repetitive with the orientation and/or safety requirements should be eliminated.		No change was made. The purposes of chapter 388-112 WAC are to describe training and certification requirements for long-term care workers and others in adult family homes and assisted living facilities. While some of the statements are duplicative of orientation and safety requirements, this particular section describes the core competencies for the basic training requirements. The duplicative items are key skills that are part of the skills testing through DOH.
•	Subsection (16)(e) "Identify beneficial ways and resources to work through feelings of grief and loss" is a judgmental statement and should be amended; ways that are beneficial for grieving vary amongst workers and should not be held above other methods. Consider changing to, "Identify methods and resources to work through feelings of grief and loss."		No change was made. The statement does not proscribe resources or methods for dealing with grief and loss.
WAC 388-112-0070 What documentation is required to show completion of basic training?
• • •	Eliminate the last part of the section title, as it is redundant: "What documentation is required to show completion of basic training, including core competencies and population-specific competencies? Subsections (1)(d) and (h) are duplicative (date(s) of training and completion date). Include just the completion date. Subsection (2) requires the provider and training entity to maintain a copy of the certificate. Once the worker becomes certified, the certificate is irrelevant and should not be maintained.		The suggested changes were made.
WAC 388-112-0075 Who is required to complete basic training, and when, unless exempt as described in WAC 388-112-0076?
•	This section is a repeat of the table in WAC 388-112-0003 and therefore should be eliminated. If maintained as-is, please recognize that this entire section is confusing and refers the reader (in numerous places) to refer to different sections of the WAC.		The table in WAC 388-112-0003 was devised to be a quick reference in response to stakeholder requests. It is not a replacement for this section of WAC.
•	Additionally, the section unnecessarily references certification requirements in subsection (6); this section specifically relates to basic training. Recommend deleting subsection (6).		Certification requirements are an extension of the basic training. This [is] an appropriate reference point for stakeholders.
WAC 388-112-0076 Which long-term care workers are exempt from the basic training requirement?
•	This section is too far back in the entire document and should be moved closer to the table near the beginning.		No change was made. The Administrative Procedures Act and code reviser's office do not allow for change at this point. Numbers would have to be repealed and recodified at a later date.
WAC 388-112-0078 What curriculum may be used in the population specific component of the basic training?
•	RCW 74.39A.009(20) notes that "Population specific competencies" means basic training topics unique to the care needs of the population the long-term care worker is serving, including but not limited to, mental health, dementia, developmental disabilities, young adults with physical disabilities, and older adults.		Changes were made to broaden the scope of this section.
•	"Population specific" curricula is broad and may address much more than just the three specialties. Since most adult family home and assisted living employers would prefer long-term care workers take courses that are required (as opposed to optional) it seems clear that they would choose one, two, or all three of these specialty courses to fulfill the population specific component. By locking the WACs into these three options, however, limits the possibility of future specialties.
WAC 388-112-0081, 388-112-0083, 388-112-0088, and 388-112-0091.
•	Question regarding who came up with these topics and learning objectives/competencies. Who were the consumers questioned for their input into these items as addressed?		The topics, and learning objectives and competencies were developed over time by the department. Contributions were made by long term care facilities, consumer advocates, and other community stakeholders.
•	AFH and ALF workers will most likely ALWAYS use the required population specific training courses (i.e. mental health, dementia, and/or developmental disabilities) in order to conserve funds while maximizing educational opportunities. The topics such as "young adults with physical disabilities" and "aging and older adults" are irrelevant for the purposes of the seventy-five hour training, then, and specific learning objectives and competencies should be removed from WAC.		While these topics may not be common for AFH/ALF, they are none-the-less relevant in some circumstances.
•	AFH/ALF facilities wishing to address these populations via training should be encouraged to do so through the continuing education venue, with the development of learning objectives and competencies left to the curriculum designer.		The learning objectives and competencies are examples. This does not limit further development by curriculum designers.
WAC 388-112-0092 What learning objectives may be included in the curriculum for young adults with physical disabilities and/or for aging and older adults?
This entire section is irrelevant; see above comments.			While these topics may not be common for AFH/ALF, they are none-the-less relevant in some circumstances.
WAC 388-112-0106 Who is required to obtain certification as a home care aide, and when?
•	Add subsection (5) that reads: "nursing assistant certification may be achieved in lieu of home care aide certification."		This WAC is being written to implement Initiative 1163 which specifically details a certified home care aide. People exempt from the requirements can be found in WAC 388-112-0076.
WAC 388-112-0108 What documentation is required for a long-term care worker to apply for the home care aide certification or recertification?
•	Subsection (3), eliminate the requirement for the "training entity" to verify that the certified home care aide has certificates or transcripts that add up to twelve hours of DSHS-approved continuing education. Rather, the certified home care aide shall verify twelve hours of CE.		The suggested changes were made.
•	Subsection (4), spell out who is a long-term care worker (RN, LPN, NAC, exempt long-term care worker) and certified home care aide.		The suggested change was made and WAC 388-112-0108(4) was deleted.
•	Subsection (4), there is no need to maintain the seventy-five hour certificate of completion once certification is achieved.		In response to public comment this stipulation was developed to address concerns about LTC workers changing jobs and former employers not forwarding evidence of completed training. The purpose of chapter 388-112 WAC is to describe "Training and certification requirements" that apply to providers AND to describe the training requirements that apply to "Adult family home applicants, resident managers, entity representatives, long-term care workers and volunteers" also assisted living facility administrators and their designees (WAC 388-112-0002).
•	You cannot require a long term care worker to maintain their CE certificates as long as they are employed and up to three years after termination of employment. This WAC is designed for PROVIDERS (AFH and ALF facilities), not the workers themselves.
WAC 388-112-0120 What topics must developmental disabilities specialty training include?
•	Add at the end "The developmental disabilities specialty training learning outcomes and competencies may be obtained from the department."		The department is required to approve topics and competencies and therefore feels that they should be outlined in WAC.
WAC 388-112-0122 What are the competencies and learning objectives for the long-term care worker developmental disability specialty training?
•	Eliminate entire section; refer to comments in WAC 388-112-0120.		See comment above.
WAC 388-112-0130 What topics must long-term care worker dementia specialty training include?
•	Add at the end "The long-term care worker dementia specialty training learning outcomes and competencies may be obtained from the department."		See comment above.
WAC 388-112-0132 What are the competencies and learning objectives for the long-term care worker dementia specialty training?
•	Eliminate entire section; refer to comments in WAC 388-112-0130.		See comment above.
WAC 388-112-0140 What topics must the long-term care worker mental health specialty training include?
•	Add at the end, "The long-term care worker mental health specialty training learning outcomes and competencies may be obtained from the department."		See comment above.
WAC 388-112-0142 What are the competencies and learning objectives for the long-term care worker mental health specialty training?
•	Eliminate entire section; refer to comments in WAC 388-112-0140.		See comment above.
WAC 388-112-0145 Who is required to complete competency testing for specialty training?
•	Eliminate the references to different WAC 388-112-0295, 388-112-0300, 388-112-0315; the remaining subsections spell out who must complete testing.		The suggested changes were made.
WAC 388-112-0155 What documentation is required for successful completion of specialty training?
•	Change to read, "Specialty training must be documented by a DSHS-issued certificate of successful completion, issued by the instructor or training entity, that includes: (1) The name of the student, (2) the name of the specialty training, (3) the number of training hours, (4) the name and identification number of the home or training entity, (5) the instructor's name, (6) the date of completion."		The suggested changes were made.
•	The last part of this section should be changed to read, "The employer must keep a copy of the certificate on file." Eliminate the remaining information that references other WAC sections, as this increases confusion.
WAC 388-112-0200 What is continuing education?
Subsection (1), eliminate the term "caregiving-related" in the first sentence and replace with "relevant." Many long-term care workers take continuing education courses that are not related to caregiving; likewise assisted living administrators as well as adult family home providers may benefit from continuing education that has precious little to do with caregiving. Also, change the last two words in this section from "would be" to "is."			The term "caregiving related" was removed from this section.
WAC 388-112-0205 Who is required to complete continuing education training, and how many hours of continuing education are required each year?
Subsection (1)(b), (c), change to read, "Effective July 1, 2012, all long-term care workers must complete 12 hours of continuing education each calendar year unless: (i) Basic training was taken, therefore allowing continuing education be delayed one calendar year, and (ii) specialty training was taken, therefore allowing continuing education be delayed two calendar years. Continuing education must include at least one-half hour per year on safe food handling in adult family homes.			The department linked continuing education (CE) time frame requirements to the recertification schedule developed by DOH so a long-term care worker or employer would have one time frame for renewal of certification and CE requirements, not two separate time frames.
Please see RCW 70.128.230(6) which describes continuing education requirements be completed via calendar year, not birthday to birthday. RCW 74.39A.341(1) also references continuing education requirements, simply stating the need for twelve hours per year, not specific to "calendar" or "birthday." Subsection (2)(b), (c), change to read, "Effective July 1, 2012, long-term care workers must complete 12 hours of continuing education each calendar year unless: (i) Basic training was taken, therefore allowing continuing education be delayed one calendar year, and (ii) specialty training was taken, therefore allowing continuing education be delayed two calendar years. An assisted living facility administrator with a current nursing home administrator license is exempt from this requirement.			We have noted this discrepancy with RCW 70.128.230 and 18.20.270 and will coordinate with residential care services (RCS) which licenses adult family homes and assisted living facilities. We will ask RCS to develop licensing rules that have consistent wording so the "per year" requirement is standard.
Please see RCW 18.20.270(6) which describes continuing education requirements be completed via calendar year, not birthday to birthday.
Subsection (3) "A long-term care worker or certified home care aide who did not complete ... ." There is no reason to call out the certified home care aide, as this term "long-term care workers" credential encompasses the home care aide credential. Subsection (4), change to read, "One hour of completed classroom instruction of other form of training (such as video or online course) equals one hour of continuing education. The training entity must establish a way for the long term care worker to ask the instructor questions." The eliminated section does not reference the specific title of this section and is best used elsewhere in the chapter.
WAC 388-112-0207 When must a long-term care worker or certified home care aide complete continuing education?
•	In the title, remove "certified home care aide." The term "long-term care worker" encompasses the home care aide credential.		The suggested change was made.
•	Subsection (1) requires CE be completed by the worker's birthday. This is not congruous with WAC 388-112-0205, nor with RCW 18.20.270(6), 70.128.0230(6), and 74.39A.341(1) which state calendar year and simply "year," respectively.		See response to comment under WAC 388-112-0205.
WAC 388-112-0220 May basic training be completed a second time and used to meet continuing education requirements?
•	This is an exclusive call-out and should be eliminated entirely. For example, a repeated course of nurse delegation cannot be used to fulfill the continuing education requirements, nor can repeating a specialty course.		This section was repealed.
WAC 388-112-0225 May specialty training be used to meet continuing education requirements?
The last two sentences do not match current statutes. "When a specific specialty training is completed as part of basic training the hours cannot be applied to continuing education. Different specialty training taken in subsequent years may be applied as continuing education hours." RCW 18.20.270(6) and 70.128.230(6) clearly state that the completion of a specialty training may fulfill two years' worth of continuing education.			RCW 74.39A.074 (1)(c) allows the training required in RCW 18.20.270(6) and 70.128.230(6), which is the specialty training, to apply towards the seventy-five hours of basic training as required by Initiative 1163. In addition, training above seventy-five hours is not required the first year of training. Since long-term care workers meet their specialty training requirements when they complete basic training, this cannot apply to CE the following year. Additional CE is required by statute.
WAC 388-112-0240 What are the documentation requirements for continuing education? This section must be amended to better match the significant changes to WAC 388-112-0205 as suggested.
•	Subsection (1)(b) eliminate "as approved by DSHS."		The suggested changes were made.
•	Subsection (f) eliminate "DSHS approved" in both locations within the subsection and "and signature" (because online or internet-based courses often lack instructor signature).
WAC 388-112-0255 What is first-aid training?
•	Eliminate subsections (1) - (4) that include all topics, since OSHA determines those and may change them in the future. Amend the last part of the first section to read "Training includes all course topics as identified in the OSHA first-aid training standards."		The suggested change was made.
WAC 388-112-0295 What components must competency testing include?
•	Subsection (1) states that all competency exams include a skills portion. This is not true; the forty-eight hour course for adult family homes does not include a skills portion, nor should it.		Changes were made to WAC 388-112-0295 by adding subsection (2), specific to adult family home residential care administrator training that does not include skills demonstration. The rule includes the following language "... knowledge should be measured by an assigned project ... ."
•	Determining in WAC that a competency test always includes both skills and written exams places DSHS in a predicament whereas creative changes cannot be made to better "test" a student's progress and knowledge (by way of a project, for example).
WAC 388-112-0320 What trainings must be taught with a curriculum approved by DSHS?
Eliminate the details in this entire section and replace it with "all required training courses must have approval from DSHS prior to use."			Changes were made to simplify this section but it was not eliminated.
WAC 388-112-0325 What must be submitted to DSHS for curriculum approval?
•	Subsection (2) Continuing education. Mimic the spirit of continuing education WAC for nursing home administrators (WAC 246-843-130); it is simple and to-the-point while eliminating DSHS time and effort at reviewing and approving every individual training entity and allows for DSHS audit of courses offered/entities offering courses.		Long-term care worker training cannot be defined in the same way as nursing home requirements. Initiative 1163 promotes choice of trainers and training methods for LTC workers across the state in residential and community settings.
Consider the following wording for this subsection (2): "A course provided to satisfy the continuing education requirement for long-term care workers, assisted living facility administrators (or designees), adult family home providers, and entity representatives shall meet the following conditions before being approved by the department:      (1) A request for approval shall be submitted on forms provided by the department at least one day prior to the start of the course;      (2) Such a course of study shall consist of a minimum of one hour of organized instruction;      (3) Such courses of study may include the following general subject areas or their equivalents, and shall be oriented to the worker and reasonably related to the worker's job duties or future job duties:      a. Resident management;      b. Personnel management;      c. Financial management;      d. Environmental factors affecting resident and staff well-being;      e. Laws relating to Washington state long-term care;      f. Common conditions affecting long-term care residents;      g. Activities and social programs;      h. Food and menu planning;      i. Legal aspects of employment, care and service;      j. Trends and new developments in long-term care;      k. First aid, CPR, and/or food handling;      l. Nursing and other adjunct services;      m. Resident rights.			The department is investigating a procedure whereby continuing education, approved by a national credentialing organization, would not have to be preapproved through DSHS. The criteria governing this circumstance would be posted on aging and disability services administration web site.
Subsection (4) Such course(s) of study shall issue to the worker certificates of attendance or other evidence of satisfactory completion.":
•	Eliminate the provision allowing self-study in this section.
•	Refer to the "Request for Approval of Educational Offering” (DOH form 661-004 dated November 2010) for the nursing home administrator CE curriculum application document. Sponsors that are automatically approved should be included, and based upon past high-quality professional training coursework and include:
	▪	Washington Health Care Association
	▪	Washington State Residential Care Council
	▪	Leading Age of Washington
	▪	American Health Care Association
	▪	National Center for Assisted Living
	▪	Department of Social and Health Services
	▪	NAB National Continuing Education Review Services (NCERS)
	▪	Assisted Living Federation of America
	▪	Residents Council of Washington
	▪	Oregon Healthcare Association
	▪	Washington Long-Term Care Ombudsman
	▪	Any state professional association affiliated with NAB NCERS registered or certified sponsors
	▪	American College of Health Care Administrators
	▪	Leading Age of America
•	Because the department may change its methods of curriculum approval in the future, consider changing all subsections (1) through (4) to "curriculum not developed by DSHS must be reviewed by DSHS prior to approval."
•	If these sections remain, subsection (3)(a) should read, "if the instructor or training entity wants to use a previously DSHS-approved basic training program with enhancements ... ."
WAC 388-112-0330 What is the curriculum approval process for orientation, basic training (core and population specific training), and continuing education?
•	Why are WAC 388-112-0325 and 388-112-0330 separate? By simply stating that DSHS must approve curricula and those applications must be submitted on DSHS-developed application forms, this seems to fit all aspects of required processes. Eliminate this entire section.		Initiative 1163 requires the department to create an "approval system." It is appropriate to clearly delineate the system developed.
WAC 388-112-0335 What are the requirements for an assisted living facility or adult family home that wishes to conduct orientation, safety, basic, on-the-job training, continuing education, or long-term care worker specialty training?
•	Subsection (1)(c)(v) if the home cannot teach others that are outside of employment by the same owner/operator, then don't include that option on the application. Eliminate this section entirely. Both RCW 18.20.270 and 70.128.230 encourage homes to "pool resources" to coordinate educational offerings amongst and between facilities and that the department must support this. The elimination of this opportunity sets up a financial hardship for many long-term care communities, especially those in rural areas of Washington.		An owner/operator is not prohibited from teaching nonemployees. Becoming a community instructor (CI) would allow the person to teach outside of their own facility. There is no cost associated with becoming a CI.
•	Subsection (1)(f) requires the home to keep the certificates on file for six years; certificates demonstrate successful completion of a course. Subsection (1)(g), then, which requires the home to maintain attendance and testing records, is irrelevant and should be eliminated.		Subsection (1)(g) was eliminated.
WAC 388-112-0340 Is department approval required to provide continuing education?
•	This section is redundant to WAC 388-112-0335 and should be eliminated.		Suggested change was made. WAC 388-112-0340 was repealed.
WAC 388-112-0345
•	Where is the department's statutory authority for suspending a training program? At what point can a training program be reinstated?		RCW 74.39A.074 (2), (4) states that only training curriculum approved by the department may be used to fulfill the training requirements and adopt rules to implement this section. The department's responsibility to approve training programs and instructors has been a long-standing authority.
•	Population-specific training is a component of basic training, therefore should be eliminated in the first sentence.		Suggested change was made.
•	Amend subsection (4) to read: The home's instructor(s) fail to meet the applicable trainer standards; eliminate the citations.		Suggested change was made.
WAC 388-112-0350 What trainings must be taught by an instructor who meets the applicable minimum qualifications under this chapter?
•	Referring the reader to multiple sections of the WAC is ineffective and difficult to follow. Eliminate the entire section and replace it with: "all required training courses must be taught by DSHS-approved instructors. CE and orientation/safety training must be taught by someone knowledgeable in the topics."		WAC 388-112-0350 was removed.
•	Alternately, eliminate this entire section and instead use WAC 388-112-0360 which states the same thing.
WAC 388-112-0370 What is a guest speaker, and what are the minimum qualifications to be a guest speaker for basic training?
•	Why limit this to just basic training (as the title suggests)? Consider eliminating the last three words of the title ("for basic training").		The suggested changes were made.
•	Subsection (2)(a) change to "The approved instructor must select guest speakers based on their knowledge and experience in the specific topic." By requiring an approved instructor to choose a guest speaker that meets the training requirements places him/her in the predicament of checking references and/or reviewing resumes and background. This may eliminate some very powerful presentations simply due to guest speaker's limited or otherwise alternate education and experience that is not included in the DSHS approval criteria.
•	Subsection (2)(b) eliminate the term "and qualifications."
WAC 388-112-0380 What are the minimum qualifications for an instructor for basic, population specific, on-the-job training, residential care administrator, and nurse delegation core and specialized diabetes training?
•	Subsections (3)(a)(i), (ii) By requiring the trainer to have experience in a "community setting" eliminates those nurses or other professionals who currently may work in another care setting (such as a nursing home) and who may teach in a nursing assistant certification course or similar. Likewise, it eliminates community colleges or technical schools from teaching the basic training course, as many of their instructors are also nursing instructors and/or NAC instructors who do not necessarily work in the "community based care settings."		Subsection (3)(a)(i) states "... work experience within last five years with elderly or persons with disabilities requiring long-term care in a community setting." The department views experience with the specific population to be crucial. That experience may be gained in a variety of settings, including, but not limited to, clinics, hospitals, and nursing facilities.
WAC 388-112-0385 What are the minimum qualifications for instructors for manager and long-term care worker mental health specialty training?
•	Subsection (2)(a) after "adult family home provider" add the term "or designee." This mimics the assisted living standards and allows the adult family home provider to promote a qualified resident manager or entity representative to teach the course, rather than limiting the training opportunities to just the provider.		The suggested change was made.
WAC 388-112-0390 What are the minimum qualifications for instructors for manager and long-term care worker dementia specialty?
•	Subsection (2)(a) after "adult family home provider" add the term "or designee." This mimics the assisted living standards and allows the adult family home provider to promote a qualified resident manager or entity representative to teach the course, rather than limiting the training opportunities to just the provider.		The suggested change was made.
WAC 388-112-0395 What are the minimum qualifications for instructors for manager and long-term care worker developmental disabilities specialty?
•	Subsection (2)(a) after "adult family home provider" add the term "or designee." This mimics the assisted living standards and allows the adult family home provider to promote a qualified resident manager or entity representative to teach the course, rather than limiting the training opportunities to just the provider.		The suggested change was made.
For ease of reference and reading, the sections on approval of instructors should be separated out between community-based instructors and facility-based instructors. Perhaps a table or grid that spells out the criteria for each would best depict the differences and "clean up" the oftentimes mixed topics that are included in the same sections.			A table delineating trainer qualifications was submitted for consideration of inclusion in chapter 388-112 WAC. While this table held merit it had not been proposed in previous filings and cannot be added now per code reviser restrictions. The department will consider for inclusion when chapter 388-112 WAC is next opened for review.
WAC 388-112-0405 What physical resources are required for classroom training and testing?
•	This section belongs in an approval letter (for a facility-based trainer) or contract (for a community instructor) to ensure that the space is appropriate.		No change was made. The need has been identified to establish these guidelines prior to approval of training program.

     A final cost-benefit analysis is available by contacting Martin Yates, P.O. Box 45600, Olympia, WA 98504-5600, phone (360) 725-2540, fax (360) 407-7582, e-mail martin.yates@dshs.wa.gov.

     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 86, Amended 63, Repealed 77.

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

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

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

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 86, Amended 63, Repealed 7.

     Date Adopted: December 13, 2012.

Katherine I. Vasquez

Rules Coordinator

     (1) Qualifications of an individual provider, as defined in WAC 388-106-0010;

     (2) Qualifications of a long-term care worker employed by a home care agency ((provider)), as defined in WAC 388-106-0010 and chapter ((246-336)) 246-335 WAC;

     (3) Conditions under which the department or the area agency on aging (AAA) will pay for the services of an individual provider or a home care agency ((provider)) long-term care worker;

     (4) Training requirements for an individual provider and home care agency ((provider)) long-term care worker;

     (5) Client's options for obtaining a long-term care worker. A client, as described in WAC 388-71-0836, eligible to receive long-term care services, or his/her legal representative acting on the client's behalf, may choose to receive personal care services in the client's home from an individual provider or a long-term care worker from a home care agency. If the client chooses to receive services from a home care agency, the agency will assign a long-term care worker employed by the agency to provide services to the client. Individual providers and home care agency long-term care workers are "long-term care workers" as defined in RCW 74.39A.009 and are subject to background checks under RCW 74.39A.055 and 43.20.710; and

     (6) Contracting requirements.

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-71-0500, filed 5/17/05, effective 6/17/05. Statutory Authority: RCW 74.08.090, 74.09.520, and 74.39A.090. 02-21-098, § 388-71-0500, filed 10/21/02, effective 11/21/02. Statutory Authority: Chapter 74.39A RCW and 2000 c 121. 02-10-117, § 388-71-0500, filed 4/30/02, effective 5/31/02. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, § 388-71-0500, filed 5/4/01, effective 6/4/01. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 00-03-043, § 388-71-0500, filed 1/13/00, effective 2/13/00.]

     (1) Has the primary responsibility for locating, screening, hiring, supervising, and terminating an individual provider;

     (2) Establishes an employer/employee relationship with the individual provider; and

     (3) May receive assistance from the social worker/case manager or other resources in this process.

[Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, § 388-71-0505, filed 5/4/01, effective 6/4/01. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 00-03-043, § 388-71-0505, filed 1/13/00, effective 2/13/00.]

     (1) Be eighteen years of age or older;

     (2) Provide the social worker/case manager/designee with:

     (a) A valid Washington state driver's license or other valid picture identification; and either

     (b) A Social Security card; or

     (c) Proof of authorization to work in the United States.

     (3) ((Complete and submit to the social worker/case manager/designee the department's criminal conviction background inquiry application, unless the provider is also the parent of the adult DDD client and exempted, per chapter 74.15 RCW;

     (a) Preliminary results may require a thumb print for identification purposes;

     (b) An FBI fingerprint-based background check is required if the person has lived in the state of Washington less than three years.

     (4))) Complete the required DSHS form authorizing a background check;

     (4) Disclose any disqualifying criminal convictions and pending charges, and also disclose civil adjudication proceedings and negative actions as those terms are defined in WAC 388-71-0512;

     (5) Effective January 8, 2012, be screened through Washington state's name and date of birth background check. Preliminary results may require a thumb print for identification purposes.

     (6) Effective January 8, 2012, be screened through the Washington state and national fingerprint-based background check, as required by RCW 74.39A.056.

     (7) Results of background checks are provided to the department and the employer or potential employer unless otherwise prohibited by law or regulation for the purpose of determining whether the person:

     (a) Is disqualified based on a disqualifying criminal conviction, a pending charge for a disqualifying crime, civil adjudication proceeding, or negative action; or

     (b) Should or should not be employed as an individual provider based on his or her character, competence, and/or suitability.

     (8) Disqualifying crimes, civil adjudication proceedings, and negative actions are listed in WAC 388-71-0540 (4), (5) and (6).

     (9) For those providers listed in RCW 43.43.837(1), a second Washington state and national fingerprint-based background check is required if they have lived out of the state of Washington since the first national fingerprint-based background check was completed.

     (10) The department may require an individual provider to have a Washington state name and date of birth background check or a Washington state and national fingerprint-based background check, or both, at any time.

     (11) Sign a home and community-based service provider contract/agreement to provide personal care services to a person under a medicaid state plan or federal waiver such as COPES((, MNIW, or medicaid personal care client)) or other waiver programs.

[Statutory Authority: 2004 c 276 § 206 (6)(b) and Townsend vs. DSHS, U.S. District Court, Western District of Washington, No. C 00-0944Z. 04-16-029, § 388-71-0510, filed 7/26/04, effective 8/26/04. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, § 388-71-0510, filed 5/4/01, effective 6/4/01. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 00-03-043, § 388-71-0510, filed 1/13/00, effective 2/13/00.]

     (a) Records contained in databases maintained by the Washington state patrol, including records of pending charges and criminal convictions.

     (b) Records maintained by the Washington state department of corrections and the Washington state administrative office of the courts judicial information system.

     (c) Records of negative actions, final findings, or civil adjudication proceedings of any agency or sub-agency.

     (i) A "negative action" includes the denial, suspension, revocation, or termination of a license, certification, or contract for the care of children, as defined in RCW 26.44.020, or vulnerable adults, as defined in RCW 74.34.020, for noncompliance with any state or federal regulation.

     (ii) A "civil adjudication proceeding" is a judicial or administrative adjudicative proceeding that results in a finding of, or upholds any agency finding of, domestic violence, abuse, sexual abuse, exploitation, financial exploitation, neglect, abandonment, violation of a child or vulnerable adult under any provision of law, including but not limited to chapters 13.34, 26.44, or 74.34 RCW or rules adopted under chapters 18.51 and 74.42 RCW. "Civil adjudication proceeding" also includes judicial or administrative findings that become final due to the failure of the alleged perpetrator to timely exercise a legal right to administratively challenge such findings.

     (iii) Negative actions and civil adjudication proceedings include but are not limited to, findings made and actions taken by:

     (A) DSHS adult protective services;

     (B) DSHS residential care services;

     (C) DSHS children's protective services;

     (D) The Washington state department of health; and

     (E) The nursing assistant registry;

     (iv) Any pending charge, criminal conviction, civil adjudication proceeding or negative action disclosed by the applicant.

     (2) The Washington state and national fingerprint-based background check includes a check of:

     (a) Washington state records;

     (b) Federal Bureau of Investigation (FBI) records; and

     (c) The national sex offender registry.

     (3) Except as prohibited by federal law, results are shared with the employer or prospective employer and with the department of health, as authorized.

[]

     (8) The department may require a long-term care worker to have a Washington state name and date of birth background check or a Washington state and national fingerprint-based background check, or both, at any time.

[Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, § 388-71-0513, filed 5/4/01, effective 6/4/01.]

[]

     (1) Take direction from the client, who is the IP's employer, or when appropriate, from the client's legal representative;

     (2) Understand the client's plan of care that ((is)) has been signed by the client or legal representative ((and social worker/case manager and)), which may be translated or interpreted, as necessary, ((for)) and as requested by the client ((and the provider));

     (((2))) (3) Provide the services as outlined on the client's plan of care, as ((defined)) described in WAC 388-106-0010, according to the client's direction, supervision, and prioritization of tasks within the number of hours authorized;

     (((3))) (4) Accommodate the client's individual preferences and ((differences)) unique needs in providing care;

     (((4))) (5) Contact the ((client's)) client, client's representative and case manager when there are changes ((which)) that affect the personal care and other tasks listed on the plan of care;

     (((5))) (6) Observe ((the client for)) and consult with the client or client's representative, regarding change(s) in health, take appropriate action, and respond to emergencies;

     (((6))) (7) Notify the case manager immediately when the client enters a hospital, or moves to another setting;

     (((7))) (8) Notify the case manager immediately ((if)) in the event of the ((client dies)) client's death;

     (((8))) (9) Notify the department or AAA immediately when unable to staff/serve the client; ((and))

     (((9))) (10) Notify the department/AAA when the individual provider ((or home care agency)) will no longer provide services. ((Notification to the client/legal guardian)) The individual provider must:

     (a) Give at least two weeks' notice, and

     (b) ((Be)) Notify the client or the client's representative in writing: and

     (c) Notify the client's case manager.

     (((10))) (11) Complete and keep accurate time sheets of authorized/paid hours that are accessible to the social worker/case manager; under WAC 388-106-0130, the department does not pay for shared benefit(s) or informal support provided to the client by anyone, including the IP; and

     (((11))) (12) Comply with all applicable laws ((and)), regulations, and the individual provider contract.

     (((12) A home care agency must not bill the department for in-home medicaid funded personal care or DDD respite services when the agency employee providing care is a family member of the client served, unless approved to do so through an exception to rule under WAC 388-440-0001. For purposes of this section, family member means related by blood, marriage, adoption, or registered domestic partnership.))

[Statutory Authority: RCW 74.08.090, 74.09.520, 2009 c 571, and Washington state 2009-11 budget, section 206(17). 10-06-112, § 388-71-0515, filed 3/3/10, effective 4/3/10. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-71-0515, filed 5/17/05, effective 6/17/05. Statutory Authority: RCW 74.08.090, 74.09.520, and 74.39A.090. 02-21-098, § 388-71-0515, filed 10/21/02, effective 11/21/02. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, § 388-71-0515, filed 5/4/01, effective 6/4/01. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 00-03-043, § 388-71-0515, filed 1/13/00, effective 2/13/00.]

     (1) Ensure that the assigned home care agency long-term care worker(s) understands the client's plan of care that is signed by the client or legal representative, and which may be translated or interpreted, as necessary for the client;

     (2) Provide tasks from services outlined in a client's plan of care, as described in WAC 388-106-0010;

     (3) Accommodate the client's individual preferences and unique needs in providing care;

     (4) Contact the client, client's representative and case manager when there are changes observed by the assigned home care agency long-term care worker that affect the personal care and other tasks listed on the plan of care;

     (5) Ensure that the assigned home care agency long-term care worker(s) observes the client for and consults with the client or representative, regarding change(s) in health, takes appropriate action, and responds to emergencies;

     (6) Notify the case manager immediately when the client enters a hospital, or moves to another setting;

     (7) Notify the case manager immediately in the event of the client's death;

     (8) Notify the department or AAA immediately when unable to staff/serve the client;

     (9) Notify the department or AAA when the home care agency will no longer provide services and the home care agency must:

     (a) Give at least two weeks' notice; and

     (b) Notify the client or the client's representative in writing; and

     (c) Notify the case manager.

     (10) Comply with time keeping requirements, and keep accurate time sheets of authorized/paid hours that are accessible to the appropriate department or designee staff; under WAC 388-106-0130, the department does not pay for shared benefit(s) or voluntary informal support that may be provided to the client by anyone, including providers; and

     (11) Comply with all applicable laws and regulations.

[]

[]

[Statutory Authority: 2008 c 146, RCW 18.20.090, 74.08.090, chapter 70.128 RCW. 09-03-066, § 388-71-0520, filed 1/14/09, effective 2/14/09. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-71-0520, filed 5/17/05, effective 6/17/05. Statutory Authority: RCW 74.39A.050, 2003 c 140, chapters 18.79, 18.88A RCW. 04-02-001, § 388-71-0520, filed 12/24/03, effective 1/24/04. Statutory Authority: Chapter 74.39A RCW and 2000 c 121. 02-10-117, § 388-71-0520, filed 4/30/02, effective 5/31/02. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 00-03-043, § 388-71-0520, filed 1/13/00, effective 2/13/00.]

Who	Status	Orientation Training	Safety Training	Basic Training	Continuing Education	Certification HCA-C
(1) An individual provider who is a licensed, certified health care professional	RN, LPN, CN-A, and allied health professionals listed in WAC 388-71-0839	Not required	Not required	Not required	Required. Ten hours through June 30, 2012 Twelve hours from July 1, 2012 forward per WAC 388-71-0990 and 388-71-0991	Not required
(2) An individual provider or home care agency long term care worker with specific employment history.	Employed as a long term care worker at some point between January 1, 2011 and January 6, 2012 and who completed the basic training requirements in effect on date of his or her hire. WAC 388-71-0840.	Not required	Not required	Not required	Required. Ten hours through June 30, 2012. Twelve hours from July 1, 2012 forward per WAC 388-71-0990 and 3888-71-0991.	Not required
(3) Individual provider/home care agency long term care worker.	Contracted with the department OR hired by a licensed home care agency to provide personal care service as defined in WAC 388-71-0836 and is not exempt under subsection (1) or (2) of this table.	Required. Two hours per WAC 388-71-0860.	Required. Three hours per WAC 388-71-0860.	Required. Seventy hours per WAC 388-71-0870 and 388-71-0875.	Required. Twelve hours per WAC 388-71-0990 and 388-71-0991.	Required per WAC 388-71-0975.
(4) An individual provider with limited hours.	Contracted individual providing twenty hours or less of care for one person per calendar month and does not meet criteria in (1) or (2) of this table.	Required. Two hours per WAC 388-71-0860.	Required. Three hours per WAC 388-71-0860.	Required. Thirty hours per WAC 388-71-0880.	Not required prior to June 30, 2014.	Not required
(5) Parent, step-parent, or adoptive parent as individual provider.	Department paid individual providing care for his or her adult child ONLY and receiving services through the division of developmental disabilities and not exempt under (1) or (2) of this table.	Required. Two hours per WAC 388-71-0895.	Required. Three hours per WAC 388-71-0895.	Required. Seven hours per WAC 388-71-0890.	Not required	Not required
(6) Biological, step, or adoptive parent/adult child as individual provider.	Who is a department paid individual providing care ONLY to his or her child or parent, and does not meet criteria in (5) and is not exempt under (1) or (2) of this table.	Required. Two hours per WAC 388-71-0860.	Required. Three hours per WAC 388-71-0860.	Required. Thirty hours per WAC 388-71-0880.	Required for adult child per WAC 388-71-0990 and 388-71-0991. Not required for parent provider per WAC 388-71-1001.	Not required.

[]

     The department, AAA, or department designee will deny payment for the services of an individual provider or home care agency provider ((who)):

     (1) When the services are provided by an employee of the home care agency who is related by blood, marriage, adoption, or registered domestic partnership to the client;

     (2) When he or she is the client's spouse, ((per 42 C.F.R. 441.360(g),)) except in the case of an individual provider for a chore services client. Note: For chore spousal providers, the department pays a rate not to exceed the amount of a one-person standard for a continuing general assistance grant, per WAC ((388-478-0030)) 388-478-0020;

     (((2))) (3) When he or she is the natural/step/adoptive parent of a minor client aged seventeen or younger receiving services under medicaid personal care;

     (((3))) (4) When he or she is a foster parent providing personal care to a child residing in their licensed foster home;

     (((4) Has been convicted of a disqualifying crime, under RCW 43.43.830 and 43.43.842 or of a crime relating to drugs as defined in RCW 43.43.830;))

     (5) ((Has abused, neglected, abandoned, or exploited a minor or vulnerable adult, as defined in chapter 74.34 RCW;)) When he or she has had any of the following:

     (a) A history of noncompliance with federal or state laws or regulations in the provision of care or services to children or vulnerable adults;

     (b) A conviction or pending charge for a crime in federal court or in any other state, when the department determines that the crime is equivalent to a crime under subsections (c), (d), (e), (f), or (g) below;

     (c) A conviction or pending charge for a "crime against children or other persons" as defined in RCW 43.43.830, unless the crime is simple assault, assault in the fourth degree, or prostitution and more than three years has passed since conviction;

     (d) A conviction or pending charge for "crimes relating to financial exploitation" as defined in RCW 43.43.830, unless the crime is theft in third degree and more than three years have passed since conviction, or unless the crime is forgery or theft in the second degree and more than five years has passed since conviction;

     (e) A conviction or pending charge for a "crime relating to drugs" which is the manufacture, delivery, or possession with intent to manufacture or deliver a controlled substance under one of the following:

     (i) Violation of the imitation controlled substances act (VICSA);

     (ii) Violation of the uniform controlled substances act (VUCSA);

     (iii) Violation of the uniform legend drug act (VULDA); or

     (iv) Violation of the uniform precursor drug act (VUPDA).

     (f) A conviction or pending charge for sending or bringing into the state depictions of a minor engaged in sexually explicit conduct;

     (g) A conviction or pending charge for criminal mistreatment;

     (h) Been found to have abused, neglected, financially exploited, or abandoned a minor or vulnerable adult by court of law or a disciplining authority, including the department of health. Examples of legal proceedings in which such findings could be made include juvenile court proceedings under chapter 13.34 RCW, domestic relations proceeding under title 26 RCW, and vulnerable adult protection proceedings under chapter 74.34 RCW;

     (i) A finding of abuse or neglect of a child under RCW 24.44.020 and chapter 388-15 WAC that is:

     (i) Listed on the department's background check central unit (BCCU) report; or

     (ii) Disclosed by the individual, except for findings made before December, 1998. Findings made before December 1998 require a character, competence, and suitability determination.

     (j) A finding of abuse, neglect, financial exploitation, or abandonment of a vulnerable adult that is:

     (i) Listed on any registry, including the department's registry;

     (ii) Listed on the department's background check central unit (BCCU) report; or

     (iii) Disclosed by the individual, except for adult protective services findings made before October 2003. Findings made before October 2003 require a character, competence, and suitability determination.

     (6) Who has had a license, certification, medicaid or medicare provider agreement, or a contract for the care of children or vulnerable adults denied, suspended, revoked, not renewed, or terminated, for noncompliance with state and/or federal regulations;

     (7) ((Does not successfully complete the training requirements within the time limits required in WAC 388-71-05665 through 388-71-05865)) Who obtained or attempted to obtain a license, certification or contract by fraudulent means or misrepresentation;

     (8) ((Is already meeting the client's needs on an informal basis, and the client's assessment or reassessment does not identify any unmet need; and/or)) Who knowingly, or with reason to know, made a false statement of material fact on his or her application for a license, certification, contract or any data attached to the application, or in any matter involving the department;

     (9) Who willfully prevented or interfered with or failed to cooperate with any inspection, investigation, or monitoring visit made by the department, including refusal to permit authorized department representatives to interview clients or have access to their records;

     (10) When the client's assessment or reassessment does not identify an unmet need;

     (11) Who is terminated by the client (in the case of an individual provider) or by the home care agency (in the case of an agency provider);

     (12) Who does not successfully complete applicable training requirements, within the timeframes described in WAC 388-71-0875, 388-71-0880, 388-71-0890 and 388-71-0991. If an individual provider or long-term care worker employed by a home care agency does not complete required training within the required timeframe, and:

     (a) If the worker is not required to be a certified home care aide, then the long-term care worker may not provide care until the training is completed; or

     (b) If the worker is required to be a certified home care aide, then the long-term care worker may not provide care until the certification has been granted.

     (13) Who does not successfully complete the certification or recertification requirements as described under WAC 388-71-0975; or

     (14) Who has had a home care aide certification denied, suspended, or revoked. If the individual is otherwise qualified, payment for services may resume when his or her certification has been reissued.

     In addition, the department, AAA, or department designee may deny payment to or terminate the contract of an individual provider as provided under WAC 388-71-0543, 388-71-0546, and 388-71-0551((, and 388-71-0556)).

[Statutory Authority: RCW 74.08.090, 74.09.520, 2009 c 571, and Washington state 2009-11 budget, section 206(17). 10-06-112, § 388-71-0540, filed 3/3/10, effective 4/3/10. Statutory Authority: RCW 74.08.090, 74.09.520. 07-24-026, § 388-71-0540, filed 11/28/07, effective 1/1/08. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. 06-05-022, § 388-71-0540, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-71-0540, filed 5/17/05, effective 6/17/05. Statutory Authority: Chapter 74.39A RCW and 2000 c 121. 02-10-117, § 388-71-0540, filed 4/30/02, effective 5/31/02. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, § 388-71-0540, filed 5/4/01, effective 6/4/01. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 00-03-043, § 388-71-0540, filed 1/13/00, effective 2/13/00.]

     (1) Has been convicted of:

     (a) Any crime that the department determines is reasonably related to the competency of the person to provide care to a client; or

     (b) A crime involving a firearm used in commission of a felony or in any act of violence against a person.

     (2) Is engaged in the misuse of alcohol, controlled substances, or legend drugs;

     (3) Has committed an act of domestic violence toward a family or household member;

     (4) Has been found in any final decision of a federal or state agency to have abandoned, neglected, abused or financially exploited a vulnerable adult, unless the department is required to deny payment under WAC 388-71-0540;

     (5) Has had a license for the care of children or vulnerable adults denied, suspended, revoked, terminated, or not renewed unless the department is required to deny payment under WAC 388-71-0540;

     (6) Has had any health care provider license, certification or contract denied, suspended, revoked, terminated, even though the license was later reinstated after satisfactory completion of conditions or other requirements. This provision also applies to a long-term care worker who voluntarily relinquished a license, certification or contract in lieu of revocation or termination;

     (7) Has had any residential care facility or health care facility license, certification, contract denied, suspended, revoked, terminated, even though the license, certification or contract was later reinstated after satisfactory completion of conditions or other requirements. This provision also applies to a long-term care worker who voluntarily relinquished a license, certification or contract in lieu of revocation or termination;

     (8) Has been enjoined from operating a facility for the care and services of children or adults; or

     (9) Has been the subject of a sanction or corrective or remedial action taken by federal, state, county, or municipal officials or safety officials related to the care or treatment of children or vulnerable adults, unless the department is required to deny payment under WAC 388-71-0540.

[]

     (1) Has been convicted of:

     (a) Any crime that the department determines is reasonably related to the competency of the person to provide care to a client; or

     (b) A crime involving a firearm used in commission of a felony or in any act of violence against a person.

     (2) Is engaged in the misuse of alcohol, controlled substances, or legend drugs;

     (3) Has committed an act of domestic violence toward a family or household member;

     (4) Has been found in any final decision of a federal or state agency to have abandoned, neglected, abused or financially exploited a vulnerable adult, unless such decision requires a denial of payment under this chapter;

     (5) Has had a license for the care of children or vulnerable adults denied, suspended, revoked, terminated, or not renewed, except as provided for under WAC 388-71-0540;

     (6) Has had any health care provider license, certification or contract denied, suspended, revoked, terminated, even though the license was later reinstated after satisfactory completion of conditions or other requirements. This provision also applies to a long-term care worker who voluntarily relinquished a license, certification or contract in lieu of revocation or termination;

     (7) Has had any residential care facility or health care facility license, certification, contract denied, suspended, revoked, terminated, even though the license, certification or contract was later reinstated after satisfactory completion of conditions or other requirements. This provision also applies to a long-term care worker who voluntarily relinquished a license, certification or contract in lieu of revocation or termination;

     (8) Has been enjoined from operating a facility for the care and services of children or adults; or

     (9) Has been the subject of a sanction or corrective or remedial action taken by federal, state, county, or municipal officials or safety officials related to the care or treatment of children or vulnerable adults.

[]

     (1) Evidence of misuse of alcohol, controlled substances, or legend drugs ((abuse));

     (2) A reported history of domestic violence committed by the individual provider, no-contact orders entered against the individual provider, or criminal conduct committed by the individual provider (whether or not the conduct is disqualifying under ((RCW 43.43.830 and 43.43.842)) WAC 388-71-0540);

     (3) A report from ((the client's health care provider or other)) any knowledgeable person that the ((requested)) individual provider lacks the ability or willingness to provide adequate care;

     (4) The individual provider has other employment or responsibilities that prevent or interfere with the provision of required services; or

     (5) Excessive commuting distance that would make it impractical for the individual provider to provide services as they are needed and outlined in ((the client's)) your service plan.

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. 06-05-022, § 388-71-0546, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, § 388-71-0546, filed 5/4/01, effective 6/4/01.]

     (1) ((Domestic violence or abuse, neglect, abandonment, or exploitation of a minor or vulnerable adult)) The provider's home care aide certification has been revoked;

     (2) ((Using or being under the influence of alcohol or illegal drugs during working hours)) The provider's inadequate performance or inability to deliver quality care is jeopardizing the client's health, safety, or well-being;

     (3) ((Other behavior directed toward the client or other persons involved in the client's life that places the client at risk of harm)) The department has determined that the provider lacks the character, competence or suitability necessary to protect the client's health, safety or well-being; and

     (4) ((A report from the client's health care provider that the client's health is negatively affected by inadequate care;

     (5) A complaint from the client or client's representative that the client is not receiving adequate care;

     (6) The absence of essential interventions identified in the service plan, such as medications or medical supplies; and/or

     (7) Failure to respond appropriately to emergencies)) The department, AAA or department designee may also terminate the individual provider's contract in accordance with the terms of the contract.

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. 06-05-022, § 388-71-0551, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, § 388-71-0551, filed 5/4/01, effective 6/4/01.]

     (1) The individual provider has committed domestic violence or abuse, neglect, abandonment, or exploitation of a child, as defined in RCW 26.44.020, or a vulnerable adult, as defined in RCW 74.34.020;

     (2) The individual provider is engaged in the misuse of alcohol, controlled substances, or legend drugs during working hours;

     (3) The individual provider engages in other behavior directed toward the client or other persons involved in the client's life that places the client at risk of harm;

     (4) A report from the client's health care provider that the client's health is negatively affected by inadequate care being provided by the individual provider;

     (5) A complaint from the client or client's representative that the client is not receiving adequate care from the individual provider;

     (6) The individual provider failed to engage in essential interventions identified in the service plan, such as medications or medical supplies;

     (7) The individual provider failed to respond appropriately to emergencies; and/or

     (8) The department, AAA or department designee may also summarily suspend the individual provider's contract in accordance with the terms of the contract.

[]

     (((1) A fair)) (a) An administrative hearing to appeal the decision, ((per)) as described in chapter 388-02 WAC and TITLE 182 WAC, and

     (((2))) (b) Receive services from another currently contracted qualified individual provider or home care agency ((provider)) long-term care worker, or ((other options)) to receive services through other programs the client is eligible for((, if a contract is summarily suspended)).

     (((3))) (2) The hearing rights ((afforded)) provided under this section are ((those)) rights of the client((, not)) and not the individual provider.

[Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, § 388-71-0560, filed 5/4/01, effective 6/4/01. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 00-03-043, § 388-71-0560, filed 1/13/00, effective 2/13/00.]

     (a) He or she has not been certified by the department of health as a home care aide within the required timeframe; or

     (b) If exempted from certification, he or she has not completed required training within the required timeframe.

     (2) An individual provider has the right to an administrative hearing when the department terminates the individual provider's contract, or takes other enforcement measures against the individual provider because:

     (a) He or she has not completed required training within the required timeframe; or     

     (b) His or her certification as a home care aide has been revoked by the department of health.

     (3) In an administrative hearing challenging an action under subsection (1) or (2) above, the individual provider may not challenge an action by the department of health that affects the individual provider's certification. Actions by the department of health must be challenged through an appeal to the department of health, as provided in department of health rules.

     (4) To request an administrative hearing, an individual provider must send, deliver, or fax a written request to the office of administrative hearings (OAH). OAH must receive the written request within thirty calendar days of the date the department's notice letter is served upon the individual provider.

     (5) The individual provider should keep a copy of the request.

     (6) The appeal process will be governed by the Administrative Procedures Act (chapter 34.05 RCW), RCW 74.39A.085, chapter 388-02 WAC, TITLE 182 WAC and this chapter. If there is a conflict between chapter 388-02 WAC, TITLE 182 WAC and this chapter, this chapter will govern.

[]

     Reviser's note: The unnecessary underscoring 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.

     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.
NEW SECTION
WAC 388-71-0562   When does a medicaid contracted home care agency have the right to an administrative hearing and how can a hearing be requested?   (1) A medicaid contracted home care agency has the right to an administrative hearing when the department or a department designee terminates its contract or takes other enforcement action related to its contract because the home care agency:

     (a) Knowingly employs a long-term care worker who has not completed training within the required timeframe.

     (b) Knowingly employs a long-term care worker who does not meet the certification or recertification requirements or whose certification has been revoked by the department of health.

     (2) In an administrative hearing under subsection (1) or (2) above, the medicaid contracted home care agency may not challenge an action taken by the department of health that affects a long-term care worker's certification. Actions by the department of health must be challenged through an appeal to the department of health, as provided in department of health rules.

     (3) To request an administrative hearing, a home care agency must send, deliver, or fax a written request to the office of administrative hearings (OAH). OAH must receive the written request within thirty calendar days of the date the department's notice letter is served upon the home care agency.

     (4) The home care agency should keep a copy of the request.

     (5) The appeal process will be governed by the Administrative Procedures Act (chapter 34.05 RCW), RCW 74.39A.085, chapter 388-02 WAC, TITLE 182 WAC and this chapter. If there is a conflict between chapter 388-02 WAC, TITLE 182 WAC and this chapter, this chapter will govern.

[]

     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.
NEW SECTION
WAC 388-71-0836   What definitions apply to the long-term care worker training requirements?   "Activities of daily living", in the context of this chapter, means self-care abilities related to personal care such as bathing, eating, using the toilet, dressing, and transfer. Instrumental activities of daily living may also be used to assess a person's functional abilities in the home and the community such as cooking, shopping, house cleaning, doing laundry, working, and managing personal finances.

     "Care team" includes the client and everyone involved in his or her care. The care team can include family, friends, doctors, nurses, long-term care workers, social workers and case managers. The role of the care team is to support the well-being of the client, however, the client directs the care plan.

     "Certified home care aide" means a long-term care worker who has obtained and maintains a home care aide certification through the department of health.

     "Challenge test" means a challenge test taken for specialty training, without first taking the class for which the test is designed and can only be used when basic training is not required.

     "Client" means an individual receiving in-home services.

     "Competency" defines the integrated knowledge, skills, or behavior expected of a long-term care worker after completing training in a required topic area. Learning objectives are associated with each competency.

     "Competency testing" is evaluating a student to determine if he or she can demonstrate the required level of skill, knowledge, and/or behavior with respect to the identified learning objectives of a particular course. The department only requires competency testing for nurse delegation core and specialized diabetes training and the specialty trainings. Training programs may integrate competency testing within their approved curricula.

     "DDD" refers to the division of developmental disabilities.

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

     "Enhancement" is additional time provided for skills practice and additional training materials or classroom activities that help a worker to thoroughly learn the course content and skills. Enhancements can include new student materials, videos or DVDs, on-line materials, and/or additional student activities.

     "Guardian" means an individual as defined in chapter 11.88 RCW.

     "Individual provider" means a person who has contracted with the department to provide personal care or respite care services to persons with functional disabilities under a medicaid state plan or federal waiver such as community options program entry system (COPES), or other waiver programs.

     "Learning objectives" are measurable, written statements that clearly describe what a long-term care worker must minimally learn to meet each competency. Learning objectives are identified for each competency. Learning objectives provide consistent, common language and a framework for curriculum designers, the curriculum approval process, and testing. Curriculum developers have the flexibility to determine how learning objectives are met and may include additional content deemed necessary to best meet the competency in a particular setting.

     "Long-term care worker" includes all persons providing paid, personal care services for the elderly or persons with disabilities, including individual providers of home care services, direct care employees of home care agencies, providers of home care services to persons with developmental disabilities under Title 71A RCW, all direct care workers in state-licensed boarding homes, adult family homes, respite care providers, community residential service providers, and any other direct care staff providing home or community-based services to the elderly or persons with functional disabilities or developmental disabilities, and supported living providers.

     The following persons are not long-term care workers:

     (1) Persons who are:

     (a) Providing personal care services to individuals who are not receiving state-funded services; and

     (b) The person is not employed by an agency or facility that is licensed by the state.

     (2) Persons employed by:

     (a) Nursing homes licensed under chapter 18.51 RCW;

     (b) Facilities certified under 42 CFR Part 483;

     (c) Residential habilitation centers under chapter 71A.20 RCW;

     (d) Hospitals or other acute care settings;

     (e) Hospice agencies licensed under chapter 70.127 RCW;

     (f) Adult day care centers or adult day health centers.

     (3) Persons whose services are exclusively limited to assistance with "instrumental activities of daily living," as that term is defined in WAC 388-106-0010.

     "Personal care services" means physical or verbal assistance with activities of daily living, or activities of daily living and instrumental activities of daily living which are provided to the client.

     "Training entity" means an organization, including an independent contractor, who is providing or may provide training under this section using approved curriculum. Training entities may only deliver approved curriculum.

     "Training partnership" means a joint partnership or trust that includes the office of the governor and the exclusive bargaining representative of individual providers under RCW 74.39A.270 with the capacity to provide training, peer mentoring, and workforce development, or other services to individual providers.

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     (1) A person already employed as a long term care worker on January 6, 2012, who completed the basic training requirements in effect on the date of his or her hire;

     (2) A person employed as a long term care worker on January 6, 2012, who completes within one hundred twenty days of hire the basic training requirements in effect on the date of his or her hire;

     (3) A person previously employed as a long term care worker who completed the basic training requirements in effect on the date of his or her hire, and was employed as a long term care worker at some point between January 1, 2011 and January 6, 2012, this exemption will be verified at time of hire or service begin date;

     (4) An individual provider who worked as a respite provider or who provided care to a minor between January 1, 2011 and January 6, 2012, and who completed the training requirements in effect on the date of his or her hire;

     (5) Registered nurses, licensed practical nurses, nurse technicians, or advanced registered nurse practitioner under chapter 18.79 RCW;

     (6) Nursing assistants certified under chapter 18.88A RCW;

     (7) Certified counselors under chapter 18.19 RCW;

     (8) Speech language pathologists or audiologists under chapter 18.35 RCW;

     (9) Occupational therapists under chapter 18.59 RCW;

     (10) Physical therapists under chapter 18.74 RCW;

     (11) A home health aide who is employed by a medicare certified home health agency and has met the requirements of 42 CFR, Part 483.35;

     (12) An individual with special education training and has an endorsement granted by the superintendent of public instruction as described in RCW 28A.300.010; and

     (13) Individuals who are in a training program to become credentialed in a category listed from subsection (5) through (10) must complete this training program within one hundred twenty days of hire or service begin date to meet this exemption.

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     (2) The department must approve orientation curricula and instructors.

     (3) There is no challenge test for orientation.

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     (1) The care setting and the characteristics and special needs of the population served or to be served;

     (2) Basic job responsibilities and performance expectations;

     (3) The care plan, including what it is and how to use it;

     (4) The care team;

     (5) Process, policies, and procedures for observation, documentation and reporting;

     (6) Client rights protected by law, including the right to confidentiality and the right to participate in care decisions or to refuse care and how the long-term care worker will protect and promote these rights;

     (7) Mandatory reporter law and worker responsibilities; and

     (8) Communication methods and techniques that can be used while working with a client or guardian, and other care team members.

     One hour of completed classroom instruction or other form of training (such as video or on-line course) equals one hour of training. The training entity must establish a way for the long-term care worker to ask the instructor questions.

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     (2) The department must approve safety training curricula and instructors.

     (3) There is no challenge test for safety training.

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     (1) Safety planning and accident prevention, including but not limited to:

     (a) Proper body mechanics;

     (b) Fall prevention;

     (c) Fire safety;

     (d) In-home hazards;

     (e) Long-term care worker safety; and

     (f) Emergency and disaster preparedness.

     (2) Standard precautions and infection control, including but not limited to:

     (a) Proper hand washing;

     (b) When to wear gloves and how to correctly put them on and take them off;

     (c) Basic methods to stop the spread of infection;

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

     (e) Appropriate disposal of contaminated/hazardous articles;

     (f) Reporting exposure to contaminated articles; and

     (g) What to do when sick or injured, including whom to report this to.

     (3) Basic emergency procedures, including but not limited to:

     (a) Evacuation preparedness;

     (b) When and where to call for help in an emergency;

     (c) What to do when a client is falling or falls;

     (d) Location of any advanced directives and when they are given; and

     (e) Basic fire emergency procedures.

     One hour of completed classroom instruction or other form of training (such as video or on-line course) equals one hour of training. The training entity must establish a way for the long-term care worker to ask the instructor questions.

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     (a) Core competencies; and

     (b) Population specific competencies.

     (2) All seventy hour basic training curriculum must be approved by the department and provided by qualified instructors.

     (3) The DSHS developed revised fundamentals of caregiving (RFOC) or another department approved training may be used to teach core basic training but it must include enhancements. Examples of enhancements are, but are not limited to:

     (a) Adding more time for workers to practice skills including:

     (i) The mechanics of completing the skill correctly.

     (ii) Client centered communication and problem solving associated with performing the skill.

     (iii) The different levels of care required for each skill (independent, supervision, limited, extensive, total).

     (iv) Working with assistive devices associated with a skill.

     (v) Helpful tips or best practices in working through common client challenges associated with a skill.

     (vi) Disease specific concerns or challenges associated with a skill.

     In most of these examples, additional student materials would be required to ensure the skill enhancements are well planned and documented for students. Materials must be submitted for approval and approved per WAC 388-71-1026.

     (b) Augmenting or adding additional materials, student activities, videos or guest speakers that:

     (i) More deeply reinforce and fortify the learning outcomes required for basic training.

     (ii) Ensure each student integrates and retains the knowledge and skills needed to provide quality basic personal care.

     (iii) Prepares workers for the certification testing environment and process.

     (c) Enhancements are NOT materials and/or activities that:

     (i) Are out of the scope of practice for a LTC worker such as content clearly written for registered nurses.

     (ii) Are identical to, or a direct replacement of, those already included in RFOC.

     (iii) Do not reinforce Washington state laws associated with client rights and client directed care.

     (iv) Long-term care workers are not paid to provide.

     (v) Are written above a high school reading level.

     (4) One hour of completed classroom instruction or other form of training (such as a video or on-line course) equals one hour of training.

     (5) The training entity must establish a way for the long-term care worker to ask the instructor questions.

     (6) There is no challenge test for basic training.

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     (1) The date of hire for home care agency long-term care workers; or

     (2) From the begin date of the authorization to provide department-paid in-home services for a client for individual providers.

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     (1) His or her biological, step, or adoptive child or parent.

     (2) An individual provider who:

     (a) Provides care to only one person; and

     (b) Provides no more than twenty hours of care in any calendar month.

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     (2) If the individual provider initially starts working for one client and the authorized monthly hours are twenty or fewer, he or she will have to complete the seventy hours of basic training, become certified, and complete continuing education whenever:

     (a) The authorized hours increase to more than twenty hours; or

     (b) He or she begins to work for a second department client.

     (3) Under these circumstances from the point of this change, the individual provider will:

     (a) Have an additional one hundred twenty days to complete the seventy hours of training and additional one hundred fifty days to become certified;

     (b) Be required to complete continuing education under WAC 388-71-0990; and

     (c) Be required to continue to comply with the higher level of training requirements, even if the monthly authorized hours are later reduced to twenty or fewer hours.

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     (a) Medicaid personal care;

     (b) Assessments completed by the division of developmental disabilities;

     (c) Community resources;

     (d) State and federal benefits;

     (f) Networking; and

     (g) Client self-determination.

     (2) There is no challenge test for this training.

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     Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-71-0906   What topics must be taught in the core competencies of basic training?   Basic training must include all of the competencies under WAC 388-71-0911 for the following topics:

     (1) Communication skills;

     (2) Long-term care worker self-care;

     (3) Problem solving;

     (4) Client rights and maintaining dignity;

     (5) Abuse, abandonment, neglect, financial exploitation and mandatory reporting;

     (6) Client directed care;

     (7) Cultural sensitivity;

     (8) Body mechanics;

     (9) Fall prevention;

     (10) Skin and body care;

     (11) Long-term care worker roles and boundaries;

     (12) Supporting activities of daily living;

     (13) Food preparation and handling;

     (14) Medication assistance;

     (15) Infection control, blood-borne pathogens, HIV/AIDS; and

     (16) Grief and loss.

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     (1) Regarding communication, communicate effectively and in a respectful and appropriate manner with clients, family members, and care team members:

     (a) Recognize how verbal and nonverbal cues impact communication with the client and care team;

     (b) Engage and respect the client through verbal and nonverbal communication;

     (c) Listen attentively and determine that the client, when able, understands what has been communicated;

     (d) Recognize and acknowledge clients' communication including indicators of pain, confusion, or misunderstanding;

     (e) Utilize communication strategies to deal with difficult situations; and

     (f) Recognize common barriers to effective communication and identify how to eliminate them.

     (2) Regarding long-term care worker self-care, take appropriate action to reduce stress and avoid burnout:

     (a) Identify behaviors, practices and resources to reduce stress and avoid burnout;

     (b) Recognize common barriers to self-care and ways to overcome them; and

     (c) Recognize aspects of a long-term care worker's job that can lead to stress and burnout, common signs and symptoms of stress and burnout; and the importance of taking action to practice self-care to avoid burnout.

     (3) Regarding the competency of effective problem solving, use effective problem solving skills:

     (a) Explain why it is necessary to understand and utilize a problem solving method;

     (b) Implement a problem solving process/method; and

     (c) Identify obstacles to effective problem solving and ways to overcome them.

     (4) Regarding the competency of client rights and dignity, take appropriate action to promote and protect a client's legal and human rights as protected by federal and Washington state laws including:

     (a) Protect a client's confidentiality, including what is considered confidential information, to whom a long-term care worker is allowed or not allowed to give confidential information, and how to respond if a noncare team member asks for confidential information;

     (b) Promote dignity, privacy, encourage, and support a client's maximum independence when providing care; and

     (c) Maintain a restraint-free environment, including physical, chemical, and environmental restraints. Use common, safe alternatives to restraint use;

     (d) Protect and promote the client's right to live free of abuse, neglect, abandonment, and financial exploitation.

     (5) Regarding the competency of abuse and mandatory reporting, recognize the signs of abuse and report suspected abuse, abandonment, neglect, and financial exploitation:

     (a) Describe long-term care workers' responsibilities as a mandatory reporter as defined in RCW 74.34.020 through 74.34.053; and

     (b) Identify common indications of abuse, abandonment, neglect, and financial exploitation.

     (6) Regarding the competency of client directed care, take appropriate action when following a client's direction regarding his or her care:

     (a) Describe a worker's role in client directed care including determining, understanding, and supporting a client's choices;

     (b) Describe the importance and impact of client directed care on a client's independence, self-determination, and quality of life;

     (c) Identify effective problem solving strategies that help balance a client's choice with personal safety; and

     (d) Report concerns when a client refuses care or makes choices that present a possible safety concern.

     (7) Regarding the competency of cultural sensitivity, provide culturally appropriate care:

     (a) Describe how cultural background, lifestyle practices, and traditions can impact care and use methods to determine and ensure that these are respected and considered when providing care.

     (8) Regarding the competency of body mechanics, utilize current best practices and evidence-based methods of proper body mechanics while performing tasks as outlined in the care plan.

     (9) Regarding the competency on fall prevention, prevent or reduce the risk of falls:

     (a) Identify fall risk factors and take action to reduce fall risks for a client; and

     (b) Take proper steps to assist when a client is falling or has fallen.

     (10) Regarding the competency of skin and body care, use personal care practices that promote and maintain skin integrity:

     (a) Explain the importance of observing a client's skin, when to observe it and what to look for including common signs and symptoms of skin breakdown;

     (b) Identify risk factors of skin breakdown;

     (c) Observe skin at pressure point locations and report any concerns;

     (d) Describe what a pressure ulcer is, what it looks like, and what actions to take if a client develops a pressure ulcer;

     (e) Describe current best practices that protect and maintain a client's skin integrity including position changes when sitting or lying for extended periods and proper positioning and transfer techniques;

     (f) Implement current best practices that promote healthy skin including hygiene, nutrition, hydration, and mobility; and

     (g) Identify when to report skin changes and to whom.

     (11) Regarding the competency on long-term care worker roles and boundaries, adhere to basic job standards, expectations, and requirements and maintain professional boundaries:

     (a) Identify when, how, and why to obtain information from appropriate sources about a client's condition or disease for which they are receiving services. Describe how to use this information to provide appropriate, individualized care;

     (b) Describe a client's baseline based on information provided in the care plan and explain why it is important to know a client's baseline;

     (c) Identify changes in a client's physical, mental, and emotional state;

     (d) Report changes from baseline and/or concerns to the appropriate care team member(s);

     (e) Identify basic job standards and requirements (e.g. coming to work on time) and describe how maintaining these standards are critical to a client's safety and well-being;

     (f) Explain the purpose of a care plan and describe how it is created, used and modified;

     (g) Use a client's care plan to direct a worker's job tasks and any client directed care tasks;

     (h) Identify what is required of a long-term care worker, as described in WAC 388-71-0946, prior to performing a nurse-delegated task;

     (i) Describe the role of a care team and a long-term care worker's role in it;

     (j) Describe professional boundaries and the importance of maintaining them; and

     (k) Identify signs of unhealthy professional boundaries, barriers to keeping clear professional boundaries, and ways to avoid or eliminate them.

     (12) Regarding the competency on supporting activities of daily living, perform required personal care tasks to the level of assistance needed and according to current best practices and evidence-based guidelines:

     (a) Demonstrate, in the presence of a qualified instructor, all critical steps required for personal care tasks including but not limited to:

     (i) Helping an individual walk;

     (ii) Transferring an individual from bed to wheelchair;

     (iii) Turning and repositioning an individual in bed;

     (iv) Providing mouth care;

     (v) Cleaning and storing dentures;

     (vi) Shaving a face;

     (vii) Providing fingernail care;

     (viii) Providing foot care;

     (ix) Providing a bed bath;

     (x) Assisting an individual with a weak arm to dress;

     (xi) Putting knee-high elastic stockings on an individual;

     (xii) Providing passive range of motion for one shoulder;

     (xiii) Providing passive range of motion for one knee and ankle;

     (xiv) Assisting an individual to eat;

     (xv) Assisting with peri-care;

     (xvi) Assisting with the use of a bedpan;

     (xvii) Assisting with catheter care;

     (xviii) Assisting with condom catheter care; and

     (xix) Providing medication assistance.

     (b) In the process of performing the personal care tasks, use proper body mechanics, listen attentively, speak clearly and respectfully while explaining what the long-term care worker is doing, incorporate client preferences, maintain privacy and dignity, support the client's level of ability, and assure their comfort and safety;

     (c) Appropriately utilize assistive device(s) specified in the care plan;

     (d) Describe any safety concerns related to each task and how to address the concerns;

     (e) Demonstrate an understanding of bowel and bladder functioning, including factors that promote healthy bowel and bladder functioning, and the signs, symptoms, and common causes of abnormal bowel and bladder function; and

     (f) Identify the importance of knowing a client's bowel and bladder functioning baseline and when to report changes.

     (13) Regarding the competency on food preparation and handling, plan and prepare meals using a basic knowledge of nutrition and hydration, incorporating any diet restrictions or modifications, and prevent food borne illness by preparing and handling food in a safe manner:

     (a) Describe how nutrition and hydration can impact a client's health;

     (b) Plan, shop, and prepare meals for a client according to the guidelines of good nutrition and hydration, incorporating any dietary requirements and restrictions per the care plan and client preferences;

     (c) Describe common signs of poor nutrition and hydration, and when to report concerns and to whom;

     (d) Understand that diet modification is required for certain health conditions, including dysphagia, and describe how to identify diet modifications required for a client;

     (e) Recognize when a client's food choices vary from specifications on the care plan, describe when and to whom to report concerns;

     (f) Describe what causes food borne illness, the risks associated with food borne illness and examples of potentially hazardous foods;

     (g) Describe appropriate food handling practices, including: avoiding cross contamination from one food to another, safe storage requirements for cooling of leftover foods, including depth, types of containers, and temperatures, the need to maintain food at proper temperatures to limit bacterial growth and what are the safe food storage and holding temperatures for both cold and hot foods, best practices for thawing and re-heating food, and using clean gloves (if possible), and clean utensils when preparing food;

     (h) Describe the importance and correct procedure for cleaning and disinfecting food contact surfaces; and

     (i) Describe why a long-term care worker with certain types of illnesses and/or symptoms must not prepare food.

     Long-term care workers who complete DSHS approved basic training meet the training requirements for adult family homes in RCW 70.128.250.

     (14) Regarding the competency of medication assistance, appropriately assist with medications:

     (a) Identify what a long-term care worker is allowed and not allowed to do when assisting with medications as described in chapter 246-888 WAC;

     (b) Define terms related to medication assistance including prescription drugs, over the counter medications, and as needed (PRN) medications, medication side effects, and drug interactions;

     (c) Identify common symptoms of medication side effects and when and to whom to report concerns;

     (d) Store medications according to safe practices and the label instructions;

     (e) Describe, in the proper sequence, each of the five rights of medication assistance; and

     (f) Identify what to do for medication-related concerns, including describing ways to work with a client who refuses to take medications, identifying when and to whom to report when a client refuses medication or there are other medication-related concerns, and identifying what is considered a medication error and when and to whom it must be reported.

     (15) Regarding the competency of infection control and blood borne pathogens including HIV/AIDS, implement best practices to prevent and control the spread of infections:

     (a) Identify commonly occurring infections, ways that infections are spread, and symptoms of infections;

     (b) Describe the purpose, benefit and proper implementation of standard precautions in infection control;

     (c) Implement current best practices for controlling the spread of infection, including the use of hand washing and gloves;

     (d) Demonstrate proper hand washing and putting on and taking off gloves;

     (e) Identify immunizations that are recommended for adults to reduce the spread of virus and bacteria;

     (f) Describe laundry and housekeeping measures that help in controlling the spread of infection;

     (g) Describe proper use of cleaning agents that destroy micro-organisms on surfaces;

     (h) Describe what blood-borne (BB) pathogens are and how they are transmitted;

     (i) Identify the major BB pathogens, diseases, and high-risk behaviors for BB diseases;

     (j) Identify measures to take to prevent BB diseases;

     (k) Describe what to do if exposed to BB pathogens and how to report an exposure;

     (l) Describe how HIV works in the body;

     (m) Explain that testing and counseling for HIV/AIDS is available;

     (n) Describe the common symptoms of HIV/AIDS;

     (o) Explain the legal and ethical issues related to HIV including required reporting, confidentiality and nondiscrimination; and

     (p) Explain the importance of emotional issues and support for clients and long-term care workers.

     Long-term care workers who complete DSHS-approved basic training meet the four hours of AIDS education as required by the department of health in WAC 246-980-040.

     (16) Regarding the competency on grief and loss, support yourself and the client in the grieving process:

     (a) Define grief and loss;

     (b) Describe common losses a client and long-term care worker may experience;

     (c) Identify common symptoms associated with grief and loss;

     (d) Describe why self-care is important during the grieving process; and

     (e) Identify beneficial ways and resources to work through feelings of grief and loss.

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     (a) Dementia;

     (b) Mental health;

     (c) Developmental disabilities;

     (d) Young adults with physical disabilities; and

     (e) Aging and older adults.

     (2) Specialty training per WAC 388-112-0110 may be used to meet the population specific component of basic training. The training program will provide a department issued specialty certificate in these instances.

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     Competencies and learning objectives described for developmental disability specialty training in WAC 388-112-0122, dementia specialty training in WAC 388-112-0132, mental health specialty training in WAC 388-112-0142, aging and older adults in WAC 388-112-0091 and young adults with physical disabilities in WAC 388-112-0083 may be used to develop the population specific training in these topic areas. This is not a requirement.

     Competencies and learning objectives used to develop the training must be submitted with the curricula when sent to DSHS for approval as described in WAC 388-71-1026.

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     (2) On-the-job training is provided by a qualified instructor as described in WAC 388-71-1055, who directly observes, coaches, and reinforces skills training for up to two long-term care workers at a time. The instructor providing the on-the-job training:

     (a) Does not have to be the instructor who has taught the core competency training;

     (b) Cannot be someone whose primary job duty is providing direct care to clients; or

     (c) Cannot be the immediate supervisor of the long-term care worker receiving the on-the-job training.

     (3) The person overseeing on-the-job training must:

     (a) Submit DSHS required forms and become an approved instructor for the core competency of basic training; and

     (b) Verify on a DSHS approved skills checklist the long-term care worker's successful completion of the demonstrated skills.

     (4) For the person receiving on-the-job training, the hours spent in on the job training may count for up to twelve hours toward the completion of basic training requirements.

     (5) The training program shall offer department approved on-the-job training as part of the seventy hour training.

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     (2) Only the curriculum developed by DSHS, "Nurse Delegation for Nursing Assistants" meets the training requirement for nurse delegation core training.

     (3) DSHS must approve the instructors for nurse delegation core training prior to an instructor offering a course.

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     (2) The specialized diabetes nurse delegation training consists of three modules which are diabetes, insulin, and injections.

     (3) Only the curriculum developed by DSHS, "Nurse Delegation for Nursing Assistants: Special Focus on Diabetes" may be used for the specialized diabetes nurse delegation training.

     (4) DSHS approves the instructors for the specialized diabetes nurse delegation training prior to an instructor offering a course.

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     (1) Be a:

     (a) Certified home care aide under chapter 18.88B RCW; or

     (b) Nursing assistant certified under chapter 18.88A RCW; or

     (c) If exempt from the home care aide certification, become a nursing assistant registered and complete the core competencies of basic training, unless the twenty-eight hours of revised fundamentals of care or a department approved alternative was already completed.

     (d) If nurse delegation is needed to implement a care plan earlier than home care aide certification can be obtained, become a nursing assistant registered and complete core competencies of basic training.

     (2) Successfully complete "Nurse Delegation for Nursing Assistants" training.

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     (1) The name of the student;

     (2) The title of the training as approved by the department;

     (3) For continuing education the department assigned curriculum approval code;

     (4) The number of hours of the training;

     (5) The name and identification number of the training entity;

     (6) The instructor's name. For basic core training, the instructor's name and identification number;

     (7) The instructor's signature or an authorized signature from the training entity the qualified instructor is training on behalf of; and

     (8) The completion date of the training.

     The long-term care worker must retain the original certificate or transcript for proof of completion of the training. A home care agency must keep a copy of the certificate or transcript on file.

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     (2) An approved training entity issuing and signing a DSHS seventy-five hour training certificate must verify that the long-term care worker has the certificates or transcript required documenting two hours of DSHS-approved orientation, three hours of DSHS-approved safety training, and seventy hours of DSHS-approved basic training, as described in this chapter. Only a DSHS or training partnership seventy-five hour training certificate or transcript can be submitted by a long-term care worker applying to the department of health for a home care aide certification.

     (3) For home care aide recertification, successful completion of twelve hours of DSHS-approved continuing education training must be documented on a certificate(s) or transcript(s) issued by a department-approved training entity.

     (4) The long-term care worker, certified home care aide, and their employer must retain the original seventy-five hour training certificate or transcript and any twelve-hour continuing education training certificates as long as the worker is employed and up to three years after termination of employment. Training entities must keep a copy of these certificates on file for six years.

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     (2) Effective July 1, 2012, certified home care aides must complete twelve hours of continuing education each year after obtaining certification as described in department of health WAC 246-980-110 and 246-12-020(3).

     (3) If exempt from certification as described in RCW 18.88B.041, all long-term care workers must complete twelve hours of continuing education each year unless exempt from continuing education as described in WAC 388-71-1001.

     (4) A long-term care worker or certified home care aide who did not complete the continuing education requirements by the timeframe described in (1) above or in WAC 388-71-0991 cannot be paid to provide care after that date and cannot be reinstated as a long-term care worker until they complete the continuing education requirements.

     (5) One hour of completed classroom instruction or other form of training (such as a video or on-line course) equals one hour of continuing education. The training entity must establish a way for the long-term care worker to ask the instructor questions.

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     (2) For long-term care workers who are required to be certified, if the first renewal period is less than a full year from the date of certification, no continuing education will be due for the first renewal period.

     (3) For long-term care workers who are biological, step, or adoptive adult child, continuing education is to be completed by their birthday in the year following completion of basic training.

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     (1) Individual providers caring only for his or her biological, step, or adoptive son or daughter; and

     (2) Before June 30, 2014, an individual provider who:

     (a) Provides care to only one person; and

     (b) Provides no more than twenty hours of care in any calendar month.

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     (1) Client rights;

     (2) Personal care services;

     (3) Mental illness;

     (4) Dementia;

     (5) Developmental disabilities;

     (6) Depression;

     (7) Medication assistance;

     (8) Communication skills;

     (9) Positive client behavior support;

     (10) Developing or improving client-centered activities;

     (11) Dealing with wandering;

     (12) Dealing with challenging client behaviors;

     (13) Medical conditions; and

     (14) Nurse delegation core and specialized diabetes.

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     (2) The nurse delegation core and diabetes training must use only the DSHS curriculum.

     (3) Continuing education curriculum delivery models will only include instructor led, on-line instructor led, or on-line self-paced learning with access to instructor.

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     (1) For orientation and/or safety training:

     (a) Effective January 7, 2012, submit an outline of what will be covered in each training offered (for example, a table of contents or a class syllabus) showing where the required introductory topics as listed in WAC 388-71-0846 for orientation and WAC 388-71-0855 for safety training are covered in the training. Department required orientation and safety training application forms must be submitted to the department at least forty-five days in advance of when the training is expected to be offered. Training cannot be offered before receiving department curriculum and instructor approval.

     (2) For continuing education:

     (a) Effective July 1, 2012, for instructor led and on line learning, submit a summary that includes the topic, a brief description of what it will cover, and a course outline. Also include the number of training hours. For on line training courses, submit a description of how the instructor or training entity will assess that the students have completed the materials and integrated the information being taught. Department required continuing education training application forms must be submitted at least forty-five days in advance of when the training is expected to be offered. The trainings cannot be offered before receiving department curriculum and instructor approval as well as the unique code assigned by the department for each curriculum.

     (3) For basic training, the thirty hour basic training, and the twelve hour parent provider training:

     (a) If the instructor or training entity wants to use the DSHS developed revised fundamentals of caregiving learner's guide with enhancements, submit the DSHS required form with all required information. Curricula must be submitted to DSHS for approval of one or both sections (core competencies and population specific competencies) of the seventy hours required for basic training, for the thirty hour basic training, and for the twelve hour parent provider training. When submitting one or both sections of the basic training curriculum for DSHS approval, it must at a minimum include:

     (i) A completed DSHS curriculum checklist indicating where all of the competencies and learning objectives, described in this chapter, are located in the long-term care worker materials from the proposed curriculum for that course;

     (ii) Any materials long-term care workers will receive, such as a textbook or long-term care worker manual, learning activities, audio-visual materials, handouts and books;

     (iii) The table of contents or outline of the curriculum including the allotted time for each section;

     (iv) Demonstration skills checklists for the personal care tasks described in WAC 388-71-0911 (12)(a) and (b), and infection control skills (hand washing and putting on and taking off gloves);

     (v) The teacher's guide or manual that includes for each section of the curriculum:

     (A) The goals and objectives;

     (B) How that section will be taught including teaching methods and learning activities that incorporate adult learning principles;

     (C) Methods instructors will use to determine whether each long-term care worker understands the material covered and can demonstrate all skills;

     (D) A list of sources or references, that were used to develop the curriculum. If the primary source or reference is not a published citation, the instructor must provide detail on how the content was established as evidence based:

     (E) Description of how the curriculum was designed to accommodate long-term care workers with limited English proficiency and/or learning disabilities; and

     (F) Description and proof of how input was obtained from consumers and long-term care worker representatives in the development of the curriculum.

     (vi) In addition, for curricula being submitted for the core competency section of the basic training as described in WAC 388-71-0911, the curriculum must include how much time long-term care workers will be given to practice skills and how instructors will evaluate and ensure each long-term care worker can proficiently complete each skill.

     (vii) Entities submitting curriculum for population specific basic training must submit their own list of competencies and learning objectives used to develop the population specific basic training curriculum.

[]

     (2) After review of the curriculum, DSHS will send a written response to the submitter, indicating approval or disapproval of the curriculum(s).

     (3) If curriculum(s) are not approved, the reason(s) for denial will be given and the submitter will be told what portion(s) of the training must be changed and resubmitted for review in order for the curriculum to be approved.

     (4) The submitter can make the requested changes and resubmit the curriculum(s) for review.

     (5) If after working with the department the reasons why the curriculum is not approved cannot be resolved, the submitter may seek review of the nonapproval decision from the assistant secretary of aging and disability services administration. The assistant secretary's review decision shall be the final decision of DSHS; no other administrative review is available to the submitter.

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     (1) Coordinating and teaching classes;

     (2) Assuring that the curriculum used is DSHS-approved and taught as designed;

     (3) Selecting and monitoring qualified guest speakers, where applicable;

     (4) Administering or overseeing the administration of the DSHS competency tests for nurse delegation core, specialized diabetes trainings, dementia specialty, mental health specialty and DDD specialty training;

     (5) Maintaining training records including long-term care worker tests and attendance records for a minimum of six years;

     (6) Reporting training data to DSHS in DSHS-identified timeframes; and

     (7) Issuing or reissuing training certificates to long-term care workers.

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     (1) DSHS must approve and/or contract with a training entity and their instructor(s) to conduct orientation, safety, seventy hour basic training (core and population specific training), thirty hour training, twelve hour DDD parent provider training, nurse delegation core training and nurse delegation specialized diabetes training, on-the-job training, and continuing education. DSHS may contract with training entities and their instructor(s) using any applicable contracting procedures.

     (2) The training partnership must ensure that its instructors meet the minimum qualifications under this chapter.

[]

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

[]

     (1) General qualifications:

     (a) Twenty-one years of age; and

     (b) Has not had a professional health care, adult family home, boarding home, or social services license or certification revoked in Washington state.

     (2) Education and work experience:

     (a) Upon initial approval or hire, an instructor must:

     (i) Be a registered nurse with work experience within the last five years with the elderly or persons with disabilities requiring long-term care in a community setting; or

     (ii) Have an associate degree or higher degree in the field of health or human services and six months of professional or caregiving experience within the last five years in an adult family home, boarding home, supported living through DDD, or home care setting; or

     (iii) Have a high school diploma, or equivalent, and one year of professional or caregiving experience within the last five years in an adult family home, boarding home, supported living through DDD, or home care setting.

     (3) Teaching experience:

     (a) Must have one hundred hours of teaching adults in an appropriate setting on topics directly related to the basic training; or

     (b) Must have forty hours of teaching while being mentored by an instructor who meets these qualifications, and must attend a class on adult education that meets the requirements in WAC 388-71-1066.

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

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

     (6) An instructor for nurse delegation core and specialized diabetes trainings must have a current Washington state RN license in good standing without practice restrictions.

[]

[]

     (1) Adult education theory and practice principles;

     (2) Instructor facilitation techniques;

     (3) Facilitating learning activities for adults;

     (4) Administering competency testing; and

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

[]

     (a) May only teach a specific subject in which he or she has expertise, background, and experience that establishes his or her expertise on that specific topic;

     (b) May not teach the entire course;

     (c) Must not supplant the primary teaching responsibilities of the instructor; and

     (d) Must cover the DSHS competencies and learning objectives for the topic he or she is teaching.

     (2) The approved instructor:

     (a) Must ensure the guest speaker meets these minimum qualifications;

     (b) Maintain documentation of the guest speaker's qualifications and background;

     (c) Supervise and monitor the guest speaker's performance; and

     (d) Is responsible for ensuring the required content is taught.

     (3) DSHS does not approve guest speakers.

[]

     (a) Verify, document using the department's attestation process, keep on file, and make available to the department upon request, that all instructors meet the minimum instructor qualifications in WAC 388-71-1055 and 388-71-1060 for the course they plan to teach;

     (b) Teach using a complete DSHS-developed or approved curriculum;

     (c) When requested by DSHS, notify DSHS in writing of their intent to conduct training prior to providing training, when changing training plans, including:

     (i) Name and schedule of training(s) the partnership will conduct;

     (ii) Name of approved curriculum(s) the partnership will use; and

     (iii) Name of the instructor(s) for only the core basic training.

     (d) Ensure that DSHS competency tests are administered when conducting nurse delegation core or specialized diabetes training;

     (e) Keep a copy of long-term care worker certificates on file for six years and give the original certificate to the student;

     (f) Keep attendance records and testing records of long-term care workers trained and tested on file for six years; and

     (g) Report training data to DSHS when requested by the department.

     (2) The department may conduct a random audit at any time to review training and instructor qualifications.

[]

[]

     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.PHYSICAL RESOURCES AND STANDARD PRACTICES FOR TRAINING
NEW SECTION
WAC 388-71-1091   What physical resources are required for classroom training and testing?   (1) Classroom facilities used for classroom training must be accessible to students and provide adequate space for learning activities, comfort, lighting, lack of disturbance, and tools for effective teaching and learning, such as white boards and flip charts. Appropriate supplies and equipment must be provided for teaching and practice of caregiving skills in the class being taught.

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

[]

     (1) Training must not exceed eight hours within one day;

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

     (3) Training must include regular breaks; and

     (4) Long-term care workers attending classroom training must not be expected to leave the class to attend job duties, except in an emergency.

[]

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

     (2) Written evaluation to show knowledge of the learning objectives included in the training; and

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

[]

[]

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

     (2) The tester must follow the DSHS guidelines for:

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

     (b) The amount and nature of instruction given long-term care workers before beginning a test;

     (c) The amount of assistance to long-term care workers allowed during testing;

     (d) The accommodation guidelines for long-term care workers with disabilities; and

     (e) Accessibility guidelines for long-term care workers with limited English proficiency.

[]

[]

[]

     The following sections of the Washington Administrative Code are repealed:

WAC 388-71-05665	What definitions apply to WAC 388-71-05670 through 388-71-05909?
WAC 388-71-05670	What is orientation?
WAC 388-71-05675	What content must be included in an orientation?
WAC 388-71-05680	Is competency testing required for orientation?
WAC 388-71-05685	Is there a challenge test for orientation?
WAC 388-71-05690	What documentation is required for orientation?
WAC 388-71-05695	Who is required to complete orientation, and when must it be completed?
WAC 388-71-05700	What is basic training?
WAC 388-71-05705	Is there an alternative to the basic training for some health care workers?
WAC 388-71-05710	What core knowledge and skills must be taught in basic training?
WAC 388-71-05715	Is competency testing required for basic training?
WAC 388-71-05720	Is there a challenge test for basic training?
WAC 388-71-05725	What documentation is required for successful completion of basic training?
WAC 388-71-05730	Who is required to complete basic training, and when?
WAC 388-71-05735	What is modified basic training?
WAC 388-71-05740	What knowledge and skills must be included in modified basic training?
WAC 388-71-05745	Is competency testing required for modified basic training?
WAC 388-71-05750	Is there a challenge test for modified basic training?
WAC 388-71-05755	What documentation is required for successful completion of modified basic training?
WAC 388-71-05760	Who may take modified basic training instead of the full basic training?
WAC 388-71-05765	What are the training requirements and exemptions for parents who are individual providers for their adult children receiving services through DDD?
WAC 388-71-05770	What are the training requirements and exemptions for parents who are individual providers for their adult children who do not receive services through DDD?
WAC 388-71-05775	What is continuing education?
WAC 388-71-05780	How many hours of continuing education are required each year?
WAC 388-71-05785	What kinds of training topics are required for continuing education?
WAC 388-71-05790	Is competency testing required for continuing education?
WAC 388-71-05795	May basic or modified basic training be completed a second time and used to meet the continuing education requirement?
WAC 388-71-05799	What are the documentation requirements for continuing education?
WAC 388-71-05805	What is nurse delegation core training?
WAC 388-71-05810	What knowledge and skills must nurse delegation core training include?
WAC 388-71-05815	Is competency testing required for nurse delegation core training?
WAC 388-71-05820	Is there a challenge test for nurse delegation core training?
WAC 388-71-05825	What documentation is required for successful completion of nurse delegation core training?
WAC 388-71-05830	Who is required to complete nurse delegation core training, and when?
WAC 388-71-05832	What is safety training and is there a challenge test for safety training?
WAC 388-71-05835	Who is required to complete safety training, when, and how often must it be completed?
WAC 388-71-05836	Will DSHS deny payment of an individual provider who does not complete safety training?
WAC 388-71-05837	What is competency testing?
WAC 388-71-05840	What components must competency testing include?
WAC 388-71-05845	What experience or training must individuals have to be able to perform competency testing?
WAC 388-71-05850	What training must include the DSHS-developed competency test?
WAC 388-71-05855	How must competency test administration be standardized?
WAC 388-71-05860	What form of identification must providers show a tester before taking a competency or challenge test?
WAC 388-71-05865	How many times may a competency test be taken?
WAC 388-71-05870	What are an instructor's or training entity's responsibilities?
WAC 388-71-05875	Must instructors be approved by DSHS?
WAC 388-71-05880	Can DSHS deny or terminate a contract with an instructor or training entity?
WAC 388-71-05885	What is a guest speaker, and what are the minimum qualifications to be a guest speaker for basic training?
WAC 388-71-05890	What are the minimum qualifications for an instructor for basic, modified basic or nurse delegation core and specialized diabetes training?
WAC 388-71-05895	What additional qualifications are required for instructors of nurse delegation core training and specialized diabetes nurse delegation training?
WAC 388-71-05899	What must be included in a class on adult education?
WAC 388-71-05905	What physical resources are required for basic, modified basic, or nurse delegation core classroom training and testing?
WAC 388-71-05909	What standard training practices must be maintained for basic, modified basic, or nurse delegation core classroom training and testing?
WAC 388-71-0801	What is specialized diabetes nurse delegation training?
WAC 388-71-0806	What knowledge and skills must specialized diabetes nurse delegation training include?
WAC 388-71-0811	Is competency testing required for the specialized diabetes nurse delegation training?
WAC 388-71-0816	Is there a challenge test for specialized diabetes nurse delegation training?
WAC 388-71-0821	What documentation is required for successful completion of specialized diabetes nurse delegation training?
WAC 388-71-0826	Who is required to complete the specialized diabetes nurse delegation training, and when?

4201.23
AMENDATORY SECTION(Amending WSR 02-15-065, filed 7/11/02, effective 8/11/02)

WAC 388-112-0001   What ((is)) are the purposes of this chapter?   The ((residential long-term care training requirements under this chapter apply to)) purposes of this chapter are to describe the following:

     (1) ((All adult family homes licensed under chapter 70.128 RCW)) Training and certification requirements that apply to adult family homes and assisted living facilities on or before January 6, 2012; and

     (2) ((All boarding homes licensed under chapter 18.20 RCW)) Training and certification requirements that apply to adult family homes and assisted living facilities on or after January 7, 2012.

     (3) Curriculums and instructor requirements.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0001, filed 7/11/02, effective 8/11/02.]

     (1) Adult family home providers, applicants, resident managers, entity representatives, long-term care workers, and volunteers; and

     (2) Assisted living facility administrators, designees, long-term care workers, and volunteers.

[]

Who	Status	Facility Orientation	Safety / Orientation training	Basic / Population Specific training	Specialty training	Continuing education	Certification HCA-C
(1) Adult family home resident manager, or long-term care worker in adult family home / assisted living facility.	(a) An RN, LPN, NA-C or allied health care professionals listed in WAC 388-112-0076	Required per WAC 388-112-0015(1)	Not required	Not required	Required per WAC 388-112-0110	Required twelve hours per WAC 388-112-0205	Not required
	(b) A long term care worker who was employed on January 6, 2012 or was previously employed sometime between 1/1/2011 and 1/6/2012 and has completed the basic training requirements in effect on his or her hire date. WAC 388-112-0076	Required per WAC 388-112-0015(1)	Not required	Not required	Required per WAC 388-112-0110	Required twelve hours per WAC 388-112-0205	Not required
	(c) Employed in an adult family home or assisted living facility and does not meet criteria in (1) or (2) of this table. Meets definition of long term care worker in WAC 388-112-0005.	Not required	Required. Five hours per WAC 388-112-0015(2); and 388-112-0018	Required. Seventy hours per WAC 388-112-0045 and 388-112-0066	Required per WAC 388-112-0110	Required. Twelve hours per WAC 388-112-0205	Required per WAC 388-112-0106
(2) Adult family home provider	A person who has an adult family home license and does not meet criteria in (a), (b) or (c). This requirement applies to an entity representative of a licensed entity. WAC 388-76-1000.	Not required	Completed prior to licensing	Completed prior to licensing	Completed prior to licensing	Required. Twelve hours per WAC 388-112-0205	Completed prior to licensing
(3) Assisted living facility administrator	A qualified assisted living facility administrator or designee who does not meet criteria in (a), (b) or (c) of this table.	Not required	Required. Five hours per WAC 388-112-0015(2); and 388-112-0018	Required. Seventy hours per WAC 388-112-0045 and 388-112-0066	Required per WAC 388-112-0110	Required. Twelve hours per WAC 388-112-0205	Required per WAC 388-112-0106
(4) Volunteer staff in adult family home or assisted living facility	An unpaid person	Required per WAC 388-112-0015(1)	Not required	Not required	Not required	Not required	Not required

     (2) Summary of the training and certification requirements for adult family home applicants prior to licensure, and resident managers prior to assuming the duties of the position.

Who	Status	Orientation and Safety training	Basic / Population Specific training	Specialty training	Continuing education	Certification HCA-C
(1) Adult family home applicant	(a) An RN, LPN, ARNP, NA-C, and other allied health professionals as listed in WAC 388-112-0076	Not required	Not required	Required per WAC 388-112-0110	Not required during application process	Not required
	(b) A long-term care worker employed on January 6, 2012 or was previously employed sometime between 1/1/2011 and 1/6/2012 and has completed the basic training requirements in effect on the date of his or her hire. WAC 388-112-0076	Not required	Not required	Required per WAC 388-112-0110	Not required during application process	Not required
	(c) Seeking a license to operate an adult family home and is not exempt under (a) or (b) of this table. WAC 388-112-0002	Required. Five hours per WAC 388-112-0018	Required. Seventy hours per WAC 388-112-0045 and 388-112-0066	Required per WAC 388-112-0110	Not required during application process	Required per WAC 388-112-0106
(2) Adult family home resident manager	Employed or designated by the provider to manage an adult family home and is not exempt under (a) or (b) of this table. WAC 388-112-0002.	Required. Five hours per WAC 388-112-0018	Required. Seventy hours per WAC 388-112-0045 and 388-112-0066	Required per WAC 388-112-0110	Required. Twelve hours per WAC 388-112-0205	Required per WAC 388-112-0106

     Note: Other trainings that are required under this chapter are not listed in tables above. They are:

     • First aid and CPR (WAC 388-112-0260)

     • Nurse delegation (WAC 388-112-0170 and 388-112-0196);

     • Adult family home administrator training (WAC 388-112-0270).

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     (a) RCW 18.20.190(2), for assisted living facility providers; or

     (b) RCW 70.128.160(2), for adult family home providers.

     (2) Except as required under subsection (1), if a provider fails to comply with any requirements under this chapter, the department may take one or more of the enforcement actions under:

     (a) RCW 18.20.190(2), for assisted living facility providers; or

     (b) RCW 70.128.160(2), for adult family home providers.

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     (2) An individual with an ownership interest in a partnership, corporation, or other entity that is applying for an adult family home license.

     (("Caregiver" means anyone providing hands-on personal care to another person including but not limited to cuing, reminding, or supervision of residents, on behalf of an adult family home or boarding home, except volunteers who are directly supervised.))

     "Care team" includes the resident and everyone involved in his or her care. The care team can include family, friends, doctors, nurses, long-term care workers, social workers and case managers. The role of the care team is to support the well-being of the resident, however, the resident directs the service plan when able.

     "Certified home care aide" means a person who has obtained and maintains a home care aide certification through the department of health.

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

     "Competency" ((means the minimum level of information and skill trainees are required to know and be able to demonstrate)) defines the integrated knowledge, skills, or behavior expected of a long-term care worker after completing the training in a required topic area. Learning objectives are associated with each competency.

     "Competency testing" including challenge testing, is evaluating a student to determine if they can demonstrate the required level of skill, knowledge, and/or behavior with respect to the identified learning objectives of a particular course.

     "DDD" refers to the division of developmental disabilities.

     "Designee" means a person in ((a boarding home)) assisted living facility who supervises ((caregivers)) long-term care workers and who is designated by ((a boarding home)) assisted living facility administrator to take the trainings in this chapter required of the ((boarding home)) assisted living facility administrator. A ((boarding home)) assisted living facility administrator may have more than one designee.

     "Direct care worker" means a paid individual who provides direct, personal care services to persons with disabilities or the elderly requiring long-term care.

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

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

     "Enhancement" means additional time provided for skills practice and additional training materials or classroom activities that help a worker to thoroughly learn the course content and skills. Enhancements can include new student materials, videos or DVDs, on-line materials, and/or additional student activities.

     "Entity representative" means the individual designated by an adult family home provider who is or will be responsible for the daily operations of an adult family home.

     "Guardian" means an individual as defined in chapter 11.88 RCW.

     "Home" refers to adult family homes and ((boarding homes)) assisted living facilities.

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

     "Learning ((outcomes)) objectives" ((means the specific information, skills and behaviors desired of the learner as a result of a specific unit of instruction, such as what they would learn by the end of a single class or an entire course. Learning outcomes are generally identified with a specific lesson plan or curriculum)) are measurable, written statements that clearly describe what a long-term care worker must minimally learn to meet each competency. Learning objectives are identified for each competency. Learning objectives provide consistent, common language and a framework for curriculum designers, the curriculum approval process, and testing.

     "Long-term care worker" includes all persons providing paid, personal care services for the elderly or persons with disabilities, including individual providers of home care services, direct care employees of home care agencies, providers of home care services to persons with developmental disabilities under title 71A RCW, all direct care workers in state-licensed assisted living facilities, adult family homes, respite care providers, community residential service providers, and any other direct care staff providing home or community-based services to the elderly or persons with functional disabilities or developmental disabilities.

     The following persons are not long-term care workers:

     (1) Persons who are:

     (a) Providing personal care services to individuals who are not receiving state-funded services; and

     (b) The person is not employed by an agency or facility that is licensed by the state.

     (2) Persons employed by:

     (a) Nursing homes licensed under chapter 18.51 RCW;

     (b) Facilities certified under 42 CFR Part 483;

     (c) Residential habilitation centers under chapter 71A.20 RCW;

     (d) Hospitals or other acute care settings;

     (e) Hospice agencies licensed under chapter 70.127 RCW;

     (f) Adult day care centers or adult day health centers.

     (3) Persons whose services are exclusively limited to assistance with "instrumental activities of daily living," as that term is defined in WAC 388-106-0010.

     "Personal care services" means physical or verbal assistance with activities of daily living, or activities of daily living and instrumental activities of daily living which is provided to meet resident's care needs.

     "Provider" means any person or entity who is licensed by the department to operate an adult family home or assisted living facility, or certified by the department to provide instruction and support services to meet the needs of persons receiving services under title 71A RCW.

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

     "Resident manager" means a person employed or designated by the provider to manage the adult family home who meets the requirements in WAC 388-76-10000 and this chapter.

     "Routine interaction" means contact with residents that happens regularly.

     "Training entity" means an organization, including an independent contractor, who is providing or may provide training under this section using approved curriculum. Training entities may only deliver approved curriculum.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0005, filed 7/11/02, effective 8/11/02.]

     (2) The long-term care worker training requirements ((of this chapter begin September 1, 2002, or one hundred twenty days from the date of employment, whichever is later, and apply to:

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

     (2) Existing adult family home providers, resident managers, and caregivers, and boarding home administrators, designees, and caregivers, who on September 1, 2002, have not successfully completed the training requirements under RCW 74.39A.010, 74.39A.020, 70.128.120, or 70.128.130 and this chapter. Existing adult family home providers, resident managers, and caregivers, and boarding home administrators, designees, and caregivers, who have not successfully completed the training requirements under RCW 74.39A.010, 74.39A.020, 70.128.120, or 70.128.130 are subject to all applicable requirements of this chapter. However, until September 1, 2002, nothing in this chapter affects the current training requirements under RCW 74.39A.010, 74.39A.020, 70.128.120, or 70.128.130)) that were in effect on or before January 6, 2012 apply to those individuals who:

     (a) Were hired on or before January 6, 2012; and

     (b) Completed basic training within the required timeframes.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0010, filed 7/11/02, effective 8/11/02.]

     (2) Long-term care worker orientation. Individuals required to complete long-term care worker training must complete long-term care worker, orientation ((provides basic introductory information appropriate to the residential care setting and population served)) which is two hours of trainnig regarding the long-term care worker's role and the applicable terms of employment as described in WAC 388-112-0016. The following individuals must complete long-term care worker orientation training.

     (a) All long-term care workers who are not exempt from certification described in RCW 18.88.041 hired on or after January 7, 2012, must complete two hours of orientation before providing care to residents. This orientation training must be provided by qualified instructors described in WAC 388-112-0383.

     (3) The department ((does not)) must approve ((specific)) this long-term care worker orientation ((programs, materials, or trainers for homes)) curriculums and instructors.

     (4) There is no test ((is required)) for this orientation.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0015, filed 7/11/02, effective 8/11/02.]

     Reviser's note: The spelling error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-112-0016   What content must be included in long-term care worker orientation?   (1) For those individuals identified in WAC 388-112-0015(1) who must compete long-term care worker orientation training:

     (a) Long-term care worker orientation may include the use of videotapes, audiotapes, and other media if the person overseeing the orientation is available to answer questions or concerns for the person(s) receiving the orientation. Orientation must include introductory information in the following areas:

     (i) The care setting;

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

     (iii) Fire and life safety, including:

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

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

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

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

     (E) The location of home policies and procedures.

     (iv) Communication skills and information, including:

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

     (B) Use of verbal and nonverbal communication;

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

     (D) Expectations about communication with other home staff; and

     (E) Whom to contact about problems and concerns.

     (v) Universal precautions and infection control, including:

     (A) Proper hand washing techniques;

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

     (C) Appropriate disposal of contaminated/hazardous articles;

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

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

     (vi) Resident rights, including:

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

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

     (C) Staff's duty to protect and promote the rights of each resident, and assist the resident to exercise his or her rights;

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

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

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

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

     (vii) In adult family homes, safe food handling information must be provided to all staff, prior to handling food for residents.

     (2) For long-term care worker orientation required of those individuals identified in WAC 388-112-0015(2):

     (a) Long-term care worker orientation is a two hour training that must include introductory information in the following areas:

     (i) The care setting and the characteristics and special needs of the population served;

     (ii) Basic job responsibilities and performance expectations;

     (iii) The care plan, including what it is and how to use it;

     (iv) The care team;

     (v) Process, policies, and procedures for observation, documentation and reporting;

     (vi) Resident rights protected by law, including the right to confidentiality and the right to participate in care decisions or to refuse care and how the long-term care worker will protect and promote these rights;

     (vii) Mandatory reporter law and worker responsibilities; and

     (viii) Communication methods and techniques that can be used while working with a resident or guardian and other care team members.

     One hour of completed classroom instruction or other form of training (such as a video or on line course) equals one hour of training. The training entity must establish a way for the long-term care worker to ask the instructor questions.

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     (2) The following individuals must complete safety training:

     (a) All long-term care workers who are not exempt from certification described in RCW 18.88.041, hired after January 7, 2012, must complete three hours of safety training. This safety training must be provided by qualified instructors described in WAC 388-112-0383.

     (3) The department must approve safety training curriculums and instructors.

     (4) There is no test for safety training.

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     (1) Safety planning and accident prevention, including but not limited to:

     (a) Proper body mechanics;

     (b) Fall prevention;

     (c) Fire safety;

     (d) In home hazards;

     (e) Long-term care worker safety; and

     (f) Emergency and disaster preparedness.

     (2) Standard precautions and infection control, including but not limited to:

     (a) Proper hand washing;

     (b) When to wear gloves and how to correctly put them on and take them off;

     (c) Basic methods to stop the spread of infection;

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

     (e) Appropriate disposal of contaminated/hazardous articles;

     (f) Reporting exposure to contaminated articles; and

     (g) What to do when the worker or the resident is sick or injured, including whom to report this to.

     (3) Basic emergency procedures, including but not limited to:

     (a) Evacuation preparedness;

     (b) When and where to call for help in an emergency;

     (c) What to do when a resident is falling or falls;

     (d) Location of any advance directives if available; and

     (e) Basic fire emergency procedures.

     One hour of completed classroom instruction or other form of training (such as video or on line course) equals one hour of training. The training entity must establish a way for the long-term care worker to ask the instructor questions. In adult family homes, safe food handling information must be provided to all staff, prior to handling food for residents.

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     (1) The ((trainee's)) name of the student;

     (2) ((A list of the specific information taught)) The title of the training;

     (3) The number of hours of the training;

     (4) The signature of the ((person overseeing)) instructor providing facility orientation((, indicating completion of the required information)) training;

     (((4))) (5) The ((trainee's)) student's date of ((employment)) hire;

     (((5))) (6) ((The name of the home giving the orientation; and

     (6))) The date(s) of facility orientation;

     (7) The documentation required under this section must be kept in a manner consistent with WAC 388-76-10198 (for adult family homes) and WAC 388-78A-2450 (for assisted living facilities).

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0035, filed 7/11/02, effective 8/11/02.]

     (a) The core ((knowledge)) competencies and skills that ((caregivers)) long-term care workers need in order to provide personal care services effectively and safely;

     (b) Practice and demonstration of skills;

     (c) Population specific competencies.

     (2) DSHS must approve basic training ((curricula)) curriculums.

     (3) Effective July 1, 2012, no more than twelve of the seventy hours may be applied for on-the-job training;

     (4) The DSHS developed revised fundamentals of caregiving (RFOC) or another department approved training may be used to teach basic training but it must include enhancements. Examples of enhancements include, but are not limited to:

     (a) More time for workers to practice skills including:

     (i) The mechanics of completing the skill correctly.

     (ii) Resident centered communication and problem solving associated with performing the skill.

     (iii) The different levels of care required for each skill (independent, supervision, limited, extensive, total).

     (iv) Working with assistive devices associated with a skill.

     (v) Helpful tips or best practices in working through common resident challenges associated with a skill.

     (vi) Disease specific concerns or challenges associated with a skill. In most of these examples, additional student materials would be required to ensure the skill enhancements are well planned and documented for students. Materials must be submitted for approval and approved per WAC 388-112-0325.

     (b) Augmenting or adding additional materials, student activities, videos or guest speakers that:

     (i) More deeply reinforce and fortify the learning outcomes required for basic training.

     (ii) Ensure each student integrates and retains the knowledge and skills needed to provide quality basic personal care.

     (iii) Prepares workers for the certification testing environment and process.

     (c) Enhancements are NOT materials and/or activities that:

     (i) Are out of the scope of practice for a long-term care worker such as content clearly written for registered nurses.

     (ii) Are identical to, or a direct replacement of, those already included in RFOC.

     (iii) Fail to reinforce Washington state laws associated with resident rights and resident directed care.

     (iv) Long-term care workers are not paid to provide.

     (v) Are written above a high school reading level.

     (5) One hour of completed classroom instruction or other form of training (such as a video or on-line course) equals one hour of training.

     (6) The long-term care worker must be able to ask the instructor questions during the training.

     (7) There is no challenge test for basic training.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0045, filed 7/11/02, effective 8/11/02.]

     (1) Communication skills;

     (2) Long-term care worker self-care;

     (3) Problem solving;

     (4) Resident rights and maintaining dignity;

     (5) Abuse, abandonment, neglect, financial exploitation and mandatory reporting;

     (6) Resident directed care;

     (7) Cultural sensitivity;

     (8) Body mechanics;

     (9) Fall prevention;

     (10) Skin and body care;

     (11) Long-term care worker roles and boundaries;

     (12) Supporting activities of daily living;

     (13) Food preparation and handling;

     (14) Medication assistance;

     (15) Infection control, blood-borne pathogens, HIV/AIDS; and

     (16) Grief and loss.

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     (2) The basic training learning outcomes and competencies may be obtained from the DSHS aging and adult services administration)) core competencies describe the behavior and skills that a long-term care worker must exhibit when working with residents. Learning objectives are associated with each competency.

     (1) Regarding communication, communicate effectively and in a respectful and appropriate manner with residents, family members, and care team members:

     (a) Recognize how verbal and non-verbal cues impact communication with the resident and care team;

     (b) Engage and respect the resident through verbal and non-verbal communication;

     (c) Listen attentively and determine that the resident, when able, understands what has been communicated;

     (d) Recognize and acknowledge residents' communication including indicators of pain, confusion, or misunderstanding;

     (e) Utilize communication strategies to deal with difficult situations; and

     (f) Recognize common barriers to effective communication and identify how to eliminate them.

     (2) Regarding long-term care worker self-care:

     (a) Identify behaviors, practices and resources to reduce stress and avoid burnout;

     (b) Recognize common barriers to self-care and ways to overcome them; and

     (c) Recognize aspects of a long-term care worker's job that can lead to stress and burnout, common signs and symptoms of stress and burnout; and the importance of taking action to practice self-care to avoid burnout.

     (3) Regarding the competency of effective problem solving, use effective problem solving skills:

     (a) Explain why it is necessary to understand and utilize a problem solving method;

     (b) Implement a problem solving process/method; and

     (c) Identify obstacles to effective problem solving and ways to overcome them.

     (4) Regarding the competency of resident rights and dignity, take appropriate action to promote and protect a resident's legal and human rights as protected by federal and Washington state laws, including:

     (a) Protect a resident's confidentiality including what is considered confidential information, to whom a long-term care worker is allowed or not allowed to give confidential information, and how to respond if a noncare team member asks for confidential information;

     (b) Promote dignity, privacy, encourage and support a resident's maximum independence when providing care;

     (c) Maintain a restraint-free environment, including physical, chemical, and environmental restraints. Use common, safe alternatives to restraint use;

     (d) Protect and promote the resident's right to live free of abuse, neglect, abandonment, and financial exploitation.

     (5) Regarding the competency of abuse and mandatory reporting, recognize the signs of abuse and report suspected abuse, abandonment, neglect, and financial exploitation:

     (a) Describe long-term care workers' responsibilities as a mandatory reporter as described in RCW 74.34.020 through 74.34.053; and

     (b) Identify common indications of abuse, abandonment, neglect, and financial exploitation.

     (6) Regarding the competency of resident directed care, take appropriate action when following a resident's direction regarding his or her care:

     (a) Describe a worker's role in resident directed care including determining, understanding, and supporting a resident's choices;

     (b) Describe the importance and impact of resident directed care on a resident's independence, self-determination, and quality of life;

     (c) Identify effective problem solving strategies that help balance a resident's choice with personal safety; and

     (d) Report concerns when a resident refuses care or makes choices that present a possible safety concern.

     (7) Regarding the competency of cultural sensitivity, provide culturally appropriate care:

     (a) Describe how cultural background, lifestyle practices, and traditions can impact care and use methods to determine and ensure that these are respected and considered when providing care.

     (8) Regarding the competency of body mechanics, utilize current best practices and evidence-based methods of proper body mechanics while performing tasks as outlined in the service plan.

     (9) Regarding the competency on fall prevention:

     (a) Identify fall risk factors and take action to reduce fall risks for a resident; and

     (b) Take proper steps to assist a resident who is falling or has fallen.

     (10) Regarding the competency of skin and body care, use of personal care practices that promote and maintain skin integrity:

     (a) Explain the importance of observing a resident's skin, when to observe it and what to look for including common signs and symptoms of skin breakdown;

     (b) Identify risk factors of skin breakdown;

     (c) Observe skin at pressure point locations and report any concerns;

     (d) Describe what a pressure ulcer is, what it looks like, and what action to take if a resident appears to be developing or develops a pressure ulcer;

     (e) Describe current best practices that protect and maintain a resident's skin integrity including position changes when sitting or lying for extended periods, and proper positioning and transfer techniques;

     (f) Implement current best practices that promote healthy skin including hygiene, nutrition, hydration, and mobility; and

     (g) Identify when to report skin changes and to whom.

     (11) Regarding the competency on long-term care worker roles and boundaries, adhere to basic job standards, expectations, and requirements and maintain professional boundaries:

     (a) Identify when, how, and why to obtain information from appropriate sources about a resident's condition or disease for which they are receiving services. Describe how to use this information to provide appropriate, individualized care;

     (b) Describe a resident's baseline functioning level using information provided in the service plan and explain why it is important to know a resident's baseline;

     (c) Identify changes in a resident's physical, mental, and emotional state through observation;

     (d) Report changes from baseline and/or concerns to the appropriate care team member(s);

     (e) Identify basic job standards and requirements (e.g. coming to work on time) and describe how maintaining these standards are critical to a resident's safety and well-being;

     (f) Explain the purpose of a service plan and describe how it is created, used, and modified;

     (g) Use a resident's service plan to direct a worker's job tasks and any resident directed care tasks;

     (h) Identify what is required of a long-term care worker, as described in WAC 388-112-0195, prior to performing a nurse-delegated task;

     (i) Describe the role of a care team and a long-term care worker's role in it;

     (j) Describe professional boundaries and the importance of maintaining them; and

     (k) Identify signs of unhealthy professional boundaries, barriers to keeping clear professional boundaries, and ways to avoid or eliminate them.

     (12) Regarding the competency on supporting activities of daily living, perform required personal care tasks to the level of assistance needed and according to current best practices and evidence-based guidelines:

     (a) Demonstrate, in the presence of a qualified instructor, all critical steps required for personal care tasks including but not limited to:

     (i) Helping a resident walk;

     (ii) Transferring a resident from a bed to a wheelchair;

     (iii) Turning and repositioning a resident in bed;

     (iv) Providing oral care;

     (v) Cleaning and storing dentures;

     (vi) Shaving a face;

     (vii) Providing fingernail care;

     (viii) Providing foot care;

     (ix) Providing a bed bath;

     (x) Assisting a resident with a weak arm to dress;

     (xi) Putting knee-high elastic stockings on a resident;

     (xii) Providing passive range of motion for one shoulder;

     (xiii) Providing passive range of motion for one knee and ankle;

     (xiv) Assisting a resident to eat;

     (xv) Assisting with peri-care;

     (xvi) Assisting with the use of a bedpan;

     (xvii) Assisting with catheter care;

     (xviii) Assisting with condom catheter care; and

     (xix) Providing medication assistance.

     (b) In the process of performing the personal care tasks, use proper body mechanics, listen attentively, speak clearly and respectfully while explaining what the long-term care worker is doing, incorporate resident preferences, maintain privacy and dignity, support the resident's level of ability, and assure their comfort and safety;

     (c) Appropriately utilize assistive device(s) specified on the service plan;

     (d) Describe any safety concerns related to each task and how to address the concerns;

     (e) Demonstrate an understanding of bowel and bladder functioning, including factors that promote healthy bowel and bladder functioning, and the signs, symptoms, and common causes of abnormal bowel and bladder function; and

     (f) Identify the importance of knowing a resident's bowel and bladder functioning baseline and when to report changes.

     (13) Regarding the competency on food preparation and handling, plan and prepare meals using a basic knowledge of nutrition and hydration, incorporating any diet restrictions or modifications, and prevent food borne illness by preparing and handling food in a safe manner:

     (a) Describe how nutrition and hydration can impact a resident's health;

     (b) Plan, shop, and prepare meals for a resident according to the guidelines of good nutrition and hydration, incorporating any dietary requirements and restrictions per the service plan and resident preferences;

     (c) Describe common signs of poor nutrition and hydration, and when to report concerns and to whom;

     (d) Understand that diet modification is required for certain health conditions, including dysphagia, and describe how to identify diet modifications required for a resident;

     (e) Recognize when a resident's food choices vary from specifications on the care plan, describe when and to whom to report concerns;

     (f) Describe what causes food borne illness, the risks associated with food borne illness and examples of potentially hazardous foods;

     (g) Describe appropriate food handling practices, including: avoiding cross contamination from one food to another, safe storage requirements for cooling of leftover foods, including depth, types of containers, and temperatures, the need to maintain food at proper temperatures to limit bacterial growth and what are the safe food storage and holding temperatures for both cold and hot foods, best practices for thawing and re-heating food, and using clean gloves (if possible) and clean utensils when preparing food;

     (h) Describe the importance and correct procedure for cleaning and disinfecting food contact surfaces; and

     (i) Describe why a long-term care worker with certain types of illnesses and/or symptoms must not prepare food.

     Long-term care workers who complete a DSHS-approved basic training meet the training requirements for adult family homes in RCW 70.128.250.

     (14) Regarding the competency of medication assistance, appropriately assist with medications:

     (a) Identify what a long-term care worker is allowed and not allowed to do when assisting with medications as described in chapter 246-888 WAC;

     (b) Define terms related to medication assistance including prescription drugs, over the counter medications, and as needed (PRN) medications, medication side effects, and drug interactions;

     (c) Identify common symptoms of medication side effects and when and to whom to report concerns;

     (d) Store medications according to safe practices and the label instructions;

     (e) Describe, in the proper sequence, each of the five rights of medication assistance; and

     (f) Identify what to do for medication-related concerns, including describing ways to work with a resident who refuses to take medications, identifying when and to whom to report when a resident refuses medication or there are other medication-related concerns, and identifying what is considered a medication error and when and to whom it must be reported.

     (15) Regarding the competency of infection control and blood borne pathogens including HIV/AIDS, implement best practices to prevent and control the spread of infections:

     (a) Identify commonly occurring infections, ways that infections are spread, and symptoms of infections;

     (b) Describe the purpose, benefit and proper implementation of standard precautions in infection control;

     (c) Implement current best practices for controlling the spread of infection, including the use of hand washing and gloves;

     (d) Demonstrate proper hand washing and putting on and taking off gloves;

     (e) Identify immunizations that are recommended for adults to reduce the spread of virus and bacteria;

     (f) Describe laundry and housekeeping measures that help in controlling the spread of infection;

     (g) Describe proper use of cleaning agents that destroy micro-organisms on surfaces;

     (h) Describe what BB pathogens are and how they are transmitted;

     (i) Identify the major BB pathogens, diseases, and high-risk behaviors for BB diseases;

     (j) Identify measures to take to prevent BB diseases;

     (k) Describe what to do if exposed to BB pathogens and how to report an exposure;

     (l) Describe how HIV works in the body;

     (m) Explain that testing and counseling for HIV/AIDS is available;

     (n) Describe the common symptoms of HIV/AIDS;

     (o) Explain the legal and ethical issues related to HIV including required reporting, confidentiality and nondiscrimination; and

     (p) Explain the importance of emotional issues and support for residents and long-term care workers.

     Long-term care workers who complete a DSHS-approved basic training meet the four hours of AIDS education as required by the department of health in WAC 246-980-040.

     (16) Regarding the competency on grief and loss, support yourself and the resident in the grieving process:

     (a) Define grief and loss;

     (b) Describe common losses a resident and long-term care worker may experience;

     (c) Identify common symptoms associated with grief and loss;

     (d) Describe why self-care is important during the grieving process; and

     (e) Identify beneficial ways and resources to work through feelings of grief and loss.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0055, filed 7/11/02, effective 8/11/02.]

     (2) On-the-job training is provided by a qualified instructor as defined in WAC 388-112-0380 who directly observes, coaches, and reinforces skills training for up to two long-term care workers at a time. The instructor providing the on-the-job training:

     (a) Does not have to be the instructor who has taught the core competency training;

     (b) Cannot be someone whose primary job duty is providing direct care to residents; or

     (c) Cannot be the immediate supervisor of the long-term care worker receiving the on-the-job training.

     (3) The person overseeing on-the-job training must:

     (a) Submit DSHS required forms and become an approved instructor for the core competency of basic training; and

     (b) Verify on a DSHS approved skills checklist the long-term care worker's successful completion of the demonstrated skills.

     (4) For the person receiving on-the-job training, the hours spent in on-the-job training may count for up to twelve hours toward the completion of basic training requirements.

     (5) The training program shall offer department approved on-the-job training as part of the seventy hour training.

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     (a) Dementia;

     (b) Mental health;

     (c) Developmental disabilities;

     (d) Young adults with physical disabilities; and

     (e) Aging and older adults.

     (2) Specialty training per WAC 388-112-0110 may be used to meet the population specific component of basic training if completed within one hundred and twenty days of date of hire.

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     (a) The name of the ((trainee)) student;

     (b) The name of the training;

     (c) The number of hours of the training;

     (d) The name of the home or training entity giving the training;

     (((d))) (e) The instructor's name and signature; and

     (((e))) (f) The name and the identification number of the instructor for core competencies, and the home or training entity giving the training; and

     (g) The ((date(s))) completion date of training.

     (2) The ((trainee)) student must be given an original certificate(s) for proof of completion of the training and retain for their records. ((A home)) The provider, and if applicable, the training entity must keep a copy of the certificate ((on file)) as described in WAC 388-76-10198 (for adult family homes) and as described in WAC 388-78A-2450 (for assisted living facilities).

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0070, filed 7/11/02, effective 8/11/02.]

     Adult family homes

     (1) Adult family home ((providers (including entity representatives as defined under chapter 388-76 WAC))) applicants must complete basic training ((and demonstrate competency)) and become certified before ((operating an)) the adult family home is licensed.

     (2) Adult family home entity representatives and resident managers ((must complete basic training and demonstrate competency)) before ((providing services in an)) assuming the duties of the position in the adult family home.

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

     ((Boarding homes)) Assisted living facilities

     (4) ((Boarding home)) Assisted living facility administrators (or their designees), except administrators with a current nursing home administrator license, ((must complete basic training and demonstrate competency)) within one hundred twenty days of ((employment or within one hundred twenty days of September 1, 2002, whichever is later)) date of hire.

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

     (6) For certification requirements for individuals in subsections (2) through (5) refer to WAC 388-112-0106.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0075, filed 7/11/02, effective 8/11/02.]

     (1) An applicant for an adult family home license on or before January 6, 2012 who met the basic training requirements in effect at the time of application.

     (2) A person already employed as a long-term care worker on January 6, 2012, who completed the basic training requirements in effect on the date of his or her hire;

     (((2))) (3) A person employed as a long-term care worker on January 6, 2012, who completes within one hundred twenty days of hire, the basic training requirements in effect on the date of his or her hire;

     (((3))) (4) A person previously employed as a long-term care worker who completed the basic training requirements in effect on the date of his or her hire, and was employed as a long-term care worker at some point between January 1, 2011 and January 6, 2012;

     (((4))) (5) Registered nurses, licensed practical nurses, nurse technicians, or advanced registered nurse practitioner under chapter 18.79 RCW;

     (((5))) (6) Nursing assistants-certified under chapter 18.88A RCW;

     (((6))) (7) Certified counselors under chapter 18.19 RCW;

     (((7))) (8) Speech language pathologists or audiologists under chapter 18.35 RCW;

     (((8))) (9) Occupational therapists under chapter 18.59 RCW;

     (((9))) (10) Physical therapists under chapter 18.74 RCW;

     (((10))) (11) A home health aide who is employed by a medicare-certified home health agency and has met the requirements of 42 CFR, Part 483.35; and

     (((11))) (12) An individual with special education training and an endorsement granted by the superintendent of public instruction as described in RCW 28A.300.010.

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     Reviser's note: The unnecessary underscoring and strike through in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-112-0078   What other required training may be used to satisfy the population specific component of the basic training?   Homes or providers may use the following DSHS-developed or approved curriculum to meet all or some of the population specific component of basic training depending on the needs of the population served:

     (1) Dementia specialty training;

     (2) Mental health specialty training;

     (3) Developmental disabilities specialty training;

     (4) Young adults with physical disabilities; and

     (5) Aging and older adults.

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     (1) It must include the department developed competencies and learning objectives as described in WAC 388-112-0122, 388-112-0132, or 388-112-0142. Homes or providers may enhance the specialty training component by adding additional competencies, learning objectives, content, or activities. If the department approves the enhancements and an increased number of training hours, the worker's training hours will apply to the seventy hour training requirement.

     (2) Long-term care workers must pass a department competency test described in WAC 388-112-0295 to meet the applicable licensing requirements for adult family homes and assisted living facilities for all specialty training.

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     (1) Introduction to physical disabilities;

     (2) Common physical disabilities and ability limitations;

     (3) Supporting residents living with chronic conditions;

     (4) Independent living and resident-directed care; and

     (5) Social connections and sexual needs of adults living with disabilities.

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     (1) Regarding the competency on young adults with physical disabilities, working effectively with young adults with physical disabilities based upon a basic understanding of disability:

     (a) Identify basic information regarding physical disabilities, injuries, and illnesses that are more common in young adults;

     (b) Describe the impact of changing and fluctuating abilities;

     (c) Identify stereotypes, biases, and misconceptions regarding the perception of young adults with physical disabilities;

     (d) Describe how biases, stereotypes, and misconceptions can influence care to young adults with physical disabilities;

     (e) Identify and explain the Americans with Disabilities Act and rights for adults with physical disabilities; and

     (f) Describe the value of personalizing care and support to the specific resident with a disability.

     (2) Regarding the competency on common physical disabilities and ability limitations, providing individualized care based upon a basic understanding of common physical disabilities and their impact on functioning:

     (a) Describe common physical disabilities, including paraplegia and quadriplegia, diabetes, multiple sclerosis, and pulmonary disease.

     (b) Describe the characteristics and functional limitations of residents with these specific disabilities.

     (3) Regarding the competency on supporting residents living with chronic conditions, providing appropriate care by recognizing chronic secondary conditions that impact functioning:

     (a) Identify how common chronic medical conditions affect physical disability;

     (b) Describe how chronic medical conditions influence and impact care for a young resident with a physical disability;

     (c) Describe how to support a resident with a physical disability and multiple chronic conditions; and

     (d) Describe how to support the resident's dignity while providing personal care.

     (4) Regarding the competency on independent living and resident-directed care, supporting independent living and self-determination for the resident living with a disability:

     (a) Define the independent living philosophy and describe what it might look like;

     (b) Describe barriers to independent living, including accessibility and attitudes;

     (c) Describe ways to support independent living and self-determination with the resident living with a disability;

     (d) Describe resident-directed support;

     (e) Identify ways to promote resident-directed support; and

     (f) Identify resources that promote independence and self-determination for a resident living with a disability.

     (5) Regarding the competency of social connections and sexual needs of young adults living with a physical disability, providing optimum support to a resident living with a disability in his or her expression of social and sexual needs:

     (a) Describe and explain the importance of full, appropriate, and equal participation of resident's living with a physical disability;

     (b) Identify ways to support social connections and activities;

     (c) Describe and explain the importance of honoring the resident as a sexual being with diverse sexual needs, desires, and orientation; and

     (d) Identify ways to support expression of sexual needs in a respectful, professional, and confidential manner.

[]

     (1) Introduction to aging;

     (2) Age-associated physical changes;

     (3) Cultural impacts on aging;

     (4) Ageism and supporting resident dignity;

     (5) Supporting residents living with a chronic condition;

     (6) Dealing with death, grief, and loss; and

     (7) Supporting health and wellness.

[]

     (1) Regarding the competency on an introduction to aging, draw upon a basic understanding of the aging process and demonstrate awareness of the unique needs of older adults:

     (a) Describe basic information on the aging process, including the difference between age-related changes and a disease process;

     (b) List typical changes that occur with aging;

     (c) Identify common stereotypes, biases, myths, and misconceptions regarding aging, ageism, and older adults;

     (d) Describe how ageism, biases, myths, and misconceptions can influence care to older residents;

     (e) Describe how aging affects the resident's needs and behaviors; and

     (f) Describe the value of adapting caregiving to the age-related concerns of the resident.

     (2) Regarding the competency on age-associated physical changes, provide individualized care by understanding physical changes that are experienced in aging:

     (a) Identify common physical changes experienced in the aging process;

     (b) Describe common sensory changes that occur in aging and their impact on an older adult's activities;

     (c) Describe the difference between age-associated physical changes versus a disease process; and

     (d) Describe how age-related physical changes can impact functioning and the ability to perform personal care.

     (3) Regarding the competency on cultural impacts of aging, provide culturally compassionate care by utilizing a basic understanding of issues related to culture and aging:

     (a) Describe how race/ethnicity, poverty, and class influence the aging process;

     (b) Describe how race/ethnicity, poverty, and class influence an older adult's help-seeking behavior; and

     (c) Describe a culturally sensitive approach to working with older adults that demonstrates shared decision-making and mutual respect.

     (4) Regarding the competency on ageism and supporting resident dignity, overcome ageism and support resident dignity by understanding stereotypes and myths regarding aging:

     (a) Describe the concept of "ageism" and its possible impact on working with older adults;

     (b) Identify his or her perceptions about aging and how these perceptions may contribute to "ageism";

     (c) Describe how "ageism" can influence resident dignity; and

     (d) Describe strategies for overcoming "ageism" and supporting resident dignity.

     (5) Regarding the competency on supporting residents living with chronic medical conditions, provide appropriate care by recognizing how chronic conditions impact functioning:

     (a) Describe how chronic medical conditions can influence and impact care for older adults;

     (b) Describe strategies for working with an older adult with multiple chronic medical conditions;

     (c) Describe proactive ways to support an older adult living with chronic medical conditions; and

     (d) Describe how to help support the older adult's dignity while providing care.

     (6) Regarding the competency on dealing with death, grief and loss, respond appropriately to a resident experiencing loss:

     (a) Describe common examples of losses encountered in the aging process;

     (b) Describe common reactions to loss of significant roles;

     (c) Describe strategies for dealing with loss;

     (d) Describe the value of promoting social engagement for the older adult;

     (e) Identify strategies and opportunities for promoting social engagement; and

     (f) Identify actions and resources that can be used to help an older adult work through feelings of grief and loss.

     (7) Regarding the competency on supporting optimum health and wellness, support the optimum health and wellness of older adults:

     (a) Identify key factors that support resident health and wellness;

     (b) Identify strategies for promoting resident optimum health while aging;

     (c) Identify strategies and opportunities to support an older adult to engage in healthy life style choices; and

     (d) Describe his or her role in promoting optimum health and wellness for older residents.

[]

[]

     (1) All long-term care workers, within one hundred and fifty days of hire;

     (2) Adult family home applicants, before licensure;

     (3) Adult family home entity representatives and resident managers, before assuming the duties of the position; and

     (4) Assisted living facility administrators or their designees within one hundred and fifty days of hire.

[]

     (2) An approved training entity issuing and signing a DSHS seventy five hour training certificate must verify that the long-term care worker has the certificates required documenting two hours of DSHS-approved orientation, three hours of DSHS-approved safety training, and seventy hours of DSHS-approved basic training, as described in this chapter. When applying to the department of health for home care aide certification, the long-term care worker may only submit a seventy-five hour training certificate that has been issued by the department or the training partnership.

     (3) For home care aide recertification, successful completion of twelve hours of DSHS-approved continuing education training must be documented on a certificate(s) or transcript(s) issued by a department approved training entity.

     (4) The long-term care worker and certified home care aide must retain any twelve hour training certificates or transcripts for as long as they are employed.

[]

     (2) Manager specialty training is required for ((boarding home)) assisted living facility administrators (or designees), adult family home applicants or providers ((and)), resident managers, and entity representatives who are affiliated with homes that serve residents who have one or more of the following special needs: developmental disabilities, dementia, or mental health. The managers described in this section must take one or more of the following specialty trainings:

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

     (b) Manager dementia specialty training, ((under)) described in WAC 388-112-0125((,)); and

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

     (3) ((Caregiver specialty training for boarding homes)) All long-term care workers including those who are exempt from basic training and who work in an assisted living facility or adult family home, serving residents with the special needs described in subsection (2) of this section, must take long-term care worker specialty training. The long-term care worker specialty training applies to the type of residents served by the home as follows:

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

     (b) ((Caregiver)) Long-term care worker dementia specialty training, ((under)) described in WAC 388-112-0130((,)); and ((caregiver))

     (c) Long-term care worker mental health specialty training, ((under)) described in WAC 388-112-0140((, are the required trainings on those specialties for boarding home caregivers)).

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

     The provider or resident manager who has successfully completed the manager specialty training, or a person knowledgeable about the specialty area, trains adult family home caregivers in the specialty needs of the individual residents in the adult family home, and there is no required curriculum)) Specialty training may be used to meet the requirements for the basic training population specific component if completed within one hundred and twenty days of date of hire.

     (5) For long-term care workers who have completed the seventy-five hour training and do not have a specialty training certificate which indicates completion and competency testing, the long-term care worker must complete specialty training when employed by the adult family home or assisted living facility that serves residents with special needs.

[Statutory Authority: RCW 18.20.090, 70.128.040, 70.128.230. 06-16-072, § 388-112-0110, filed 7/28/06, effective 8/28/06. Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0110, filed 7/11/02, effective 8/11/02.]

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0115, filed 7/11/02, effective 8/11/02.]

     (a) Overview of developmental disabilities;

     (b) Values of service delivery;

     (c) Effective communication;

     (d) Introduction to interactive planning;

     (e) Understanding behavior;

     (f) Crisis prevention and intervention; and

     (g) Overview of legal issues and ((individual)) resident rights.

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

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

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0120, filed 7/11/02, effective 8/11/02.]

     (1) Regarding the competency on an overview of developmental disabilities, drawing upon a basic understanding of developmental disabilities and demonstrate awareness of the unique needs of residents with developmental disabilities:

     (a) Define developmental disability and describe intellectual disability, cerebral palsy, epilepsy, and autism;

     (b) Identify common myths and misconceptions about developmental disabilities;

     (c) Describe the negative effects of using labels such as "retarded" or "handicapped" to represent people and positive alternatives; and

     (d) Differentiate between developmental disabilities and mental illness.

     (2) Regarding the competency on values of service delivery, promote and support a resident's self-determination:

     (a) Identify the principle of normalization and its significance to the work of long-term care workers;

     (b) Explain how understanding each resident's needs leads to better services and supports, which lead to better outcomes for the resident;

     (c) Describe each of the residential services guidelines and identify how the values represented in the guidelines are important in the lives of people with developmental disabilities;

     (d) Describe the principle of self-determination; and

     (e) Identify positive outcomes for residents with developmental disabilities when they are connected to the community they live in.

     (3) Regarding the competency on communication, provide culturally compassionate and individualized care by utilizing a basic understanding of a resident or resident's history, experience, and cultural beliefs:

     (a) List the key elements of effective communication;

     (b) Describe the impact communication has on the lives of residents with developmental disabilities;

     (c) Explain the impact a long-term care worker's behavior can have on eliciting communication;

     (d) Explain the impact of a resident's physical environment on their ability to communicate;

     (e) Describe methods of communication, other than verbal, that long-term care workers might use when supporting residents with developmental disabilities; and

     (f) List tips for communication with residents with developmental disabilities.

     (4) Regarding the competency on interactive planning, using person-centered and interactive planning when working with residents with developmental disabilities:

     (a) Identify the benefits of using a person-centered planning process rather than the traditional planning methods used to develop supports for people with developmental disabilities;

     (b) Identify key elements involved in interactive planning;

     (c) Identify ways to include people with developmental disabilities and their families in the planning process; and

     (d) Identify the required planning document for the setting and list ways to have a positive impact on the plan.

     (5) Regarding the competency on challenging behaviors, use a problem solving approach and positive support principles when dealing with challenging behaviors:

     (a) Identify the essential components of the concept of positive behavioral supports;

     (b) Define the "ABCs" and describe how to use that process to discover the function of behavior;

     (c) Explain why it is critical to understand the function of behavior before developing a support plan;

     (d) Define reinforcement and identify ways to utilize it as a tool to increase a resident's ability to be successful;

     (e) Identify the problems with using punishment to manage behavior;

     (f) Identify behavior management techniques that are not allowed under DSHS policies and applicable laws;

     (g) Identify factors that can positively and negatively influence the behavior of residents with developmental disabilities; and

     (h) List steps to be taken when crisis or danger to people is immediate.

     (6) Regarding the competency on crisis prevention, support a resident experiencing a crisis and get assistance when needed:

     (a) Identify behaviors in people with developmental disabilities that might constitute "normal stress";

     (b) Define "crisis";

     (c) Differentiate the behaviors a resident who is in crisis exhibits from mental illness;

     (d) Identify the principles of crisis prevention and intervention;

     (e) Identify what types of situations require outside assistance and at what point it becomes necessary; and

     (f) Name several ways to provide support to a resident experiencing a crisis.

     (7) Regarding the competency on legal rights, promote and protect the legal and resident rights of residents with developmental disabilities:

     (a) Explain how the rights of residents with disabilities compare to those of the general population;

     (b) List the rights of residents living in adult family homes and assisted living facilities and the laws that support those rights;

     (c) Describe how long-term care workers can help residents to exercise their rights;

     (d) List ways a caregiver or long-term care worker must safeguard each resident's confidentiality;

     (e) Describe the three types of guardianship an resident with developmental disabilities might be subject to and why;

     (f) List less restrictive alternatives to guardianship;

     (g) Describe the responsibilities, powers, and limitations of a guardian; and

     (h) Describe the relationship between long-term care workers and guardians/families.

[]

     (1) Medications and dementia:

     (a) ((Introduction to the dementias)) Common medications for general health problems;

     (b) ((Differentiating dementia, depression, and delirium)) Medication side effects;

     (c) ((Caregiving goals, values, attitudes and behaviors)) Reporting side effects;

     (d) ((Caregiving principles and dementia problem solving)) Drugs used with people who have dementia;

     (e) ((Effects of cognitive losses on communication)) Extrapyramidal side effects;

     (f) ((Communicating with people who have dementia)) Medications to treat dementia and their side effects; and

     (g) ((Sexuality and dementia;

     (h) Rethinking "problem" behaviors;

     (i) Hallucinations and delusions;

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

     (k) Drugs and dementia;

     (l) Working with families;

     (m) Getting help from others; and

     (n) Self-care for caregivers)) Treating dementia with antipsychotic drugs.

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

     (a) Working with families and friends;

     (b) Considerations for dealing with family members and friends; and

     (c) Encouraging self-care for the caregiver.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0125, filed 7/11/02, effective 8/11/02.]

     (((a))) (1) Introduction to the dementias;

     (((b))) (2) Dementia, depression, and delirium;

     (((c) Resident-based caregiving;

     (d))) (3) Dementia caregiving principles;

     (((e))) (4) Communicating with people who have dementia;

     (((f))) (5) Sexuality and dementia;

     (((g))) (6) Rethinking "problem" behaviors;

     (((h))) (7) Hallucinations and delusions;

     (((i))) (8) Helping with activities of daily living (ADLs); and

     (((j))) (9) Working with family and friends.

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

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0130, filed 7/11/02, effective 8/11/02.]

     (1) Regarding the competency on an introduction to dementia, draw upon a basic understanding of dementia and demonstrate awareness of the unique needs of residents with dementia:

     (a) Identify basic information on dementia, including causes and treatments;

     (b) Describe how dementia affects resident needs and behaviors;

     (c) List typical behaviors and symptoms a resident with dementia would most likely experience;

     (d) Describe the differences that might be seen based on the type of dementia a resident has.

     (2) Regarding the competency on dementia, depression, and delirium, respond appropriately to residents who have dementia, delirium, and/or depression:

     (a) Identify and differentiate between dementia, depression, and delirium;

     (b) Describe common symptoms of dementia, depression, and delirium and list possible causes;

     (c) Compare and contrast among common symptoms of dementia, depression, and delirium; and

     (d) Identify what symptom changes require immediate professional attention and how to access professional help.

     (3) Regarding the competency on dementia caregiving principles, incorporate current best practices when providing dementia care:

     (a) Identify current best practices in dementia caregiving;

     (b) Describe current best practices in caregiving;

     (c) Demonstrate the ability to support the resident's strengths using caregiving techniques to support those strengths; and

     (d) Describe how to use cultural and life information to develop and enhance care provided to residents with dementia.

     (4) Regarding the competency on communicating with people who have dementia, communicate in a respectful and appropriate manner with residents with dementia:

     (a) Describe common dementia-caused cognitive losses and how those losses can affect communication;

     (b) Identify appropriate and inappropriate nonverbal communication skills and discuss how each impacts a resident's behavior;

     (c) Describe how to effectively initiate and conduct a conversation with a resident who has dementia; and

     (d) Identify communication strategies to work with residents who have dementia.

     (5) Regarding the competency on sexuality and dementia, protect a resident or resident's rights when dealing with issues of sexuality and appropriately manage unwanted or inappropriate sexual behavior:

     (a) Identify ways in which dementia affects sexuality and sexual behaviors;

     (b) Identify a resident's rights as they relate to sexuality and sexual behavior and discuss ways to support these rights; and

     (c) Describe how to respond using nonjudgmental caregiving skills to residents' appropriate and inappropriate sexual behaviors.

     (6) Regarding the competency on dealing with challenging behaviors, use a problem-solving approach when dealing with challenging behaviors:

     (a) Describe how to use a problem-solving method to intervene in challenging behaviors or situations;

     (b) Describe some possible common causes of challenging behaviors, including aggression, catastrophic reactions, wandering, and inappropriate sexual behavior and explore their causes;

     (c) Describe how to implement a problem-solving process when working with a resident who has dementia; and

     (d) Describe how to respond appropriately to a resident who is expressing a challenging behavior.

     (7) Regarding the competency on hallucinations and delusions, respond appropriately when a resident is experiencing hallucinations or delusions:

     (a) Define and differentiate between hallucinations and delusions;

     (b) List different types of dementia-related hallucinations; and

     (c) Describe how to appropriately and safely respond to a resident with dementia who is experiencing hallucinations and delusions.

     (8) Regarding the competency on activities of daily living, make activities of daily living pleasant and meaningful:

     (a) Identify and describe ways in which to support making activities of daily living pleasant for residents with dementia; and

     (b) Describe strategies that support meaning and utilize an individualized approach when assisting a resident with dementia with activities of daily living.

     (9) Regarding the competency on working with family and friends, respond respectfully, appropriately, and with compassion when interacting with families and friends of residents with dementia:

     (a) Identify common concerns friends and family have when a loved one has dementia;

     (b) Describe ways to be supportive and compassionate in interactions with family and friends of the resident with dementia;

     (c) Identify how to find local resources for family support needs; and

     (d) Describe a method to gather cultural and life history information from a resident and/or representative(s).

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     (1) Medications and mental health:

     (a) ((Introduction to mental illness)) Medications used with mental disorders;

     (b) ((Culturally compassionate care)) Antipsychotic medications;

     (c) ((Respectful communications)) Anti-mania medications/anticonvulsants;

     (d) ((Understanding mental illness - major mental disorders)) Anti-anxiety medications;

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

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

     (g) ((Aggression)) Extrapyramidal side effects;

     (h) ((Suicide;

     (i) Medications;

     (j) Getting help from others; and

     (k) Self-care for caregivers)) Medications to treat mental disorders and their side effects.

     (2) ((The manager mental health specialty training learning outcomes and competencies may be obtained from the DSHS aging and adult services administration)) Getting help and self-care:

     (a) Dealing with mental health issues;

     (b) Dealing with crisis;

     (c) Dealing with the risk of violence;

     (d) Crisis resources;

     (e) Crisis resources (activity);

     (f) Your mental wellness;

     (g) Strategies to cope;

     (h) Who to get help from and what they do.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0135, filed 7/11/02, effective 8/11/02.]

     (a) Understanding major mental ((disorders)) illnesses;

     (b) ((Individual)) Resident background, experiences and beliefs;

     (c) ((Responding to)) Respectful communication;

     (d) Creative approaches to challenging behaviors;

     (e) Decompensation((,)) and relapse((,)) planning;

     (f) Responding to hallucinations and delusions;

     (((d) Interventions for behaviors perceived as problems;

     (e))) (g) Crisis intervention and dealing with aggression; and

     (((f))) (h) Suicide prevention.

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

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0140, filed 7/11/02, effective 8/11/02.]

     (1) Regarding the competency on understanding major mental illnesses, draw upon a basic understanding of mental illness and demonstrate awareness of the unique needs of residents with mental illness:

     (a) Define and describe main symptoms of depression, bipolar schizophrenia, and anxiety disorder, and list treatment options for each;

     (b) Describe causes of mental illness;

     (c) Describe the progression of mental illness;

     (d) Identify common myths and misinformation about mental illness; and

     (e) Define stigma and identify how stigma can impact caregiving.

     (2) Regarding the competency on resident background, experiences and beliefs, provide culturally compassionate and individualized care by utilizing a basic understanding of the resident's history, experience, and cultural beliefs:

     (a) Demonstrate a method for gathering cultural, lifestyle, and personal value information from a resident;

     (b) Identify why obtaining cultural information from a resident is important;

     (c) Describe the importance of being sensitive to cultural differences when providing care;

     (d) Differentiate how cultural beliefs and symptoms may be misinterpreted as mental illness; and

     (e) Identify how the long-term care worker's culture might affect caregiving.

     (3) Regarding the competency on communication and mental illness, communicate respectfully and appropriately with residents with a mental illness:

     (a) Identify what is considered respectful and disrespectful communication when interacting with a resident with a mental illness;

     (b) Identify what is judgmental communication toward a resident with a mental illness and ways to ensure communication is nonjudgmental;

     (c) Identify examples of verbal and nonverbal communication and describe how each impacts communication; and

     (d) Describe how to effectively initiate and conduct a respectful conversation with a resident who has a mental illness.

     (4) Regarding the competency on creative approaches to challenging behaviors, use a problem-solving approach when dealing with challenging behaviors:

     (a) Define and differentiate between inappropriate learned behaviors and symptoms of a mental illness;

     (b) Identify possible common causes of challenging behaviors in a resident with a mental illness;

     (c) Differentiate how challenging behaviors may be misinterpreted as mental illness; and

     (d) Describe intervention strategies that can be used to reduce or prevent challenging behaviors.

     (5) Regarding the competency on responding to de-compensation and relapse, respond appropriately when a resident is decompensating to help prevent a relapse:

     (a) Define the terms baseline, de-compensation, and relapse;

     (b) Identify common causes and symptoms of de-compensation and relapse;

     (c) Describe the term "relapse plan" and review an example of a relapse plan; and

     (d) Identify how a long-term care worker can support and use the relapse plan.

     (6) Regarding the competency on responding to hallucinations and delusions, respond appropriately to a resident experiencing hallucinations or delusions:

     (a) Define the terms hallucination and delusion;

     (b) Identify common triggers (including stress) of delusions and hallucinations;

     (c) Identify and describe appropriate intervention strategies for a resident experiencing a hallucination or delusion; and

     (d) Describe how to accurately document a resident's behavioral symptoms, interventions, and outcomes.

     (7) Regarding the competency on crisis intervention and dealing with aggression, intervene early when dealing with aggressive behavior to increase emotional stability and ensure safety:

     (a) Define the term aggression;

     (b) Identify the difference between aggressive behaviors and aggressive feelings;

     (c) List de-escalation "do's" and "don'ts" as they relate to working with a resident expressing aggressive behavior;

     (d) Describe appropriate de-escalation techniques when working with a resident expressing aggressive behavior; and

     (e) Differentiate between nonimmediate and immediate danger and at what point additional assistance may be needed.

     (8) Regarding the competency on suicide prevention, respond appropriately to a resident at risk of suicide:

     (a) Identify and list signs a resident is possibly suicidal;

     (b) Describe how to respond appropriately to a resident experiencing suicidal thoughts, including:

     (i) How, where, and when to refer a resident who is experiencing suicidal thoughts and/ or planning; and

     (ii) Methods to keep a suicidal resident safe and ensure the safety for others.

     (c) Describe strategies to help cope with a resident's suicide.

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     (1) All adult family home applicants or providers ((and)), resident managers (or designees), ((and for)) entity representatives, and long-term care workers; and

     (2) All ((boarding home)) assisted living facility administrators (or designees) ((and caregivers, as provided under WAC 388-112-0290 through 388-112-0315. Competency testing is not required for adult family home caregivers)), and long-term care workers.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0145, filed 7/11/02, effective 8/11/02.]

     (1) Individuals may take the DSHS challenge test instead of required specialty training. A person who does not pass a challenge test on the first attempt must attend the class.

     (2) A challenge test is not permitted when specialty training is taken to meet the population specifics of basic training per WAC 388-112-0066.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0150, filed 7/11/02, effective 8/11/02.]

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     (1) The ((trainee's)) name of the student;

     (2) The name of the specialty training;

     (3) The number of training hours;

     (4) The name and identification number of the home or training entity ((giving the training));

     (((4))) (5) The instructor's name ((and signature)); and

     (((5))) (6) The ((date(s) of training)) date of completion.

     (((6))) The ((trainee)) student must be given an original certificate. The ((home)) employer must keep a copy of the certificate on file.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0155, filed 7/11/02, effective 8/11/02.]

     (1) Adult family home applicants, providers (((including)), entity representatives ((as defined under chapter 388-76 WAC))) and resident managers must complete manager specialty training or developmental disability caregiver training, and demonstrate competency before ((admitting and serving residents)) the home is licensed or before a new entity representative or resident manager assumes the duties of the position in order to admit or serve residents who have special needs related to mental illness, dementia, or a developmental disability.

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

     ((Boarding homes)) Assisted living facilities

     (3) If ((a boarding home)) an assisted living facility serves one or more residents with special needs, the ((boarding home)) assisted living facility administrator (or designee) must complete manager specialty training or developmental disability caregiver training, and demonstrate competency within one hundred twenty days of ((employment or within one hundred twenty days of September 1, 2002, whichever is later)) date of hire. ((A boarding home)) An assisted living facility administrator with a current nursing home administrator license is exempt from this requirement, unless the administrator will train ((their facility caregivers)) the facility's long-term care workers in a ((caregiver)) specialty.

     (4) If a resident develops special needs while living in ((a boarding home)) an assisted living facility, the ((boarding home)) assisted living facility administrator (or designee) has one hundred twenty days to complete manager specialty training and demonstrate competency. ((A boarding home)) An assisted living facility administrator with a current nursing home administrator license is exempt from this requirement, unless the administrator will train ((their facility caregivers)) the facility's long-term care workers in a ((caregiver)) specialty.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0160, filed 7/11/02, effective 8/11/02.]

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

     ((Boarding homes))

     If ((a boarding home)) an assisted living facility or adult family home serves one or more residents with special needs, ((caregivers)) long-term care workers in those settings must complete ((caregiver)) specialty training and demonstrate competency.

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

     (2) ((If the caregiver specialty training is not integrated with basic training, caregivers)) Long-term care workers who are exempt from basic training must complete the relevant ((caregiver)) specialty training within ninety days of ((completing basic training)) hire.

     (3) Until competency in the ((caregiver)) specialty training has been demonstrated, ((caregivers)) long-term care workers may not provide ((hands-on)) personal care to a resident with special needs without direct supervision in an assisted living facility or in an adult family home.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0165, filed 7/11/02, effective 8/11/02.]

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0170, filed 7/11/02, effective 8/11/02.]

     (1) Before performing any delegated nursing task, long-term care workers in adult family ((home staff)) homes and assisted living facilities must:

     (a) Successfully complete DSHS-designated nurse delegation core training, "Nurse Delegation for Nursing Assistants";

     (b) Be a:

     (i) Certified home care aide under chapter 18.88B RCW ((nursing assistant registered)); or

     (ii) Nursing assistant certified under chapter 18.88A RCW; ((and)) or

     (iii) If exempt from the home care aide certification under WAC 246-980-070, become a nursing assistant registered and complete the core competencies of basic training, unless the twenty eight hours of revised fundamentals of care or a department approved alternative was already completed.

     (iv) If nurse delegation is needed to implement a care plan earlier than home care aide certification can be obtained, become a nursing assistant registered and complete core competencies of basic training.

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

     Boarding homes))

     (2) Before performing ((any delegated nursing task, boarding home staff)) the task of insulin injections, long-term care workers in adult family homes and assisted living facilities must:

     (a) ((Successfully complete DSHS-designated nurse delegation core training)) Meet the requirements in subsections (1)(a) and (b) of this section; and

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

     (c) If a nursing assistant registered, successfully complete basic training)) Successfully complete DSHS-designated specialized diabetes nurse delegation training.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-065, § 388-112-0195, filed 7/11/02, effective 8/11/02.]

[Statutory Authority: 2008 c 146, RCW 18.20.090, 74.08.090, chapter 70.128 RCW. 09-03-066, § 388-112-0196, filed 1/14/09, effective 2/14/09.]

[]

     (2) Nurse delegation core and nurse delegation specialized diabetes training may be used to count towards continuing education.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0200, filed 7/11/02, effective 8/11/02.]

     (((1) Individuals subject to a continuing education requirement)) (a) From January 1, 2012 through June 30, 2012, adult family home providers, entity representatives, resident managers, and long-term care workers whose birth date is within these dates and the required basic training was previously completed must complete ((at least)) ten hours of continuing education ((each calendar year (January 1 through December 31) after the year in which they successfully complete basic or modified basic training)). If ten hours of continuing education were completed between January 1, 2012 through June 30, 2012 for any one listed above, regardless of birth date, then the continuing education requirements have been met for 2012.

     (((2))) (b) Effective July 1, 2012, certified home care aides must complete twelve hours of continuing education each year after obtaining certification as described in RCW 74.39A.341.

     (c) If exempt from certification as described in RCW 18.88B.041, all long-term care workers must complete twelve hours of continuing education per year.

     (d) Continuing education must include one-half hour per year on safe food handling in adult family homes described in RCW 70.128.250.

     (2) Assisted living facilities

     (a) From January 1, 2012 through June 30, 2012, assisted living facility administrators (or their designees) and long-term care workers whose birthdate is within these dates and the required basic training was previously completed must complete ten hours of continuing education. If ten hours of continuing education were completed between January 1, 2012 through June 30, 2012, for any one listed above, regardless of birthdate then the continuing education requirements have been met for 2012.

     (b) Effective July 1, 2012, certified home care aides must complete twelve hours of continuing education each year after obtaining certification as described in RCW 74.39A.341.

     (c) Long-term care workers exempt from certification under RCW 18.88.041, must complete twelve hours of continuing education per year. An assisted living facility administrator with a current nursing home administrator license is exempt from this requirement.

     (3) A long-term care worker who does not complete continuing education as required in subsections (1)(a) and (b) and (2)(a) and (b) of this section or in RCW 74.39A.341 cannot be paid to provide care until the required continuing education is completed.

     (4) One hour of completed classroom instruction or other form of training (such as ((a video or)) an on-line course) equals one hour of continuing education. For on-line courses, the training entity must establish a way for the long-term care worker to ask the instructor questions.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0205, filed 7/11/02, effective 8/11/02.]

     (2) For long-term care workers who are required to be certified, if the first renewal period is less than a full year from the date of certification, no continuing education will be due for the first renewal period.

[]

     (1) Resident rights, such as freedom from abuse, neglect, abandonment and financial exploitation;

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

     (3) Mental illness;

     (4) Dementia;

     (5) Developmental disabilities;

     (6) Depression;

     (7) Medication assistance;

     (8) Communication skills;

     (9) Positive resident behavior support;

     (10) Developing or improving resident centered activities;

     (11) Dealing with wandering or aggressive resident behaviors;

     (12) Medical conditions; ((and))

     (13) ((In adult family homes,)) Safe food handling, CPR and First aid described in WAC 388-112-0255 and 388-112-0260; and

     (14) Nurse delegation core and specialized diabetes.

[Statutory Authority: RCW 18.20.090, 70.128.040, 70.128.230, and 2005 c 505. 06-01-046, § 388-112-0210, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0210, filed 7/11/02, effective 8/11/02.]

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

     (2) If one or more specialty trainings are completed in a different year than the year when basic or modified basic training was taken, the specialty training hours may be applied toward the continuing education requirement for the calendar year in which the specialty training is taken and the following calendar year)) When hours from a specialty training are counted toward basic training requirements, the hours may not be counted toward continuing education. Additional hours not used to meet the basic training requirement may be applied toward the continuing education requirement.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0225, filed 7/11/02, effective 8/11/02.]

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0235, filed 7/11/02, effective 8/11/02.]

     (a) The ((trainee's)) name of the student;

     (b) The title ((or content)) of the training;

     (c) The number of hours of the training;

     (d) The assigned curriculum approval code;

     (e) The instructor's name((,)) and signature;

     (f) The name of the home or training entity giving the training((, or the name of the video, on-line class, professional journal, or equivalent instruction materials completed)); and

     (((d) The number of hours of training; and))

     (((e))) (g) The date(s) of training.

     (2) The ((trainee)) student must be given an original certificate or other documentation of continuing education. The adult family home or assisted living facility must keep a copy of the certificate or transcript on file as described in WAC 388-76-10198 (for adult family homes) and as described in WAC 388-78A-2450 (for assisted living facilities).

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0240, filed 7/11/02, effective 8/11/02.]

     (4) Successful completion of first aid training, following the OSHA guidelines, also serves as proof of the CPR training.))

[Statutory Authority: RCW 18.20.090, 70.128.040, 70.128.230, and 2005 c 505. 06-01-046, § 388-112-0255, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0255, filed 7/11/02, effective 8/11/02.]

     (((1))) (a) Adult family home applicants, providers, entity representatives, and resident managers must possess a valid CPR and first-aid card or certificate prior to ((providing care for residents)) obtaining a license, and must maintain a valid ((cards)) card or ((certificates)) certificate.

     (((2))) (b) Licensed nurses working in adult family homes must possess a valid CPR card or certificate within thirty days of ((employment)) date of hire and must maintain a valid card or certificate. If the licensed nurse is an adult family home provider or resident manager, the valid CPR card or certificate must be obtained prior to providing care for residents.

     (((3))) (c) Adult family home ((caregivers)) long-term care workers must obtain and maintain a valid CPR and first-aid card or certificate:

     (((a))) (i) Within thirty days of beginning to provide care for residents, if the provision of care for residents is directly supervised by a fully qualified ((caregiver)) long-term care worker who has a valid first-aid and CPR card or certificate; or

     (((b))) (ii) Before providing care for residents, if the provision of care for residents is not directly supervised by a fully qualified ((caregiver)) long-term care worker who has a valid first-aid and CPR card or certificate.

     ((Boarding homes)) (2) Assisted living facilities

     (((4) Boarding home)) (a) Assisted living facility administrators who provide direct care, and ((caregivers)) long-term care workers must possess a valid CPR and first-aid card or certificate within thirty days of ((employment)) date of hire, and must maintain valid cards or certificates. Licensed nurses working in ((boarding homes)) assisted living facility must possess a valid CPR card or certificate within thirty days of ((employment)) date of hire, and must maintain a valid card or certificate.

[Statutory Authority: RCW 18.20.090, 70.128.040, 70.128.230, and 2005 c 505. 06-01-046, § 388-112-0260, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0260, filed 7/11/02, effective 8/11/02.]

     Prospective providers applying for a license after January 1, 2007: Before a license for an adult family home is granted, the prospective provider)) All applicants for an adult family home license must successfully complete the department approved ((forty-eight hour)) residential care administrator training for adult family homes.

[Statutory Authority: RCW 74.08.090, 18.20.090, 70.128.040, chapter 70.128 RCW and 2006 c 249. 07-01-045, § 388-112-0270, filed 12/14/06, effective 1/14/07. Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0270, filed 7/11/02, effective 8/11/02.]

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0280, filed 7/11/02, effective 8/11/02.]

     (1) Skills demonstration (see subsection 2 of this section) of ability to perform and/or implement specific caregiving approaches, and/or activities as appropriate for the training;

     (2) Adult family home residential care administrator training does not contain a skills demonstration. Student's progress and knowledge will be measured by assigned projects and other means of measuring competency.

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

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

     (5) Instructors who conduct competency testing must have experience or training in assessing competencies.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0295, filed 7/11/02, effective 8/11/02.]

     (8) Nurse delegation specialized diabetes training.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0300, filed 7/11/02, effective 8/11/02.]

     (2) If a challenge test is available for a course, it may be taken only once. If the test is failed, the person must take the classroom course.

[Statutory Authority: RCW 18.20.090, 70.128.040, 70.128.230, and 2005 c 505. 06-01-046, § 388-112-0315, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0315, filed 7/11/02, effective 8/11/02.]

     (3))) department must preapprove the curriculum and instructors for all training required under this chapter.

     (2) The nurse delegation core and diabetes training must use only the DSHS curriculum.

     (((4))) (3) ((A curriculum other than the DSHS curriculum must be approved before it is used. An attestation that the curriculum meets all requirements under this chapter will be sufficient for initial approval. Final)) Approval will be based on curriculum review, as described ((under)) in WAC 388-112-0330.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0320, filed 7/11/02, effective 8/11/02.]

     (7) A plan for updating material. Substantial changes to a previously approved curriculum must be approved before they are used)) A department developed curriculum does not require submission to the department for approval unless the curriculum is being modified in any manner by the training entity.

     (1) For orientation and/or safety training:

     Effective January 7, 2012, submit an outline of what will be covered in each training offered (for example, a table of contents or a class syllabus) showing where the required introductory topics as listed in WAC 388-112-0016 for orientation and WAC 388-112-0019 for safety training are covered in the training. Department required orientation and safety training application forms must be submitted to the department at least forty-five days in advance of when the training is expected to be offered. Training cannot be offered before receiving department curriculum and instructor approval.

     (2) For continuing education:

     (a) Continuing education curriculum delivery models will only include instructor led, on-line instructor led, or on-line self-paced learning with access to an instructor;

     (b) Effective July 1, 2012, for instructor led and on-line learning, submit a summary that includes the topic, a brief description of what it will cover, a course outline, the number of training hours, and a description of how the training is relevant to the care setting, care needs of residents, or long-term care worker career development.

     (c) For on line training courses, the information requested in (2)(a) and a description of how the instructor or training will assess that the students have integrated the information being taught must be submitted.

     (d) Department required continuing education training application forms must be submitted at least forty five days in advance of when the training is expected to be offered. The trainings cannot be offered before receiving department curriculum and instructor approval.

     (3) For basic training:

     (a) If the instructor or training entity will use the DSHS developed revised fundamentals of caregiving learner's guide with enhancements, submit the DSHS form with all required information.

     (b) If a DSHS developed revised fundamentals of caregiving learner's guide with enhancements, is not used to teach seventy hours required for basic training, the following must be submitted to DSHS for approval:

     (i) A completed DSHS curriculum checklist indicating where all of the competencies and learning objectives, described in this chapter, are located in the long-term care worker materials from the proposed curriculum for that course;

     (ii) Any materials long-term care workers will receive, such as a textbook or long-term care worker manual, learning activities, audio-visual materials, handouts, and books;

     (iii) The table of contents or outline of the curriculum, including the allotted time for each section;

     (iv) Demonstration skills checklists for the personal care tasks described in WAC 388-112-0055 (12)(a) and (b), and infection control skills (hand washing and putting on and taking off gloves);

     (v) The teacher's guide or manual that includes for each section of the curriculum:

     (A) The goals and objectives;

     (B) Method of teaching, including learning activities that incorporate adult learning principles;

     (C) Methods used to determine whether each long-term care worker understands the materials covered and can demonstrate all skills;

     (D) A list of the sources or references that were used to develop the curriculum. If the primary source or reference is not a published citation, the instructor must provide detail on how the content was established as evidence based;

     (E) Description of how the curriculum was designed to accommodate long-term care workers with limited English proficiency and/or learning disabilities; and

     (F) Description and proof of how input was obtained from consumer and long-term care worker representatives in the development of the curriculum.

     (c) In addition, for curriculum being submitted for the core competency section of basic training as described in WAC 388-112-0055, the curriculum must include how much time students will be given to practice skills and how instructors will evaluate and ensure each long-term care worker can proficiently complete each skill.

     (d) Entities submitting curriculum for population specific basic training must submit their own list of competencies and learning objectives used to develop the population specific basic training curriculum.

     (4) For specialty training:

     For specialty training that is not the DSHS developed curriculum or other department approved curriculum, submit the required specialty training application form and any additional learning objectives added to the competency and learning objectives checklist, the enhancements that have been added, and additional student materials or handouts. To be approved, an alternative curriculum must at a minimum include:

     (a) All the DSHS-published learning outcomes and competencies for the course;

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

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

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

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

     (ii) Practice of skills to increase competency;

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

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

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

     (e) A list of the sources or references, if any, used to develop the curriculum;

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

     (g) A plan for updating material;

     (h) Substantial changes to a previous approved curriculum must be approved before they are used.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0325, filed 7/11/02, effective 8/11/02.]

     (4))) In order to obtain the department's approval of the curriculum for orientation, safety, basic training (core and population specific training), and continuing education:

     (1) Submit the required training application forms and any other materials required for specific curriculums to the department.

     (2) After review of the ((alternative)) curriculum, DSHS will send a written response to the submitter, indicating approval or disapproval of the curriculum ((and if disapproved, the reasons for denial;)).

     (((5))) (3) If curriculum are not approved, the reason(s) for denial will be given and the submitter will be told what portion(s) of the training must be changed and resubmitted for review in order for the curriculum to be approved.

     (4) The submitter can make the requested changes and resubmit the curriculum for review.

     (5) If after working with the department the ((alternative curriculum is not approved, a revised curriculum may be resubmitted to DSHS for another review)) reasons why the curriculum is not approved cannot be resolved, the submitter may seek a review of the nonapproval decision from the assistant secretary of aging and disability services administration (ADSA). The assistant secretary's review decision shall be the final decision of DSHS. No other administrative review is available to the submitter.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0330, filed 7/11/02, effective 8/11/02.]

     (a) Verifies ((and)), documents using the department's attestation process, keeps on file, and makes available to the department upon request that all instructors meet ((each of)) the minimum instructor qualifications in WAC 388-112-0370 through 388-112-0395 for the course they plan to teach;

     (b) Teaches using a complete DSHS-developed or approved ((alternative)) curriculum.

     (c) Notifies DSHS in writing of the ((home's)) provider's intent to conduct staff training prior to providing the ((home's)) provider's first training, and when changing training plans, including:

     (i) ((Home)) The provider's name;

     (ii) Name of training(s) the ((home)) provider will conduct;

     (iii) Name of approved ((curriculum(s))) curriculum the ((home)) provider will use;

     (iv) Name of lead instructor and instructor's past employment in ((boarding homes and)) assisted living facility or adult family homes; and

     (v) Whether the ((home)) provider will train only the ((home's)) provider's staff, or will also train staff from other ((homes)) providers. If training staff outside the home or corporation, the instructor must become a DSHS-contracted community instructor;

     (d) Ensures that DSHS competency tests are administered as required under this chapter;

     (e) Provides a certificate or transcript of completion of training to all staff that successfully complete the entire course((, including:

     (i) The trainee's name;

     (ii) The name of the training;

     (iii) The name of the home giving the training;

     (iv) The instructor's name and signature; and

     (v) The date(s) of training));

     (f) Keeps a copy of ((student)) long-term care worker certificates on file for six years, and gives the original certificate to the ((trainee)) student; and

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

     (h))) Reports training data to DSHS ((in DSHS-identified time frames)) when requested by the department.

     (2) ((An adult family home wishing to conduct caregiver specialty training that is taught by the provider, resident manager, or person knowledgeable about the specialty area, as required under WAC 388-112-0110 subsection (3), must document the specialty training as provided under WAC 388-112-0155)) The department may conduct a random audit at any time to review training and instructor qualifications.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0335, filed 7/11/02, effective 8/11/02.]

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

     (2) The home fails to notify DSHS of changes in the curriculum prior to teaching the curriculum;

     (3) The home provides false or misleading information to long-term care workers or the public concerning the courses offered or conducted;

     (4) The home's ((instructor does not)) instructor(s) fail to meet the applicable qualifications described under ((WAC 388-112-0375 through 388-112-0395)) this chapter; or

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

     (((4))) (6) The home has been operated under temporary management or has been subject to a revocation or suspension of the home license, a stop placement of admissions order, a condition on the license related to resident care, or a civil fine of five thousand dollars or more, within the previous ((twelve)) eighteen months.

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

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0345, filed 7/11/02, effective 8/11/02.]

     (1) Coordinating and teaching classes((,));

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

     (3) Selecting qualified guest speakers where applicable((,));

     (4) Establishing a method whereby the long-term care worker can ask the instructor questions;

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

     (((5))) (6) Maintaining training records including ((student)) long-term care worker tests, certificates and attendance records for a minimum of six years((,));

     (((6))) (7) Reporting training data to DSHS ((in DSHS-identified time frames,)) when requested by the department; and

     (((7))) (8) Issuing or reissuing training certificates to ((students)) long-term care workers.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0355, filed 7/11/02, effective 8/11/02.]

     (a) DSHS must approve ((any)) and/or contract with a training entity and their instructor(s) ((under contract with DSHS)) to conduct orientation, safety, basic, ((modified basic,)) population specific, residential care administrator, manager and long-term care worker specialty, ((or)) nurse delegation core and specialized diabetes training ((classes using the training curricula developed by DSHS)), on-the-job training, and continuing education.

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

     (2) Homes conducting their own training

     ((Homes conducting their own training)) programs using the training ((curricula)) curriculums developed by DSHS or ((alternative curricula)) another curriculum approved by DSHS must ensure, through an attestation process, that their instructors meet the minimum qualifications for instructors under this chapter.

     (3) ((Other instructors))

     DSHS must approve all other training entities and their instructor(s) not described in subsection (1) and (2) of this section.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0360, filed 7/11/02, effective 8/11/02.]

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

     (3) DSHS may terminate an existing training approval of a person or entity to conduct orientation, safety, basic, modified basic, population specific, residential care administrator, specialty, continuing education, or nurse delegation core or diabetes training.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0365, filed 7/11/02, effective 8/11/02.]

     (a) May only teach a specific subject in which they have expertise, ((under the supervision of the instructor. A guest speaker must have as minimum qualifications, an appropriate)) and the background and experience ((that)) demonstrates ((that)) the guest speaker has expertise on the topic he or she will teach.

     (b) May not teach the entire course;

     (c) Must not supplant the primary teaching responsibilities of the primary instructor; and

     (d) Must cover the DSHS competencies and learning objectives for the topic he or she is teaching.

     (2) The approved instructor:

     (a) Must select guest speakers ((that meet the minimum qualifications, and)) based on the guest speaker's knowledge and experience in the specific topic;

     (b) Maintain documentation of ((this background)) the guest speaker's qualifications and/or experience;

     (c) Supervise and monitor the guest speaker's performance; and

     (d) Is responsible for insuring the required content is taught.

     (3) DSHS does not approve guest speakers.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0370, filed 7/11/02, effective 8/11/02.]

     (1) Twenty-one years of age;

     (2) Has not had a professional health care, adult family home, assisted living facility, or social services license or certification revoked in Washington state; and

     (3) Has education and work experience((:)).

     (a) Upon initial approval or hire, an instructor must ((have)):

     (i) Be a registered nurse with work experience within the last five years with the elderly or persons with disabilities requiring long-term care in a community setting; or

     (ii) Have an associate degree or higher degree in the field of health or human services and six months professional or caregiving experience within the last five years in a community based setting or an adult family home, assisted living facility, supported living through DDD, or home care setting; or

     (iii) Have a high school diploma, or equivalent, and one year of professional or caregiving experience within the last five years in an adult family home, ((boarding home)) assisted living, supported living through DDD ((per chapter 388-820 WAC)), or home care setting((; or

     (ii) An associate degree in a health field and six months professional or caregiving experience within the last five years in an adult family home, boarding home, supported living through DDD per chapter 388-820 WAC, or home care setting)).

     (((2))) (4) Teaching experience:

     (a) Must have one hundred hours of experience teaching adults in an appropriate setting on topics directly related to the basic training; or

     (b) Must have forty hours of teaching while being mentored by an instructor who meets these qualifications, and must attend a class ((in)) on adult education that meets the requirements of WAC 388-112-0400.

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

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

     (((5) If required under WAC 388-112-0075 or 388-112-0105 , instructors must successfully complete basic or modified basic training prior to beginning to train others.))

     (7) In addition, an instructor for nurse delegation core and diabetes training must have a current Washington state RN license in good standing without practice restrictions.

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0380, filed 7/11/02, effective 8/11/02.]

[]

     Reviser's note: The unnecessary strike through 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 02-15-066, filed 7/11/02, effective 8/11/02)

WAC 388-112-0385   What are the minimum qualifications for instructors for manager and ((caregiver)) long-term care worker mental health specialty training?   (1) ((Instructors for manager mental health specialty training:)) The minimum qualifications for instructors for manager mental health specialty, in addition to the general qualifications in WAC ((388-112-0375)) 388-112-0380 (1) and (2) include:

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

     (b) Education:

     (i) Bachelor's degree, registered nurse, or mental health specialist, with at least one year of education in seminars, conferences, continuing education, or in college classes, in subjects directly related to mental health, such as, but not limited to, psychology. (One year of education equals twenty-four semester hours, thirty-six quarter hours, or at least one hundred ninety-two hours of seminars, conferences, and continuing education.)

     (ii) If required ((under)) by WAC 388-112-0160, successful completion of the mental health specialty training, prior to beginning to train others.

     (c) Work experience - Two years full-time equivalent direct work experience with people who have a mental illness; and

     (d) Teaching experience:

     (i) Two hundred hours experience teaching mental health or closely related subjects; and

     (ii) Successful completion of an adult education class ((or train the trainer as follows)):

     (A) For instructors teaching alternate ((curricula)) curriculums, a class in adult education that meets the requirements of WAC 388-112-0400((, or a train the trainer class for the curriculum they are teaching;)).

     (((B))) (iii) For instructors teaching ((DSHS-developed)) mental health specialty training, successful completion of the DSHS((-developed train the trainer)) instructor qualification/demonstration process:

     (iv) And has been approved and contracted by the department as a community instructor.

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

     (2) Instructors for ((caregiver)) long-term care worker mental health specialty training:

     (a) ((Caregiver)) Long-term care worker mental health specialty may be taught by ((a boarding home)) an assisted living facility administrator (or designee), adult family home provider (or designee), or corporate trainer, who has successfully completed the manager mental health specialty training. A qualified instructor under this subsection may teach ((caregiver)) specialty to ((caregivers)) long-term care workers employed at other home(s) licensed by the same licensee.

     (((b) Caregiver)) (3) Long-term care worker mental health specialty taught by a person who does not meet the requirements in subsection (2)(a) must meet the same requirements as the instructors for manager mental health specialty in subsection (1).

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0385, filed 7/11/02, effective 8/11/02.]

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

     (b) Education:

     (i) Bachelor's degree, registered nurse, or mental health specialist, with at least one year of education in seminars, conferences, continuing education or college classes, in dementia or subjects directly related to dementia, such as, but not limited to, psychology. (One year of education equals twenty-four semester hours, thirty-six quarter hours, or at least one hundred ninety-two hours of seminars, conferences, or continuing education.)

     (ii) If required ((under)) in WAC 388-112-0160, successful completion of the dementia specialty training, prior to beginning to train others.

     (c) Work experience - Two years full-time equivalent direct work experience with people who have dementia; and

     (d) Teaching experience:

     (i) Two hundred hours experience teaching dementia or closely related subjects; and

     (ii) Successful completion of an adult education class ((or train the trainer as follows:)).

     (A) For instructors teaching alternate ((curricula)) curriculums, a class in adult education that meets the requirements of WAC 388-112-0400((, or a train the trainer class for the curriculum they are teaching;)).

     (((B))) (iii) For instructors teaching DSHS-developed dementia specialty training, successful completion of the DSHS((-developed train the trainer)) instructor qualification/demonstration process;

     (iv) And has been approved and contracted by the department as a community instructor.

     (((d))) (e) Instructors who will administer tests must have experience or training in assessment and competency testing.

     (2) Instructors for ((caregiver)) long-term care worker dementia specialty training:

     (a) ((Caregiver)) Long-term care worker dementia specialty may be taught by ((a boarding home)) an assisted living facility administrator (or designee), adult family home provider (or designee), or corporate trainer, who has successfully completed the manager dementia specialty training. A qualified instructor under this subsection may teach ((caregiver)) specialty to ((caregivers)) long-term care workers employed at other home(s) licensed by the same licensee.

     (b) ((Caregiver)) Long-term care worker dementia specialty taught by a person who does not meet the requirements in subsection (2)(a) must meet the same requirements as the instructors for manager dementia specialty in subsection (1).

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0390, filed 7/11/02, effective 8/11/02.]

     (a) The instructor must be experienced in developmental disabilities caregiving practices and capable of demonstrating competency in the entire course content, including the administration of competency testing;

     (b) Education and work experience:

     (i) Bachelor's degree with at least two years of full-time work experience in the field of disabilities; or

     (ii) High school diploma or equivalent, with four years full time work experience in the field of developmental disabilities, including two years full time direct work experience with people who have a developmental disability((.)); and

     (((b))) (iii) Successful completion of the eighteen hour developmental disabilities specialty training under WAC 388-112-0120((; and)).

     (c) Teaching experience:

     (i) Two hundred hours of teaching experience; and

     (ii) Successful completion of an adult education ((or train the trainer)) class as follows:

     (A) For instructors teaching alternative ((curricula)) curriculums, a class in adult education that meets the requirements of WAC 388-112-0400((, or a train the trainer class for the curriculum they are teaching));

     (B) For instructors teaching ((DSHS-developed)) developmental disabilities specialty training, successful completion of the ((DSHS-developed train the trainer)) DSHS instructor qualification/demonstration process.

     (e) Has been approved and contracted by the department as a community instructor.

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

     (2) Instructors for ((caregiver)) developmental disabilities specialty training:

     (a) ((Caregiver)) Developmental disabilities specialty may be taught by ((a boarding home)) an assisted living facility administrator (or designee), adult family home provider (or designee), or corporate trainer, who has successfully completed the ((manager developmental disabilities specialty training)) mental health or manager dementia specialty course, the eighteen hour developmental disabilities specialty training, and has successfully completed the instructor qualification/demonstration process. A qualified instructor under this subsection may teach ((caregiver)) developmental disabilities specialty to ((caregivers)) long-term care workers employed at other home(s) licensed by the same licensee.

     (b) ((Caregiver)) Developmental disabilities specialty taught by a person who does not meet the requirements in subsection (2)(a) must meet the same requirements as the instructors for ((manager)) developmental disabilities specialty in subsection (1).

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0395, filed 7/11/02, effective 8/11/02.]

     Reviser's note: The typographical errors in the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.
AMENDATORY SECTION(Amending WSR 02-15-066, filed 7/11/02, effective 8/11/02)

WAC 388-112-0405   What physical resources are required for ((basic, modified basic, specialty, or nurse delegation core)) classroom training and testing?   (1) Classroom ((space used for basic, modified basic, specialty, or nurse delegation core classroom training)) facilities must be accessible to ((trainees)) students and provide adequate space for learning activities, comfort, lighting, lack of disturbance, and tools for effective teaching and learning such as white boards and flip charts. Appropriate supplies and equipment must be provided for teaching and practice of caregiving skills in the class being taught.

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

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0405, filed 7/11/02, effective 8/11/02.]

     (1) Training((, including all breaks,)) must not exceed eight hours within one day;

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

     (3) Training must include regular breaks; and

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

[Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050, 34.05.020, 2000 c 121, and 2002 c 233. 02-15-066, § 388-112-0410, filed 7/11/02, effective 8/11/02.]

     The following sections of the Washington Administrative Code are repealed:

WAC 388-112-0020	What content must be included in an orientation?
WAC 388-112-0025	Is competency testing required for orientation?
WAC 388-112-0030	Is there a challenge test for orientation?
WAC 388-112-0040	Who must complete orientation and safety training, and by when?
WAC 388-112-0050	Is there an alternative to the basic training for some health care workers?
WAC 388-112-0060	Is competency testing required for basic training?
WAC 388-112-0065	Is there a challenge test for basic training?
WAC 388-112-0080	What is modified basic training?
WAC 388-112-0085	What knowledge and skills must be included in modified basic training?
WAC 388-112-0090	Is competency testing required for modified basic training?
WAC 388-112-0095	Is there a challenge test for modified basic training?
WAC 388-112-0100	What documentation is required for successful completion of modified basic training?
WAC 388-112-0105	Who may take modified basic training instead of the full basic training?
WAC 388-112-01965	Who is required to complete the specialized diabetes nurse delegation training, and when?
WAC 388-112-0215	Is competency testing required for continuing education?
WAC 388-112-0220	May basic or modified basic training be completed a second time and used to meet the continuing education requirement?
WAC 388-112-0230	May nurse delegation core training or nurse delegation specialized diabetes training be used to meet continuing education requirements?
WAC 388-112-0245	Who is required to complete continuing education training, and when?
WAC 388-112-02610	What is HIV/AIDS training?
WAC 388-112-02615	Is competency testing required for HIV/AIDS training?
WAC 388-112-02620	Is there a challenge test for HIV/AIDS training?
WAC 388-112-02625	What documentation is required for completion of HIV/AIDS training?
WAC 388-112-02630	Who is required to complete HIV/AIDS training, and when?
WAC 388-112-0340	Do homes need department approval to provide continuing education for their staff?
WAC 388-112-0350	What trainings must be taught by an instructor who meets the applicable minimum qualifications under this chapter?
WAC 388-112-0375	What are the minimum general qualifications for an instructor teaching a DSHS curriculum or DSHS-approved alternate curriculum as defined under chapter 388-112 WAC?