PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 06-09-084.
Title of Rule and Other Identifying Information: Chapter 388-76 WAC, Adult family homes minimum licensing requirements.
Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6097), on September 4, 2007, at 10:00 a.m.; and at the Division of Developmental Disabilities, Region 1 Headquarters, 1611 West Indiana Avenue, Spokane, WA 99205-4221, on September 6, 2007, at 10:00 a.m.
Date of Intended Adoption: Not before September 7, 2007.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504-5850, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail schilse@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m. on September 6, 2007.
Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS Rules Consultant, by August 28, 2007,
TTY (360) 664-6178 or (360) 664-6094 or by e-mail at johnsjl4@dshs.wa.gov.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of the proposed rules are to:
(1) Comply with the governor's executive order 05-03 plain talk;
(2) Simplify language, eliminate the question and answer format, reorganize and renumber the chapter so that the requirements are clearer for adult family home providers to understand;
(3) Clarify issues that have been brought to the attention of the department; and
(4) Update rules to comply with statute changes.
Reasons Supporting Proposal: These changes make the rule:
(1) Easier to read and understand and enforce;
(2) Easier to find information by changing the format;
(3) Easier to comply with by clarifying issues that have been brought to the attention of the department; and
(4) Up-to-date with statute changes.
Statutory Authority for Adoption: RCW 70.128.040.
Statute Being Implemented: Chapters 70.128 and 74.34 RCW.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Department of social and health services, governmental.
Name of Agency Personnel Responsible for Drafting: Roger Woodside, P.O. Box 45600, Mailstop 45600, Olympia, WA 98504-5600, (360) 725-3204; Implementation and Enforcement: Pat Bossert, P.O. Box 45600, Mailstop 45600, Olympia, WA 98504-5600, (360) 725-2404.
No small business economic impact statement has been prepared under chapter 19.85 RCW. RCS analyzed the proposed rule amendments and concludes that costs to small businesses will be minor, if there are any costs at all. The primary purpose of the proposed amendments are to clarify preexisting requirements and to update existing rules to conform to changes in procedures, Washington state statutes, or rules of other Washington state agencies. As a result, the preparation of a small business economic impact statement is not required. A copy of the statement may be obtained by contacting Roger Woodside, P.O. Box 45600, Mailstop 45600, Olympia, WA 98504-5600, phone (360) 725-3204, fax (360) 438-7903, e-mail WoodsR@dshs.wa.gov.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Roger Woodside, P.O. Box 45600, Mailstop 45600, Olympia, WA 98504-5600, phone (360) 725-3204, fax (360) 438-7903, e-mail WoodsR@dshs.wa.gov.
June 22, 2007
Stephanie E. Schiller
Rules Coordinator
3891.4ADULT FAMILY HOME MINIMUM LICENSING REQUIREMENTS
"Abuse" means:
(1) The willful action or inaction that inflects injury, unreasonable confinement, intimidation, or punishment on a vulnerable adult;
(2) In instances of abuse of a vulnerable adult who is unable to express or demonstrate physical harm, pain, or mental anguish, the abuse is presumed to cause physical harm, pain or mental anguish; and
(3) Abuse includes sexual abuse, mental abuse, physical abuse, and exploitation of a vulnerable adult, which have the following meanings:
(a) "Sexual abuse" means any form of nonconsensual sexual contact, including but not limited to unwanted or inappropriate touching, rape, sodomy, sexual coercion, sexually explicit photographing, and sexual harassment. Sexual abuse includes any sexual contact between a staff person, who is not also a resident or client, of a facility or a staff person of a program authorized under chapter 71A.12 RCW, and a vulnerable adult living in that facility or receiving service from a program authorized under chapter 71A.12 RCW, whether or not consensual.
(b) "Physical abuse" means a willful action of inflicting bodily injury or physical mistreatment. Physical abuse includes, but is not limited to, striking with or without an object, slapping, pinching, chocking, kicking, shoving, prodding, or chemical restraints unless the restraints are consistent with licensing requirements, and includes restraints that are otherwise being used inappropriately.
(c) "Mental abuse" means any willful action or inaction of mental or verbal abuse. Mental abuse includes, but is not limited to, coercion, harassment, inappropriately isolating a vulnerable adult from family, friends, or regular activity, and verbal assault that includes ridiculing, intimidating, yelling, or swearing.
(d) "Exploitation" means an act of forcing, compelling, or exerting undue influence over a vulnerable adult causing the vulnerable adult to act in a way that is inconsistent with relevant past behavior, or causing the vulnerable adult to perform services for the benefit of another.
"Adult family home" means:
(1) A residential home in which a person or entity are licensed to provide personal care, special care, room, and board to more than one but not more than six adults who are not related by blood or marriage to the person or persons providing the services; and
(2) For the purposes of this chapter, any person or entity who has been granted a license to operate an adult family home.
"Affiliated with an applicant" means any person listed on the application as a partner, officer, director, resident manager, or majority owner of the applying entity, or is the spouse of the applicant.
"Applicant" means an individual, partnership, corporation, or other entity seeking a license to operate an adult family home.
"Capacity" means:
(1) The maximum number of persons in need of personal or special care permitted in an adult family home at a given time; and
(2) Includes related children or adults in the home who receive personal or special care and services.
"Caregiver" for purposes other than training, means any person eighteen years of age or older responsible for providing direct personal or special care to a resident and who is not the provider, entity representative, or a student or volunteer.
"Dementia" is defined as a condition documented through the assessment process required by WAC 388-76-10335.
"Department" means the Washington state department of social and health services.
"Department case manager" means the department authorized staff person or designee assigned to negotiate, monitor, and facilitate a care and services plan for residents receiving services paid for by the department.
"Developmental disability" means:
(1) A person who meets the eligibility criteria defined by the division of developmental disabilities under WAC 388-823-0040; or
(2) A person with a severe, chronic disability which is attributable to cerebral palsy or epilepsy, or any other condition, other than mental illness, found to be closely related to mental retardation which results in impairment of general intellectual functioning or adaptive behavior similar to that of a person with mental retardation, and requires treatment or services similar to those required for these persons (i.e., autism); and
(a) The condition was manifested before the person reached age twenty-two;
(b) The condition is likely to continue indefinitely; and
(c) The condition results in substantial functional limitations in three or more of the following areas of major life activities:
(i) Self-care;
(ii) Understanding and use of language;
(iii) Learning;
(iv) Mobility;
(v) Self-direction; and
(vi) Capacity for independent living.
"Direct supervision" means oversight by a person who:
(1) Has demonstrated competency in the basic training and specialty training if required, or who has been exempted from the basic training requirements and is:
(a) On the premises; and
(b) Quickly and easily available to the caregiver.
"Entity provider" means any corporation, partnership, association, or limited liability company that is licensed under this chapter to operate an adult family home.
"Entity representative" means the individual designated by an entity provider who is responsible for the daily operation of the adult family home.
"Home" means adult family home.
"Indirect supervision" means oversight by a person who:
(1) Has demonstrated competency in the basic training and specialty training if required; or
(2) Has been exempted from the basic training requirements; and
(3) Is quickly and easily available to the care giver, but not necessarily on-site.
"Inspection" means an on-site visit by department personnel to determine the adult family home's compliance with this chapter and chapters 70.128, 70.129, 74.34 RCW, and other applicable rules and regulations.
"Medical device" as used in this chapter, means any piece of medical equipment used to treat a resident's assessed need.
(1) A medical device is not always a restraint and should not be used as a restraint;
(2) Some medical devices have considerable safety risks associated with use; and
(3) Examples of medical devices with known safety risks when used are transfer poles, Posey or lap belts, and side rails.
"Medication administration" means giving resident medications by a person legally authorized to do so, such as a physician, pharmacist or nurse.
"Medication organizer" is a container with separate compartments for storing oral medications organized in daily doses.
"Mental illness" is defined as an Axis I or II diagnosed mental illness as outlined in volume IV of the Diagnostic and Statistical Manual of Mental Disorders (a copy is available for review through the aging and disability services administration).
"Multiple facility provider" means an individual or entity provider who is licensed to operate more than one adult family home.
"Neglect" means:
(1) a pattern of conduct or inaction by a person or entity with a duty to care that fails to provide the goods and services that maintain physical or mental health of a vulnerable adult, or that fails to avoid or prevent physical or mental harm or pain to a vulnerable adult; or
(2) an act or omission that demonstrates a serious disregard of consequences of such a magnitude as to constitute a clear and present danger to the vulnerable adult's health, welfare, or safety, including but not limited to conduct prohibited under RCW 9A.41.100.
"Nurse delegation" means a registered nurse transfers the performance of selected nursing tasks to competent nursing assistants in selected situations. The registered nurse delegating the task retains the responsibility and accountability for the nursing care of the resident.
"Over-the-counter medication" is any medication that can be purchased without a prescriptive order, including but not limited to vitamin, mineral, or herbal preparations.
"Personal care services" means:
(1) Both physical assistance and/or prompting and supervising the performance of direct personal care tasks as determined by the resident's needs; and
(2) Does not include assistance with tasks performed by a licensed health professional.
"Physical restraint" means a manual method, obstacle, or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that restricts freedom of movement or access to his or her body, is used for discipline or convenience, and not required to treat the resident's medical symptoms.
"Practitioner" includes a physician, osteopathic physician, podiatric physician, pharmacist, licensed practical nurse, registered nurse, advanced registered nurse practitioner, dentist, and physician assistant licensed in the state of Washington.
"Prescribed medication" refers to any medication (legend drug, controlled substance, and over-the-counter) that is prescribed by an authorized practitioner.
"Provider" means any person or entity that is licensed under this chapter to operate an adult family home.
"Qualified staff" means a person who:
(1) Is employed, directly or by contract, by an adult family home; and
(2) Meets all of the requirements of a provider, entity representative, resident manager or caregiver.
"Resident" means:
(1) Any adult unrelated to the provider who lives in the adult family home and who is in need of care; and
(2) For decision-making purposes, the term "resident" includes the resident's surrogate decision maker following state law or at the resident's request.
"Resident manager" means a person employed or designated by the provider or entity representative to manage the adult family home.
"Significant change" means:
(1) A lasting change, decline or improvement, in the resident's baseline physical, mental or psychosocial status;
(2) The change is significant enough so the current assessment and/or negotiated care plan do not reflect the resident's current status; and
(3) A new assessment may be needed when the resident's condition does not return to baseline within a two week period of time.
"Special care" means care beyond personal care services as defined in this section.
"Staff" means any person who:
(1) Is employed, directly or by contract, by an adult family home; and
(2) Provides care and services to any resident.
"Unsupervised" means not in the presence of:
(1) Another employee or volunteer from the same business or organization; or
(2) Any relative or guardian of any of the children or developmentally disabled persons or vulnerable adults to which the employee, student or volunteer has access during the course of his or her employment or involvement with the business or organization.
"Usable floor space" means resident bedroom floor space exclusive of:
(1) Toilet rooms;
(2) Closets;
(3) Lockers;
(4) Wardrobes;
(5) Vestibules, and
(6) If the bedroom door opens into the resident bedroom the space required for the door to swing.
"Willful" means the deliberate or nonaccidental action or inaction by an alleged perpetrator that he/she knew or reasonably should have known could cause a negative outcome, including harm, injury, pain or anguish.
"Vulnerable adult" includes a person:
(1) Sixty years of age or older who has the functional, mental, or physical inability to care for himself or herself;
(2) Found incapacitated under chapter 11.88 RCW;
(3) Who has a developmental disability as defined under RCW 71A.10.020;
(4) Admitted to any facility;
(5) Receiving services from home health, hospice, or home care agencies licensed or required to be licensed under chapter 70.127 RCW; or
(6) Receiving services from a provider.
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LICENSE(2) No person or entity may not provide personal care, special care, and room and board for more than one resident without a license.
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(2) The license remains valid unless:
(a) The department takes enforcement action to suspend or revoke the license per law;
(b) The home voluntarily surrenders the license and closes the home;
(c) The home relinquishes the license; or
(d) The home fails to pay the annual licensing fee.
(3) The home license is:
(a) Not transferable; and
(b) Valid only for the provider and address listed on the license.
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(2) The provider or entity representative is ultimately responsible for the operation of the adult family home.
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(2) The home must send the annual license fee to the department upon receipt of notice of fee due.
(3) If the department does not renew the license, the annual license fee is refundable.
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(2) In determining the home's capacity, the department must consider the:
(a) Structural design of the house;
(b) Number and qualifications of staff;
(c) Total number of people living in the home who require personal or special care, including:
(i) Children; and
(ii) Other household members;
(d) The number of people for whom the home provides adult day care; and
(e) The ability for the home to safely evacuate all people living in the home.
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(1) Evidence that the provider or entity representative has:
(a) Successfully completed the forty-eight hour residential care administrator's training to meet the related requirements of chapter 388-112 WAC.
(2) Operated an adult family home in Washington for at least one year without a significant violation of chapters 70.128, 70.129 or 74.34 RCW, this chapter or other applicable laws and regulations; and
(3) The ability to operate more than one home.
(4) The following plans for each home the applicant intends to operate:
(a) A twenty-four hour a day, seven day a week staffing plan:
(b) A plan for how the provider entity representative, or resident manager will manage the daily operations of each home; and
(c) A plan for emergencies, deliveries, staff and visitor parking.
(5) A credit history considered if the history relates to the ability to provide care and services.
(6) An applicant, entity representative or a qualified resident manager at each home who is responsible for the care of each resident at all times.
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(a) Live in the home; or
(b) Employ or contract with a qualified resident manager who lives in the home and is responsible for the care and services of each resident at all times.
(2) The provider, entity representative or resident manager is exempt from the live-in requirement if the home has:
(a) Twenty-four staffing; and
(b) A qualified staff person who can make needed decisions is always present.
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(1) Aging and disability services administration; or
(2) The department when the employee's duties include:
(a) Placement of persons in an adult family home; or
(b) Authorizing payments for any resident's care and services in an adult family home.
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(a) Within thirty days of the last resident leaving the home; or
(b) When the home moves all residents out of the home for purposes other than remodeling or construction.
(2) The department may revoke the license if the home does not:
(a) Relinquish the adult family home license; or
(b) Does not relinquish the adult family home license with the specified timeframe.
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LICENSE APPLICATION(a) An initial adult family home license;
(b) A change of ownership of the adult family home; or
(c) A change of the adult family home location or address.
(2) Prior to sending the application to the department, the applicant must ensure:
(a) The people listed on the application meet the minimum qualifications listed in WAC 388-76-10130 through 388-76-10145 as required; and
(b) After January 1, 2007, the provider and entity representative must successfully complete the department approved forty-eight hour adult family home administration and business planning class as required in chapter 388-112 WAC.
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(2) If an applicant has not obtained an adult family home license within one calendar year of submitting the application to the department the applicant must attend department orientation again.
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(1) Provide all information required on the application form;
(2) Provide any additional information requested by the department; and
(3) Send the complete application form to the department.
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(1) Fifty dollars of this fee is the application processing fee;
(2) Fifty dollars is the annual license fee; and
(3) The fifty dollar annual license fee will be returned to the applicant by the department if the application is withdrawn, voided or the license is denied.
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(1) Does not return information to the department within sixty calendar days of the department's first request for additional information for an incomplete application; or
(2) Has not obtained an adult family home license within one calendar year of first submitting the application to the department.
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(1) May not apply for separate licenses for each spouse; and
(2) May apply jointly as co-providers.
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(1) Include a list of all facilities or homes in which the applicant or persons affiliated with the applicant, managerial employee, or owner of five percent or more of the entity provided care and services to children or vulnerable adults within the last ten years;
(2) Designate an entity representative who:
(a) Is responsible for the daily operations of the adult family home;
(b) Will be considered the department's primary contact person; and
(c) May act as both the entity representative and the resident manager in only one home.
(3) Designate a qualified resident manager for the home if the entity representative is not the designated resident manager in subsection (2)(c) of this section.
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(1) Building to be used as an adult family home is leased, under contract, or rented; and
(2) The landlord takes an active interest in the operation of the home.
(3) An active interest includes but is not limited to:
(a) The charging of rent as a percentage of the business;
(b) Assistance with start-up and/or operational costs;
(c) Collection of resident fees;
(d) Recruitment of residents;
(e) Management oversight;
(f) Assessment and/or negotiated care plan development of residents; or
(g) The provision of personal or special care of residents.
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(2) The department will not process an incomplete application and will return the application requesting the missing information.
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(2) A change of owner occurs when there is a change in:
(a) The provider or entity representative ultimately responsible for the daily operational decisions of the home; or
(b) Control of an entity provider.
(3) Events which constitute a change of ownership include, but are not limited to:
(a) The form of legal organization of the provider is changed, such as when a provider forms:
(i) A partnership;
(ii) Corporation;
(iii) Association; or
(iv) A dissolution or merger of a licensed entity with another legal organization.
(b) The provider or entity representative transfers business operations and management responsibility to another party, whether there is a partial or whole transfer of adult family home real property and/or personal property assets.
(c) Two people are both licensed as a married couple to operate an adult family home and an event, such as a divorce or death results in only one person operating the home.
(d) An event dissolves the partnership, if the provider or entity representative is a business partnership.
(e) If the provider or entity representative is a corporation and the corporation:
(i) Is dissolved;
(ii) Merges with another corporation which is the survivor; or
(iii) Consolidates with one or more corporations to form a new corporation;
(iv) Whether by a single transaction or multiple transactions within a continuous twenty-four month period, fifty percent or more of the stock is transferred to one or more:
(A) New or former stockholders; or
(B) Present stockholders each having less than five percent of the stock before the initial transaction; or
(f) Any other event or combination of events which results in a substitution or of control of the provider or entity representative.
(4) The new owner:
(a) Must correct all deficiencies that exist at the time of the ownership change;
(b) Is subject to the provisions of chapters 70.128, 70.129, 74.34 RCW, this chapter and other applicable laws and regulations;
(c) Must obtain a new license from the department before the transfer of ownership; and
(d) Must not begin operation of the adult family home as the new owner, provider or entity representative until the department has granted the license.
(5) The home must notify each resident, in writing at least thirty days before the effective date of the ownership change.
(6) If a currently licensed provider or entity representative seeking to change ownership wants the department to give priority to processing an application to minimize or prevent disruption of residents that live in the existing home, the applicant must:
(a) Make the request to the department in writing, including the reason for changing the location of the home; and
(b) Explain how or why the reason for the change is beyond the control of the home.
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(2) The home must not start operations of the home at a new location until the department has granted the license for the new location.
(3) The home must notify each resident or resident representative, in writing at least thirty days before the effective date of the change of the home location or address.
(4) If a currently licensed provider or entity representative, seeking to change the home location or address wants the department to give priority to processing an application to minimize or prevent the disruption of residents that live in the existing home, the applicant must:
(a) Make the request in writing, including the reason for changing the location of the home to the department; and
(b) Explain how or why the reason for change is beyond the control of the home.
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GRANTING OR DENYING A LICENSE(1) Separately and jointly as applicants each person and entity named in an application, including each person or entity affiliated with the applicant;
(2) Information in the application;
(3) Other documents and information the department deems relevant which may include, but not be limited to:
(a) Inspection and complaint investigation findings in each facility or home in which the applicant, person affiliated with the applicant, or owner of five percent or more of the entity provided care or services to children or vulnerable adults; and
(b) Credit information.
(4) The history of each individual listed on the application for negative findings identified in WAC 388-76-10120 and 388-76-10125, including, but not limited to the following:
(a) Applicant;
(b) Person affiliated with the applicant;
(c) Entity representative;
(d) Caregiver;
(e) An owner who:
(i) Exercised daily control over the operations: or
(ii) Owns fifty-one percent or more of the entity.
(f) Any person who has unsupervised access to residents in the home; and
(g) Any person who lives in the home and is not a resident.
(5) Applicants who are licensed to care for children in the same home to determine if:
(a) Necessary to allow a resident's child(ren) to live in the same home as the resident or allow a resident child(ren) who turn eighteen to stay in the home;
(b) The applicant provides satisfactory evidence to the department of the home's ability to meet the needs of children and adults residing in the home; and
(c) The total number of persons receiving care and services in the home do not exceed the licensed capacity of the adult family home.
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(1) Has a history of prior violations of chapter 70.128 RCW or any law regulating to residential care facilities within the past five years that resulted in revocation, suspension, or nonrenewal of a license or contract with the department;
(2) When providing care or services to children or vulnerable adults:
(a) Has been found to be in significant noncompliance with federal or state regulations; or
(b) Had a license for the care of children or vulnerable adults suspended or revoked.
(3) For a period of twenty years after a provider surrendered or relinquished an adult family home license after notification of the department's intention to deny, suspend, not renew or revoke, in lieu of appealing the department's action;
(4) Been enjoined from operating a facility for the care and services of children or adults;
(5) A stipulated finding of fact, conclusion of law, an agreed order, or finding of fact, conclusion of law, final order issued by a disciplining authority or final decision by any federal or state agency or department, a court of law, or entered into a state registry or department or agency list with a finding of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW;
(6) Had a revocation or suspension of a license for the care of children or adults;
(7) Had a revocation, cancellation, suspension or nonrenewal of:
(a) A medicaid or medicare provider agreement by the contracting agency; or
(b) Any agreement with a public agency for the care and treatment of children or vulnerable adults, when the action was taken by the public agency.
(8) Been convicted of any crime listed in RCW 43.43.830 or 43.43.842;
(9) Been found by a court:
(a) In a protection proceeding under chapter 74.34 RCW to have abandoned, neglected, abused, or financially exploited a vulnerable adult; or
(b) In a domestic relations proceeding under Title 26 RCW to have sexually or physically abused, neglected or exploited any minor.
(10) Been found in any final decision issued by a disciplinary board to have:
(a) Sexually or physically abused, neglected or exploited any minor or a person with a developmental disability; or
(b) Abandoned, abused, neglected or financially exploited any vulnerable adult.
(11) Been found in any final decision by any federal or state agency or department to have abandoned, neglected, abused or financially exploited a vulnerable adult;
(12) Found in any dependency action under RCW 13.34.030 (5)(b) to have sexually or physically abused, neglected or exploited any minor;
(13) The home currently licensed:
(a) As a boarding home; or
(b) To provide care for children in the same home, unless:
(i) It is necessary in order to allow a resident's child(ren) to live in the same home as the resident or to allow a resident who turns eighteen to remain in the home;
(ii) The applicant provides satisfactory evidence to the department of the home's capacity to meet the needs of children and adults residing in the home; and
(iii) The total number of persons receiving care and services in the home does not exceed the number permitted by the licensed capacity of the home.
(14) After January 1, 2007, if the provider or entity representative has not successfully completed a department-approved forty-eight hour adult family home administration and business planning class.
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(1) Been convicted of a crime:
(a) As defined under RCW 43.43.830 or 43.43.842;
(b) Relating to financial exploitation as defined under RCW 43.43.830 or 43.43.842;
(c) A felony against a person if the conviction reasonably relates to the competency of the person to own or operate an adult family home;
(d) Involving a firearm used in the commission of a felony or in any act of violence against a person; or
(e) Engaged in illegally selling or distributing drugs illegal use of drugs or excessive use of alcohol within the past five years without the evidence of rehabilitation.
(2) Found by a court in a protection proceeding under chapter 74.34.RCW to have abandoned, abused, neglected, or financially exploited a vulnerable adult;
(3) Found in a final decision issued by a disciplinary board to have sexually or physically abused, neglected or exploited any minor person or a person with a developmental disability or to have abused or financially exploited any vulnerable adult;
(4) Found in any dependency action under RCW 13.34.030(5) to have sexually abused, neglected or exploited any minor or to have physically abused any minor;
(5) Found in a court in a domestic relations proceeding under Title 26 RCW to have:
(a) Sexually abused, neglected or exploited any minor or to have physically abused any minor; or
(b) Committed an act of domestic violence toward a family or household member.
(6) Had sanction, 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;
(7) Obtained or attempted to obtain a license by fraudulent means or misrepresentation;
(8) Knowingly, or with reason to know, made a false statement of material fact on his or her application for a license or any data attached to the application or in any matter under investigation by the department;
(9) Permitted, aided, or abetted the commission of any illegal act on the adult family home premises;
(10) Willfully prevented or interfered with or failed to cooperate with any inspection, investigation or monitoring visit made by the department;
(11) Failed or refused to comply with:
(a) A condition imposed on a license or a stop placement order; or
(b) The applicable requirements of chapters 70.128, 70.129, 74.34 RCW or this chapter.
(12) Misappropriated property of a resident;
(13) Denied a license or license renewal to operate a facility that was licensed to care for children or vulnerable adults;
(14) Exceeded licensed capacity in the operation of an adult family home;
(15) Operated a facility for the care of children or adults without a license or revoked license;
(16) Relinquished or returned a license in connection with the operation of any facility for the care of children or adults, or did not seek license renewal following written notification of the licensing agency's intention of denial, suspension, cancellation or revocation of a license;
(17) Had resident trust funds or assets of an entity providing care to children or vulnerable adults seized by the Internal Revenue Service or a state entity for failure to pay income or payroll taxes;
(18) Failed to meet financial obligations as the obligations fell due in the normal course of business, thereby impeding the ability to provide care and services to residents;
(19) Refused to permit authorized department representatives to interview residents or to have access to resident records or home;
(20) Interfered with a long-term care ombudsman or department staff in the performance of his or her duties; or
(21) Found to be in non-compliance with the requirements established in chapters 70.128, 70.129, 74.34 RCW, this chapter or other applicable laws and regulations.
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QUALIFICATIONS OF INDIVIDUALS PROVIDING CARE AND SERVICES(1) Be twenty-one years of age or older;
(2) Have a United States high school diploma or general education development certificate, or any English translated government document of the following:
(a) Successful completion of government approved public or private school education in a foreign country that includes an annual average of one thousand hours of instruction a year for twelve years, or no less than twelve thousand hours of instruction;
(b) Graduation from a foreign college, foreign university, or United States community college with a two-year diploma, such as an Associate's degree;
(c) Admission to, or completion of coursework at a foreign or United States college or university for which credit was awarded;
(d) Graduation from a foreign or United States college or university, including award of a Bachelor's degree;
(e) Admission to, or completion of postgraduate coursework at, a United States college or university for which credits were awarded, including award of a Master's degree; or
(f) Successful passage of the United States board examination for registered nursing, or any professional medical occupation for which college or university education was required.
(3) Meet the department's training requirements of chapter 388-112 WAC;
(4) Have good moral and responsible character and reputation;
(5) Be literate in the English language, or meet alternative requirements:
(a) By assuring that a person on staff and available at the home who is able to communicate or make provisions for communicating with the resident in his or her primary language; and
(b) Capable of understanding and speaking English well enough to be able to respond appropriately to emergency situations and be able to read, understand and implement resident negotiated care plans.
(6) Be able to carry out the management and administrative requirements of chapters 70.128, 70.129 and 74.34 RCW, this chapter and other applicable laws and regulations;
(7) Have completed at least three hundred and twenty hours of successful direct care experience obtained after age eighteen to vulnerable adults in a licensed or contracted setting before operating or managing a home;
(8) Have no criminal convictions listed in RCW 43.43.830 or 43.43.842 or state or federal findings of abandonment, abuse, neglect or financial exploitation;
(9) Obtain and keep valid cardio-pulmonary resuscitation (CPR) and first-aid card or certificate as required in chapter 388-112 WAC; and
(10) Tuberculosis screening to establish tuberculosis status per this chapter.
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(1) Be eighteen years of age or older;
(2) Have a clear understanding of the caregiver job responsibilities and knowledge of each resident's negotiated care plan to provide care specific to the needs of each resident;
(3) Have basic communication skills to:
(a) Be able to communicate or make provisions to communicate with the resident in his or her primary language;
(b) Understand and speak English well enough to:
(i) Respond appropriately to emergency situations; and
(ii) Read, understand and implement resident negotiated care plans.
(4) Meet the department's training requirements of chapter 388-112 WAC;
(5) Have no criminal convictions listed in RCW 43.43.830 or 43.43.842 or state or federal findings of abandonment, abuse, neglect or financial exploitation;
(6) Have a current valid first-aid and cardio-pulmonary resuscitation (CPR) card or certificate as required in chapter 388-112 WAC; and
(7) Tuberculosis screening to establish tuberculosis status per this chapter.
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(1) Be eighteen years old or older;
(2) Meet the department's training requirements of chapter 388-112 WAC;
(3) Have no criminal convictions listed in RCW 43.43.830 and 43.43.842 or state or federal findings of abandonment, abuse, neglect or financial exploitation; and
(4) Tuberculosis screening to establish tuberculosis status per this chapter.
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(1) No criminal convictions listed in RCW 43.43.830 or 43.43.842 or state or federal findings of abandonment, abuse, neglect or financial exploitation; and
(2) A current valid first-aid and cardio-pulmonary resuscitation (CPR) card or certificate as required in chapter 388-112 WAC.
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(a) A master's degree in social services, human services, behavioral sciences or an allied field and two years social service experience working with adults who have functional or cognitive disabilities; or
(b) A bachelor's degree in social services, human services, behavioral sciences or an allied field and three years social service experience working with adults who have functional or cognitive disabilities; or
(c) Have a valid Washington state license to practice as a nurse under chapter 18.79 RCW and three years of clinical nursing experience; or
(d) Is currently a licensed physician, including an osteopathic physician, in Washington State.
(2) The home must ensure than an assessor who meets the requirements of subsections (1)(a), (b), or (c) of this section does not have unsupervised access to any resident unless the assessor has:
(a) A current criminal history background check; and
(b) Has not been convicted of any crime listed in RCW 43.43.830 or 43.43.842 or state or federal findings of abandonment, abuse, neglect or financial exploitation.
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CRIMINAL HISTORY BACKGROUND CHECK(1) Staff;
(2) Volunteers or students acting as a caregiver; and
(3) Household members over the age of eleven.
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(1) Require the person to complete the residential care services background inquiry form which includes:
(a) A disclosure statement; and
(b) A statement authorizing the home, the department, and the Washington state patrol to conduct a background inquiry.
(2) Verbally inform the person:
(a) That he or she may ask for a copy of the background inquiry result; and
(b) Of the inquiry result within ten days of receiving the result.
(3) Send the information to the department and any additional documentation and information as requested by the department to satisfy the requirements of this section; and
(4) Notify the appropriate licensing or certification agency of any person resigning or terminated as a result of having a conviction record.
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(2) The adult family home must have a valid criminal history background check for all persons in the home who may have unsupervised access to any resident; and
(3) The home must submit, receive and keep the results of the check every two years.
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(1) Establish and implement procedures that ensure:
(a) All disclosure statements background inquiry applications, responses, related information, and all copies are kept in a confidential and secure manner;
(b) All background inquiry results and disclosure statements are used for employment purposes only;
(c) Background inquiry results and disclosure statements are not disclosed to any person except:
(i) The person about whom the home made the disclosure or background inquiry;
(ii) Authorized state and federal employees; and
(iii) The Washington state patrol auditor.
(2) Keep a record of inquiry results for eighteen months after the date an employee either quits or is terminated.
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(1) Asks the individual if they have been convicted of a crime listed under RCW 43.43.830 or 43.43.842 and the individual denies they have a conviction;
(2) Requests the background inquiry within seventy-two hours of the conditional employment;
(3) Does not allow, the conditionally hired person, to have unsupervised access to any resident without direct supervision; and
(4) Ensures the individual is competent and receives the necessary training to perform assigned tasks and meets the staff training requirements in chapter 388-112 WAC.
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(1) A stipulated finding of fact, conclusion of law, an agreed order, or finding of fact, conclusion of law, final order issued by a disciplining authority or final decision by any federal or state agency or department, a court of law, or entered into a state registry or department or agency list with a finding of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW; or
(2) Convicted of a crime against persons as defined under RCW 43.43.830 or 43.43.842.
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(2) The adult family home may choose to employ a person if the person has one or more convictions for a past offense and the offense was:
(a) Simple assault, assault in the fourth degree and three or more years has passed between the most recent conviction and the date of the application for employment;
(b) Prostitution and three or more years has passed between the most recent conviction and the date of the application for employment;
(c) Theft in the third degree and three or more years has passed between the most recent conviction and the date of the application for employment;
(d) Theft in the second degree and five or more years has passed between the most recent conviction and the date of the application for employment; or
(e) Forgery and five or more years has passed between the most recent conviction and the date of the application for employment.
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ADMINISTRATION GENERAL(1) This chapter;
(2) Chapters 70.128, 70.129 and 74.34 RCW; and
(3) Other applicable state and federal laws.
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(1) Enough staff is available in the home to meet the needs of each resident if residents are in the home or not, except as per WAC 388-76-10200;
(2) Staff are readily available to meet resident needs if the home takes the resident out to another location and the resident negotiated care plan does not indicate it is safe for the resident to be left unattended for a specific time period; and
(3) All staff are skilled and able to do the tasks assigned to meet the needs of each resident.
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(1) Designate an experienced, capable staff member of responding on behalf of the provider or entity representative:
(a) By phone or pager;
(b) At all times including:
(i) When no residents are present in the home; and
(ii) When the provider entity representative and residents are on vacation or away from the home.
(2) Give residents the telephone or pager number for the contact required in subsection (1) of this section;
(3) Ensure the provider, entity representative or resident manager is readily available to:
(a) Each resident;
(b) Residents' representatives;
(c) Caregivers; and
(d) Authorized state staff.
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(1) Notify the following in writing of the closure at least thirty days before the home closes:
(a) The department;
(b) Each resident; and
(c) Each resident's representative.
(2) Develop, organize, and carry out a discharge plan that meets the needs of each resident.
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(2) If a deceased resident had some of his or her adult family home care paid for by the department, then the home must:
(a) Send the final accounting and funds payable to:
Secretary, Department of Social and Health Services
Office of Financial Recovery
Estate Recovery Unit
(b) Include with the final accounting required in
subsection (2)(a) of this section:
(i) The deceased resident's name; and
(ii) The deceased resident's social security number.
(3) When a resident is missing from the home, in addition to other licensing requirements, the home must make a reasonable effort to find the missing resident before transferring resident funds to the department of revenue as per subsection (4) of this section.
(4) The adult family home must notify the department of revenue of abandoned property when:
(a) A resident is missing from the home for more than ninety days; and
(b) The missing resident:
(i) Gave money to the home to manage or for safekeeping;
(ii) Does not have a legal guardian;
(iii) Did not appoint a power of attorney to handle his or her financial affairs;
(iv) Did not name a family member to act on the resident's behalf; and
(v) Did not have his or her care paid for by the department.
(5) The home must send any money received from the missing resident, to the department of revenue:
(a) According to chapter 63.29 RCW;
(b) Within twenty days of notifying the department of revenue per subsection (2) of this section.
(6) Before the adult family home changes its owner, the home must:
(a) Give each resident a written statement that accounts for any personal funds held by the home;
(b) Give the prospective adult family home owner a written statement that accounts for all of the residents' funds that home will transfer to the new adult family home owner; and
(c) Get a written receipt of the transferred residents' funds from the new adult family home owner.
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(1) Alleged or suspected instances of abandonment, neglect, abuse or financial exploitation;
(2) Accidents or incidents affecting a resident's welfare; and
(3) Any injury to a resident.
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(a) Report suspected abuse, neglect, exploitation or abandonment of a resident:
(i) According to chapter 74.34 RCW;
(ii) To the department by calling the complaint toll-free hotline number; and
(iii) To the local law enforcement agency when required by RCW 74.34.035.
(b) Report the following to the department by calling the complaint toll-free hotline number:
(i) Any actual or potential event requiring any resident to be evacuated;
(ii) Conditions that threaten the provider's or entity representative's ability to continue to provide care or services to each resident; and
(iii) A missing resident.
(2) When there is a significant change in a resident's condition, or a serious injury, trauma, or death of a resident, the adult family home must immediately notify:
(a) The resident's family;
(b) The resident's representative, if one exists;
(c) The resident's physician;
(d) Other appropriate professionals working with the resident;
(e) Persons identified in the negotiated care plan; and
(f) The resident's case manager if the resident is a department client.
(3) Whenever an outbreak of suspected food poisoning or communicable disease occurs, the adult family home must notify:
(a) The local public health officer; and
(b) The department's complaint toll-free hotline number.
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(1) Does not compromise any resident rights, preferences or medical needs;
(2) Has a suitable temperament, is clean and healthy, and otherwise poses no significant health or safety risks to any resident, staff, or visitors; and
(3) Have proof of regular immunizations.
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HEALTH CARE DECISION MAKING(1) A court has appointed the home to be the guardian under chapter 11.88 RCW; and
(2) The home has petitioned the court in writing according to RCW 11.92.040(6) to:
(a) Inform the court:
(i) The home provides care for the resident in the home;
(ii) The fees the home is paid to care for the resident, the home's duties, and the types of care provided to the resident for those fees; and
(iii) Why the guardianship fees would not be duplicative of the fees paid.
(b) Request the court to direct payment to the home from the resident's funds for the resident's care, maintenance and education.
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(1) Spouse;
(2) Adult child; or
(3) Brother or sister.
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(1) Chapter 7.70 RCW;
(2) Chapter 70.122 RCW;
(3) Chapter 11.88 RCW;
(4) Chapter 11.92 RCW; and
(5) Chapter 11.94 RCW.
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(a) Unless the caregiver, present at the time of the emergency, is a licensed physician or registered nurse acting within his or her scope of practice;
(b) Whether or not:
(i) Any order exists directing medical care for the resident;
(ii) The resident has provided an advance directive for medical care; or
(iii) The resident has expressed any wishes involving medical care; and
(c) If available, the home must immediately give arriving emergency medical services personnel a copy of:
(i) Any order that exists directing medical care for the resident; and
(ii) The resident's advance directive for medical care.
(2) The home must inform the resident of the requirements in this section.
(3) The home is not required to contact emergency medical services when a resident is receiving hospice care by a licensed hospice agency and the:
(a) Emergency relates to the expected hospice death; and
(b) Situation is watched by the hospice agency.
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INFECTION CONTROL AND COMMUNICABLE DISEASE(1) Uses nationally recognized infection control standards;
(2) Emphasizes frequent hand washing and other means of limiting the spread of infection;
(3) Follows the requirements of chapter 40.17 RCW, Washington Industrial Safety and Health Act to protect the health and safety of each resident and employees; and
(4) Directs all staff to:
(a) Dispose of razor blades, syringes, and other sharp items in a manner that will not risk the health and safety of residents, staff, other persons residing in the home or the public; and
(b) Use all disposable and single-service supplies and equipment only one time as specified by the manufacturer.
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TUBERCULOSIS SCREENING(a) Provider;
(b) Entity representative;
(c) Resident manager;
(d) Caregiver;
(e) Staff; and
(f) Any student or volunteer providing any resident care and services.
(2) For the purposes of the tuberculosis sections "person" means the people listed in this section as required to have tuberculosis testing.
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(1) Is done through a nationally recognized testing method such as by intradermal (Mantoux) administration or a TB Gold Test; and
(2) The test result is read:
(a) Within forty-eight to seventy-two hours of the test; and
(b) By a trained professional.
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(1) A documented history of a previous positive test, ten or more millimeters in duration; or
(2) Documented evidence of:
(a) Adequate therapy for active disease; or
(b) Preventive therapy of infection.
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(1) A positive result from the person's first skin test -a person who has a positive result from an initial first step test should not have a second test;
(2) A documented history of a negative result from previous two step testing; or
(3) A documented negative result from one step testing in the previous twelve months.
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(1) An initial skin test within three days of employment; and
(2) A second test done one to three weeks after the first test; except
(3) A two-step test is not required for the TB Gold Test which is only a one-step test.
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(1) After exposure to active tuberculosis;
(2) When tuberculosis symptoms are present; or
(3) For periodic testing as determined by health official.
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(1) The signed statement includes the reason for declining; and
(2) Additional evidence is provided to support the reason.
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(1) Report any person with tuberculosis symptoms or a positive chest x-ray to the appropriate public health authority; and
(2) Follow the infection control and safety measures ordered by the public health authority, the person's personal physician, or other licensed health care professional.
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(1) Keep the records of tuberculosis test results, reports of x-ray findings, and physician or public health orders and waivers;
(2) Make them readily available to the appropriate health authority and licensing agency; and
(3) Keep them for eighteen months after the date an employee either quits or is terminated.
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RESIDENT RECORDS(1) Create, maintain, and keep records for residents in the home where the resident lives and ensure that the records:
(a) Contain enough information so home can provide the needed care and services to each resident;
(b) Be in a format useful to the home;
(c) Be kept confidential so that only authorized persons see their contents;
(d) Are only released to the following persons:
(i) A health care institution;
(ii) When requested by the law;
(iii) To department representatives; and
(iv) To the resident;
(e) Be protected to prevent loss, alteration or destruction and unauthorized use;
(f) Be kept for three years after the resident leaves the home or death of the resident;
(g) Be available so that department staff may review them when requested; and
(h) Provide access to the resident to review their record and obtain copies of their record at a reasonable cost.
(2) Ensure staff has access to the parts of residents' records needed by staff to provide care and services; and
(3) Allow representatives of the long-term care ombudsman access to a resident record if approved by the resident.
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(1) Identifying information about the resident;
(2) The name, address and telephone number of the resident's:
(a) Representative;
(b) Health care providers;
(c) Significant family members identified by the resident; and
(d) Other individuals the resident wants involved or notified.
(3) Current medical history;
(4) The resident assessment information;
(5) The preliminary service plan;
(6) The negotiated care plan;
(7) List of resident medications;
(8) The resident's social security number;
(9) When the resident was:
(a) Admitted to the home;
(b) Absent from the home; and
(c) Discharged from the home.
(10) A current inventory of the resident's personal belongings dated and signed by:
(a) The resident; and
(b) The adult family home.
(11) Financial records.
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(1) Any powers of attorney granted by the resident, including for health care decision making and financial; and
(2) Court order of guardianship for the resident.
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RESIDENT ASSESSMENT(1) Obtain a new written assessment before admitting a resident to the home;
(2) Not admit a resident without an assessment except in cases of a genuine emergency;
(3) Ensure the assessment contains all of the information required in WAC 388-76-10340 unless the assessor can not:
(a) Obtain an element of the required assessment information; and
(b) The assessor documents the attempt to obtain the information in the assessment.
(4) Be knowledgeable about the needs and preferences of each resident documented in the assessment.
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(a) How the resident performs with passive range of motion, applications of dressings and ointments or lotions to the body and pedicure to trim toenails and apply lotion to feet; and
(b) Dressing changes using clean technique and topical ointments must be performed by a licensed nurse or through nurse delegation in accordance with chapter 246-840 WAC; and
(c) Body care includes:
(i) Foot care if the resident is diabetic or has poor circulation; or
(ii) Changing bandages or dressings when sterile procedures are required.
(2) The adult family home must ensure that each resident's assessment includes the following minimum information:
(a) Recent medical history;
(b) Current prescribed medications, and contraindicated medications, including but not limited to, medications known to cause adverse reactions or allergies;
(c) Medical diagnosis reported by the resident, the resident representative, family member, or by a licensed medical professional;
(d) Medication management:
(i) The ability of the resident to be independent in managing medications;
(ii) The amount of medication assistance needed;
(iii) If medication administration is required; or
(iv) If a combination of the elements in (i) through (iii) above is required.
(e) Food allergies or sensitivities;
(f) Significant known behaviors or symptoms that may cause concern or require special care, including:
(i) The need for and use of medical devices;
(ii) The refusal of care or treatment; and
(iii) Any mood or behavior symptoms that the resident has had within the last five years.
(g) Cognitive status, including an evaluation of disorientation, memory impairment, and impaired judgment;
(h) History of depression and anxiety;
(i) History of mental illness, if applicable;
(j) Social, physical, and emotional strengths and needs;
(k) Functional abilities in relationship to activities of daily living including:
(i) Eating;
(ii) Toileting;
(iii) Walking;
(iv) Transferring;
(v) Positioning;
(vi) Specialized body care;
(vii) Personal hygiene;
(viii) Dressing; and
(ix) Bathing.
(l) Preferences and choices about daily life that are important to the resident, including but not limited to:
(i) The food that the resident enjoys;
(ii) Meal times; and
(iii) Sleeping and nap times.
(m) Preferences for activities; and
(n) A preliminary service plan.
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(1) The resident's specific problems and needs identified in the assessment;
(2) The needs for which the resident chooses not to accept or refuses care or services;
(3) What the home will do to ensure the resident's health and safety related to the refusal of any care or service;
(4) Resident defined goals and preferences; and
(5) How the home will meet the resident's needs.
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(1) A qualified assessor; or
(2) For a resident who receives care and services paid for by the department, an authorized department case manager.
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(1) There is a significant change in the resident's physical or mental condition;
(2) The resident's negotiated care plan no longer reflects the resident's current status, needs and preferences;
(3) At the resident's request or at the request of the resident's representative; or
(4) At least every twelve months.
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NEGOTIATED CARE PLAN(1) A list of the care and services to be provided;
(2) Identification of who will provide the care and services;
(3) When and how the care and services will be provided;
(4) How medications will be managed, including how the resident will get their medications when the resident is not in the home;
(5) The resident's activities preferences and how the preferences will be met;
(6) Other preferences and choices about issues important to the resident, including, but not limited to:
(a) Food;
(b) Daily routine;
(c) Grooming; and
(d) How the home will accommodate the preferences and choices.
(7) If needed, a plan to:
(a) Follow in case of a foreseeable crisis due to a resident's assessed needs;
(b) Reduce tension, agitation and problem behaviors;
(c) Respond to resident's special needs, including, but not limited to medical devises and related safety plans;
(d) Respond to a resident's refusal of care or treatment, including when the resident's physician or practitioner should be notified of the refusal;
(8) Identification of any communication barriers the resident may have and how the home will use behaviors and nonverbal gestures to communicate with the resident;
(9) A statement of the ability for resident to be left unattended for a specific length of time; and
(10) A hospice care plan if the resident is receiving services for hospice care delivered by a licensed hospice agency.
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(1) The resident, to the greatest extent he or she can participate;
(2) The resident's family, if approved by the resident;
(3) The resident's representative, if the resident has a representative;
(4) Professionals involved in the care of the resident;
(5) Other individuals the resident wants included; and
(6) The department case manager, if the resident is receiving care and services paid for by the department.
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(1) Resident; and
(2) Adult family home.
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(1) After an assessment for a significant change in the resident's physical or mental condition;
(2) When the plan, or parts of the plan, no longer address the resident's needs and preferences;
(3) At the request of the resident or the resident representative; or
(4) At least every twelve months.
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CARE AND SERVICES(1) The home can safely and appropriately meet the assessed needs and preferences of the person:
(a) With available staff; and
(b) Through reasonable accommodation.
(2) Admitting the resident does not negatively affect the ability of the home to:
(a) Meet the needs and does not endanger the safety of other residents; or
(b) Safely evacuate all people in the home during an emergency.
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(2) To establish that a true emergency exists, the home must verify that the resident's life, health or safety is at serious risk due to circumstances in the resident's current place of residence or harm to the resident has occurred.
(3) After establishing that a true emergency exists, the home must:
(a) Ensure the assessment and preliminary service plan are completed within five working days after admitting the resident, if the resident pays for services with private funds; or
(b) Obtain approval from an authorized department case manager before admission if the resident's care and services are paid by the department; and
(c) If approval is obtained verbally, document the time, date, and name of the case manager who gave approval.
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(1) The care and services identified in the negotiated care plan.
(2) The necessary care and services to help the resident reach the highest level of physical, mental, and psychosocial well-being consistent with resident choice, current functional status and potential for improvement or decline.
(3) The care and services in a manner and in an environment that:
(a) Actively supports, maintains or improves each resident's quality of life;
(b) Actively supports the safety of each resident; and
(c) Reasonably accommodates each resident's individual needs and preferences except when the accommodation endangers the health or safety of another resident.
(4) Services by the appropriate professionals based upon the resident's assessment and negotiated care plan, including nurse delegation if needed.
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(1) Contract with a nurse currently licensed in the state of Washington to provide the nursing care and service; or
(2) Hire or contract with a nurse to provide nurse delegation.
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(1) Provide laundry services as needed; and
(2) Launder sheets and pillowcases weekly or more often if soiled.
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FOOD SERVICES(1) Ensure the provider, entity representative and all staff meet the safe food handling training requirements of chapter 388-112 WAC; and
(2) Serve meals:
(a) In the home where each resident lives; and
(b) That accommodate each resident's:
(i) Preferences;
(ii) Food allergies and sensitivities;
(iii) Caloric needs;
(iv) Cultural and ethnic background; and
(v) Physical condition that may make food intake difficult such as being hard for the resident to chew or swallow.
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(1) Serve at least three meals:
(a) In each twenty-four hour period;
(b) At regular times comparable to normal meal times in the community; and
(c) That meet the nutritional needs of each resident.
(2) Provide nutritious snacks to residents:
(a) Between meals; and
(b) In the evening.
(3) Get input from residents' in meal planning and scheduling;
(4) Serve nutrient concentrates, supplements, and modified diets only with written approval of the resident's physician;
(5) Only serve pasteurized milk; and
(6) Process any home-canned foods served in the home, according to the latest guidelines of the county cooperative extension service.
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(1) Persons preparing food, at a location separate from the home, have a current food handler's permit issued by the department of health;
(2) Prepared food transported to the home is in airtight containers; and
(3) Food stays at the appropriate and safe temperature:
(a) During transportation; and
(b) When served.
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RESIDENT MEDICATIONS(a) The services provided meet the medication needs of each resident; and
(b) Meet all related laws and rules relating to medications.
(2) When providing medication assistance or medication administration for any resident, the home must ensure each resident:
(a) Assessment indicates the amount of medication assistance needed by the resident;
(b) Negotiated care plan identifies the medication service that will be provided to the resident;
(c) Medication log is kept current as required in WAC 388-76-10480;
(d) Receives medications as required.
(3) Records are kept which include a current list of prescribed and over-the-counter medications including name, dosage, frequency and the name and phone number of the practitioner as needed.
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(2) If the adult family home is assisting with or administering a resident's medications and the resident refuses to take or does not receive a prescribed medication:
(a) The home must notify the resident's practitioner; unless
(b) The provider, entity representative, resident manager or caregiver is a nurse or other health professional, acting within their scope of practice, is able to make a judgment about the impact of the resident's refusal.
(3) If the home becomes aware that a resident who self-administers, or takes their own medications, refuses to take a prescribed medication:
(a) The home must notify the practitioner; unless
(b) The provider, entity representative, resident manager or caregiver is a nurse or other health professional, acting within their scope of practice, is able to make a judgment about the impact of the resident's refusal.
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(a) Ensure each resident assessment identifies the amount of assistance the resident needs when taking medications; and
(b) Let the practitioner know when the following may affect the resident's ability to take their medications:
(i) Resident's physical or mental limitations; and
(ii) The setting or environment where the resident lives.
(2) The amount of assistance needed by a resident when taking their medications is as follows:
(a) Independent with self-administration is when the resident does not need help taking medications and is able to directly take medications by eating or drinking, inhaling, by shot, through the skin or other means;
(b) Self-administration with assistance, as described in chapter 246-888 WAC, is when a resident is assisted in taking their medication by a non-practitioner; and
(c) Medication administration is when medications are administered to the resident by a person legally authorized to do so, such as but not limited to a physician, nurse or pharmacist or through nurse delegation.
(3) The home must contact the resident's practitioner who will decide if a reassessment is necessary when:
(a) The resident has a change in the health status, medications, physical or mental limitations, or environment that might change the resident's need for medication assistance; or
(b) There is a need for a resident to have more than one type of medication assistance.
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(1) Administer their own medications; and
(2) Are allowed to keep their prescribed and over-the-counter medications securely locked in either their room or another agreed upon area if documented in the resident negotiated care plan.
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(2) The adult family home must ensure that the resident can:
(a) Put the medication into their own mouth; or
(b) Apply, inject, or instill the medications.
(3) The home must:
(a) Provide set-up assistance just before the resident takes or applies the medication; or
(b) Only give oral medications through a gastrostomy or "g-tube" when ordered by the practitioner; and
(c) Ensure the resident is aware they are taking a medication, however the resident does not have to name the medication, effects or side effects.
(4) Self-administration with assistance:
(a) Does not include shots or intravenous medications as defined in WAC 264-888-020, except for a pre-filled insulin syringe;
(b) May include steadying or guiding a resident's hand while applying or instilling medications such as ointments, eye, ear and nasal preparations, but does not include the practice of "hand-over-hand" (total physical assistance) administration;
(c) May include transferring the medications from one container to another to make a single dose such as pouring a liquid from the medication container to a calibrated spoon or measuring cup;
(d) May include reminding or coaching the resident to take their medication;
(e) Does not include direct assistance with intravenous and injectable medications except the home may carry a pre-filled insulin syringe which the resident can administer;
(f) May include using an enabler; and
(g) Could include delivering a pre-filled insulin syringe to the resident if the resident independently self-administers the injection per WAC 246-888-020.
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(1) Performed by a person as defined in chapter 69.41 RCW; or
(2) By nurse delegation per WAC 246-840-910 through 970; unless
(3) Done by a family member or legally appointed resident representative.
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(a) The reasons why a resident needs that amount of medication assistance; and
(b) When there is a need for the resident to have more than one type of medication assistance.
(2) How the resident will get their medications when the resident is away from the home or when a family member or resident representative is assisting with medications is not available.
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(2) The adult family home must consult with the practitioner or pharmacist:
(a) Before altering a medication, and
(b) If the practitioner or pharmacist agrees with altering a medication, record the:
(i) Time;
(ii) Date; and
(iii) Name of the person who provided the consultation.
(2) The home must ensure the resident is aware that a medication is:
(a) Altered; and/or
(b) Put in the resident's food or drink.
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(a) At the specific time(s) ordered by the practitioner; and
(b) As follows, when the practitioner does not order a medication to be given at a specific time:
(i) One time per day, every twenty four hours;
(ii) Two times a day, approximately twelve hours apart;
(iii) Three times a day, approximately six hours apart; and
(iv) Four times a day, approximately four hours apart.
(2) The home must ensure all directions given by the practitioner are followed when assisting or giving each resident medication. This includes but is not limited to:
(a) Before meals;
(b) After meals;
(c) With or without food; and
(d) At bed time.
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(1) Keep an up-to-date daily medication log for each resident except for residents assessed as medication independent with self-administration.
(2) Include in each medication log the:
(a) Name of the resident;
(b) Name of all prescribed and over-the-counter medications;
(c) Dosage of the medication;
(d) Frequency which the medications are taken; and
(e) Approximate time the resident must take each medication.
(3) Ensure the medication log includes:
(a) Initials of the staff who assisted or gave each resident medication(s);
(b) If the medication was refused and the reason for the refusal; and
(c) Documentation of any changes or new prescribed medications including:
(i) The change;
(ii) The date of the change;
(iii) A logged call requesting written verification of the change; and
(iv) A copy of written verification of the change from the practitioner received by the home by mail, facsimile, or other electronic means, or on new original labeled container from the pharmacy.
(4) The home must ensure that the changed or new medication is received from the pharmacy.
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(1) A licensed nurse, pharmacist, the resident or the resident's family members fills a resident's medication organizer;
(2) Prescribed and over-the-counter medications placed in a medication organizer come from the original container labeled for the resident by the pharmacist or pharmacy service;
(3) Each resident and anyone giving care to a resident can readily identify medications in the medication organizer;
(4) Medication organizer labels clearly show the following:
(a) The name of the resident;
(b) A list of all prescribed and over-the-counter medications;
(c) The dosage of each medication;
(d) The frequency which the medications are given.
(5) The person filling the medication organizer updates the labels on the medication organizer when the practitioner changes a medication.
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(1) In locked storage;
(2) In the original container with legible and original labels; and
(3) Appropriately for each medication, such as if refrigeration is required for a medication and the medication is kept in refrigerator in locked storage.
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SPECIALTY CARE(1) Developmental disability;
(2) Mental illness; and
(3) Dementia.
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(1) The provider, entity representative and resident manager has successfully completed training in one or more of the specialty care designated areas;
(2) The home provides the department with written documentation;
(a) Of successful completion of the required specialty care training or challenge test for each person in subsection (1) of this section; and
(b) For the specialty care training for all caregivers in the adult family home provided by a person knowledgeable in specialty care.
(3) The home ensures the specialty care need of each resident is met.
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RESIDENT RIGHTS(1) Receives appropriate services;
(2) Is treated with courtesy;
(3) Continues to enjoy basic civil and legal rights;
(4) Has the chance to exercise reasonable control over life decisions such as choice, participation, and privacy;
(5) Is provided the opportunity to engage in religious, political, civic, recreational, and other social activities of their choice;
(6) Is cared for in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life including a safe, clean, comfortable, and homelike environment; and
(7) Is allowed to use his or her personal belongings to the extent possible.
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(1) Protect each resident's right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the home;
(2) Protect and promote the rights of each resident and assist the resident to exercise his or her rights as a resident of the home, as a citizen or resident of the United States and the state of Washington.
(3) Be free of interference, coercion, discrimination, and reprisal from the home in exercising his or her rights; and
(4) Ensure the resident's right to choose a representative who may exercise the resident's rights to the extent provided by law.
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(1) Inform each resident both orally and in writing in a language the resident understands of resident rights and all rules and regulations governing resident conduct and responsibilities during the stay in the home;
(2) Ask the resident to sign and date they received the information; and
(3) Provide a statement indicating whether the provider or entity representative will accept medicaid or other public funds as a source of payment for services.
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(1) Description of how the home will protect personal funds;
(2) Posting of names, addresses, and telephone numbers of the:
(a) State survey and certification agency;
(b) State licensing office;
(c) State ombudsmen program; and
(d) Protection and advocacy systems.
(3) A statement informing the resident that he or she may file a complaint with the appropriate state licensing agency concerning alleged abandonment, abuse, neglect, or financial exploitation.
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(1) Services, items, and activities customarily available in the home or arranged for by the home as permitted by the license;
(2) Charges for those services, items, and activities including charges for services, items, and activities not covered by the home's per diem rate or applicable public benefit programs; and
(3) Rules of the home's operations.
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(a) In writing; and
(b) In advance of changes in the availability or the charges for services, items, or activities, or of changes in the home's rules.
(2) The home must provide notice:
(a) Thirty days before the change, except in emergencies; or
(b) Fourteen days before the change, if there has been a substantial and continuing change in the resident's condition necessitating substantially greater or lesser services, items, or activities.
(3) The home is not required to give notice:
(a) If the home gives each resident written notice of the availability and charges of services, items and activities before admission, when there are changes and every twenty-four months; and
(b) If the resident is provided different or additional services, items or activities from the home.
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(2) The disclosure must include:
(a) A statement of the amount of any admissions fees, deposits, prepaid charges, or minimum stay fees;
(b) The home's advance notice or transfer requirements; and
(c) The amount of the deposits, admission fees, prepaid charges, or minimum stay fees that will be refunded to the resident or his if the resident leaves the home.
(3) The home must ensure that the receipt of the disclosures required under subsection (1) of this section is in writing and signed and dated by the resident and the home.
(4) If the home does not provide these disclosures, the home must not keep the deposits, admission fees, prepaid charges, or minimum stay fees.
(5) If a resident dies, is hospitalized or is transferred and does not return to the home, the adult family home:
(a) Must refund any deposit or charges already paid less the home's per diem rate for the days the resident actually resided, reserved or retained a bed in the home in spite of any minimum stay policy or discharge notice requirements; except that
(b) May keep an additional amount to cover its reasonable and actual expenses incurred as a result of a private-pay resident's move, not to exceed five days per diem charges; unless the resident has given advance notice in compliance with the admission agreement.
(6) All adult family homes covered under this section are required to refund any and all refunds due the resident or his or within thirty days from the resident's date of discharge from the home.
(7) Nothing in this section applies to provisions in contracts negotiated between a home or and a certified health plan, health or disability insurer, health maintenance organization, managed care organization, or similar entities.
(8) If the home requires the implementation of an admission contract by or on behalf of an individual seeking admission the home must ensure the terms of the contract are consistent with the requirements of this section, chapters 70.128, 70.129 and 74.34 RCW, and other applicable state and federal laws.
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(1) Only admit or keep individuals whose needs the home can safely serve in the home:
(a) With appropriate available staff; and
(b) Through the provision of reasonable accommodations required by state and federal law.
(2) Not admit an individual before obtaining a thorough assessment of the resident's needs and preferences, except in cases of a genuine emergency;
(3) Ensure that the admission of the individual does not negatively affect the ability of the home to meet the needs of or endangers the safety of other residents; and
(4) Comply with all applicable federal and state requirements regarding nondiscrimination.
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(1) Information about the provider, entity representative and resident manager, if there is a resident manager:
(a) Availability in the home, including a general statement about how often he or she is in the home;
(b) Education and training relevant to resident caregiving;
(c) Caregiving experience;
(d) His or her primary responsibilities, including whether he or she makes daily general care management decisions; and
(e) How to contact the provider, entity representative or resident manager when he or she is not in the home.
(2) Information about a licensed practical nurse or registered nurse, if there is one, who is in any way involved in the care of residents:
(a) Who the licensed practical nurse or registered nurse is employed by;
(b) The specific routine hours that the licensed practical nurse or registered nurse is on-site, if they are on-site routinely;
(c) His or her primary responsibilities, including whether he or she makes daily general care management decisions;
(d) The non-routine times when the licensed practical nurse or registered nurse will be available, such as on-call; and
(e) A description of what the provider or entity representative will do to make available the services of a licensed nurse in for an emergency or change in a resident's condition.
(3) A statement indicating whether the provider, entity provider, caregiver or staff is qualified or willing to become qualified to perform nurse delegation as allowed under state law.
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(1) Hold, safeguard, manage, and account for the personal funds of the resident deposited with the home;
(2) Have a written authorization from the resident;
(3) Deposit a resident's personal funds in excess of one hundred dollars in an interest-bearing account or accounts separate from any of the home's operating accounts, and that credits all interest earned on residents' funds to that account;
(4) If funds are pooled accounts, there must be a separate accounting for each resident's share; and
(5) Keep a resident's personal funds that do not exceed one hundred dollars in a non-interest-bearing account, interest-bearing account, or petty cash fund.
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(1) Develop and maintain a system that assures a full, complete, and separate accounting of each resident's personal funds given to the home on the resident's behalf;
(2) Ensure the:
(a) System prevents resident funds from being mixed with the home's funds or with the funds of any person other than another resident; and
(b) Individual financial record is available upon request to the resident.
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(1) The individual or probate jurisdiction administering the resident's estate; except that
(2) For a resident who received long-term care services paid by the state, the home must send funds and accounting to the state of Washington, department of social and health services, office of financial recovery.
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(a) The home;
(b) Medical treatment;
(c) Clinical or resident records;
(d) Personal care; and
(e) Visits and meetings of family and resident groups; however
(2) The resident right to personal privacy does not require the home to provide a private room for each resident.
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(1) Ensure each resident's right to voice grievances, including those about care and treatment given or not given that has been furnished as well as that which has not been furnished; and
(2) Make prompt efforts to resolve grievances the resident may have, including those about the behavior of other residents.
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(1) Ensure each resident is given the ability to examine the most recent inspection report of the home and related plans of correction; and
(2) Publicly post a notice that the inspection report is available for review.
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(1) Receives information from client advocate agencies; and
(2) Has opportunities to contact client advocate agencies.
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(1) Any representative of the state;
(2) The resident's own physician;
(3) The state long-term care ombudsman program as established under chapter 43.190 RCW;
(4) The agency responsible for the protection and advocacy system for developmentally disabled individuals as established under Part C of the developmental disabilities assistance and bill of rights act;
(5) The agency responsible for the protection and advocacy system for mentally ill individuals as established under the protection and advocacy for mentally ill individuals act;
(6) Immediate family or other relatives of the resident and others who are visiting with the consent of the resident, subject to reasonable limits to protect the rights of others and to the resident's right to deny or withdraw consent at any time;
(7) The agency responsible for the protection and advocacy system for individuals with disabilities as established under section 509 of the rehabilitation act of 1973, as amended, who are not served under the mandates of existing protection and advocacy systems created under federal law; and
(8) The resident's representative or an entity or individual that provides health, social, legal, or other services to the resident, subject to the resident's right to deny or withdraw consent at any time.
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(1) Send and receive unopened mail without delay;
(2) Have writing paper, postage, and pens or pencils available that have been paid for by resident; and
(3) Be able to use a telephone where calls can be made without being overheard.
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(1) Potential liability for losses of personal property or injury; and
(2) Residents' rights set forth in chapters 70.128, 70.129, 74.34 RCW, this chapter or in the applicable licensing laws.
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(a) The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the home;
(b) The safety or health of individuals in the home is or would otherwise be endangered;
(c) The resident has failed to make the required payment for his or her stay; or
(d) The home ceases to operate.
(2) Before a home transfers or discharges a resident, the home must:
(a) First attempt through reasonable accommodations to avoid the transfer or discharge, unless agreed to by the resident;
(b) Notify the resident and representative and make a reasonable effort to notify, if known, an interested family member of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand;
(c) Record the reasons in the resident's record; and
(d) Include in the notice the items described in subsection (5) of this section.
(3) Except as specified in (4) of this section, the home must give notice of the transfer or discharge at least thirty days before the resident is transferred or discharged.
(4) The home may make the notice as soon as practicable before transfer or discharge when:
(a) The safety and health of the individuals in the home would be endangered;
(b) An immediate transfer or discharge is required by the resident's urgent medical needs; or
(c) A resident has not resided in the home for thirty days.
(5) The home must include the following in the written notice specified in subsection (2) of this section:
(a) The reason for transfer or discharge;
(b) The effective date of transfer or discharge;
(c) The location where the resident is transferred or discharged;
(d) The name, address, and telephone number of the state long-term care ombudsman;
(e) For residents with developmental disabilities, the mailing address and telephone number of the agency responsible for the protection and advocacy of developmentally disabled individuals; and
(f) For residents who are mentally ill, the mailing address and telephone number of the agency responsible for the protection and advocacy of mentally ill individuals.
(6) The home must give residents enough preparation and orientation to ensure a safe and orderly transfer or discharge from the home.
(7) If the home discharges a resident in violation of this section, the home must readmit the resident to the home as soon as a gender-appropriate bed becomes available.
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QUALITY OF LIFE(2) Within reasonable home rules designed to protect the rights and quality of life of residents, the home must ensure the resident's right to:
(a) Choose activities, schedules, and health care consistent with his or her interests, assessments, and negotiated care plan;
(b) Interact with members of the community both inside and outside the home;
(c) Make choices about aspects of his or her life in the home that are significant to the resident;
(d) Wear his or her own clothing and decide his or her own dress, hair style, or other personal effects according to individual preference;
(e) Unless adjudged incompetent or otherwise found to be legally incapacitated to:
(i) Be informed in advance about recommended care and services and of any recommended changes in the care and services;
(ii) Participate in planning care and treatment or changes in care and treatment;
(iii) Direct his or her own service plan and changes in the service plan, or
(iv) Refuse any particular service so long as such refusal is documented in the record of the resident.
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(1) A resident's right to:
(a) Organize and take part in resident groups in the home;
(b) Have family meet in the home with the families of other residents; and
(c) Have staff or visitors attend meetings at the group's invitation.
(2) The home must provide a resident or family group, if one exists, with meeting space.
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(1) Receives reasonable accommodation to meet the needs and preferences of the resident, except when the reasonable accommodation endangers the health or safety of the individual or other residents; and
(2) Has the ability to share a double room with his or her spouse when both spouses consent to the arrangement.
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MEDICAL DEVICES AND RESTRAINTS(1) Review the resident assessment to determine the resident's need for and use of a medical device;
(2) Ensure the resident negotiated care plan includes the resident use of a medical device or devices; and
(3) Provide the resident and family with enough information about the significance and level of the safety risk of use of the device to enable them to make an informed decision about whether or not the use the device.
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(1) Each resident's right to be free from physical restraints used for discipline or convenience;
(2) Less restrictive alternatives have been tried;
(3) That physical restraints used have been assessed as necessary to treat the resident's medical symptoms; and
(4) That if physical restraints are used to treat a resident's medical symptoms that the restraints are applied and immediately supervised on-site by a:
(a) Licensed registered nurse;
(b) Licensed practical nurse; or
(c) Licensed physician; and
(d) For the purposes of this subsection, immediate supervised means that the licensed person is in the home and quickly and easily available.
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(2) The adult family home must ensure that:
(a) Each resident is free from chemical restraints used for discipline or convenience;
(b) The resident assessment indicates that a chemical restraint is necessary to treat the resident's medical symptoms;
(c) In situations when a psychopharmacological drug is used for a resident, the home must ensure that the:
(i) Drug is prescribed by a physician or health care professional with prescriptive authority;
(ii) Resident's negotiated care plan includes strategies and modifications of the environment and staff behavior to address the symptoms for which the medication is prescribed;
(iii) Changes in medication only occur when the prescriber decides it is medically necessary; and
(iv) Resident has given informed consent for its use.
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ABUSE(1) Meet the requirements of chapter 74.34 RCW;
(2) Ensure each resident's right to be free from abandonment, verbal, sexual, physical and mental abuse, exploitation, financial exploitation, neglect, and involuntary seclusion;
(3) Protect each resident who is an alleged victim of abandonment, verbal, sexual, physical and mental abuse, exploitation, financial exploitation, neglect, and involuntary seclusion; and
(4) Prevent future potential abandonment, verbal, sexual, physical and mental abuse, exploitation, financial exploitation, neglect, and involuntary seclusion from occurring.
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(1) Do not allow abandonment, abuse, neglect of any resident, exploitation or financial exploitation of any resident's property;
(2) Require staff to report possible abuse, and other related incidents, as required in chapter 74.34 RCW; and
(3) Do not interfere with the requirement that employees and other mandated reporters file reports directly with the department, and with law enforcement, if they suspect sexual or physical assault to have occurred.
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PHYSICAL PLANT BASIC REQUIREMENTS(1) Ensure each resident's bedroom is an outside room, which allows entrance of natural light;
(2) Ensure window and door screens:
(a) Do not hinder emergency escape; and
(b) Prevent entrance of flies and other insects.
(3) Ensure each resident's bedroom has direct access to hallways and corridors and unrestricted or free access to common use areas;
(4) Make separate bedrooms available for each sex;
(5) Make reasonable efforts to accommodate residents wanting to share the room;
(6) Provide each bedroom with a minimum usable floor space as required in WAC 388-76-10690.
(7) Ensure no more than two residents to a bedroom;
(8) Unless the resident chooses to provide their own furniture and bedding, the home must provide each resident a bed thirty-six inches or more wide with:
(a) A clean, comfortable mattress;
(b) A waterproof cover for use when needed or requested by the resident;
(c) Clean sheets and pillow cases;
(d) Adequate clean blankets to meet the needs of each resident; and
(e) Clean pillows.
(9) Not use the upper bunk of double-deck beds for a resident's bed;
(10) May be required by the department to provide a call bell or intercom system if the provider, entity representative, resident manager or caregiver bedroom is not within hearing distance of each resident bedroom;
(11) Ensure that members of the household, other than residents, do not share bedrooms with residents; and
(12) Ensure a resident does not share a bedroom with a person under eighteen years of age, unless the person is the resident's own child.
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(2) The adult family home must ensure each resident bedroom has a minimum usable floor space as follows, excluding the floor space for toilet rooms, closets, lockers, wardrobes and vestibules:
(a) Single occupancy bedrooms with at least eighty square feet; and
(b) Double occupancy bedrooms with at least one-hundred twenty square feet.
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(a) New; or
(b) An existing building converted for use as an adult family home.
(2) For buildings licensed as a home before July 1, 2007, the requirement of subsection (1) of this section does not apply if:
(a) The building sells or transfers to a new owner; and
(b) The new owner takes possession of the building before the issuance of the license.
(3) The home must ensure that every area used by residents:
(a) Has direct access to at least one exit which does not pass through other areas such as a room or garage subject to being locked or blocked from the opposite side; and
(b) Is not accessible only by or with the use of a:
(i) Ladder;
(ii) Folding stairs; or
(iii) Trap door.
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(1) Before licensing; and
(2) After any construction changes that:
(a) Affect resident's ability to exit the home; or
(b) Change, add or modify a resident's bedroom.
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(a) Are areas and rooms of the adult family home that residents use each day for tasks such as eating, visiting, and leisure activities; and
(b) Include but are not limited to dining and eating rooms, living and family rooms, and any entertainment and recreation areas.
(2) The adult family home must ensure common use areas are:
(a) Homelike, with furnishings that each resident can use;
(b) Large enough for all residents to use at the same time; and
(c) Not used as bedrooms or sleeping areas.
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(1) Notify the residents of the move date and the resident's options consistent with chapter 70.129 RCW;
(2) Notify the department at least thirty days before the anticipated move, including:
(a) The location to which the residents will be moved;
(b) The home's plans for providing and ensuring care and services during the relocation;
(c) The home's plans for returning residents to the building; and
(d) The projected timeframe for completing the construction or remodeling.
(3) Obtain the department's approval of the relocation plans before moving the residents.
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(1) Every bedroom and bathroom door opens from the inside and outside;
(2) Every closet door opens from the inside and outside; and
(3) All exit doors leading to the outside will open from the inside without a key or any special knowledge or effort by residents.
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(a) In the home;
(b) In combination with video monitoring equipment; or
(c) Except as provided in section WAC 388-76-10730.
(2) The home may video monitor and video record activities in the home, without an audio component, only in the following areas:
(a) Entrances and exits if the cameras are:
(i) Focused only on the entrance or exit doorways; and
(ii) Not focused on areas where residents gather.
(b) Outdoor areas not commonly used by residents; and
(c) Designated smoking areas, subject to the following conditions when:
(i) Residents are assessed as needing supervision for smoking;
(ii) A staff person watches the video monitor at any time the area is used by such residents;
(iii) The video camera is clearly visible;
(iv) The video monitor is not viewable by general public; and
(v) The home notifies all residents in writing of the video monitoring equipment.
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(2) If the resident requests audio or video monitoring, before any electronic monitoring occurs the home must ensure:
(a) Appropriate actions are taken to ensure electronic monitoring is consistent with and does not violate chapter 9.73 RCW;
(b) The resident has identified a threat to the resident's health, safety or personal property and has requested electronic monitoring;
(c) The resident's roommate has provided written consent to electronic monitoring, if the resident has a roommate; and
(d) The resident and the home have agreed upon a specific duration for the electronic monitoring documented in writing.
(3) The home must reevaluate the need for the electronic monitoring with the resident at least quarterly and:
(a) Must document the reevaluation in writing; and
(b) Have each reevaluation signed and dated by the resident.
(4) The home must immediately stop electronic monitoring if the:
(a) Resident no longer wants electronic monitoring;
(b) Roommate objects or withdraws the consent to the electronic monitoring, or
(c) Resident becomes unable to give consent.
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(2) At a minimum, grab bars must be installed and securely fastened in:
(a) Bathing facilities such as tubs and showers; and
(b) Next to toilets, if needed by any resident.
(3) If needed by any resident, hand rails must be installed and conveniently located on:
(a) A step or steps; and
(b) Ramps.
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(a) Food handling;
(b) Preparation; and
(c) Food storage.
(2) The home must keep the kitchen and equipment in a clean and sanitary manner.
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(1) Adequate light fixtures for each task a resident or staff does; and
(2) Emergency lighting, such as working flashlights:
(a) For staff and residents; that
(b) Are readily accessible.
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(1) Meet all applicable local licensing, zoning, building and housing codes as they pertain to a single family dwelling;
(2) Meet state and local fire safety regulations as they pertain to a single family dwelling; and
(3) Check with local authorities to ensure the home meets all local codes and ordinances.
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(1) Keep the home both internally and externally in good repair and condition with a safe, comfortable, sanitary, homelike environment that is free of hazards;
(2) Provide clean, functioning, safe, adequate household items and furnishings to meet the needs of each resident;
(3) Provide safe and functioning systems for:
(a) Heating;
(b) Cooling, which may include air circulating fans;
(c) Hot and cold water;
(d) Electricity;
(e) Plumbing;
(f) Garbage disposal;
(g) Sewage;
(h) Cooking;
(i) Laundry;
(j) Artificial and natural light;
(k) Ventilation; and
(l) Any other feature of the home.
(4) Ensure water temperature does not exceed one hundred twenty degrees Fahrenheit at all fixtures used by or accessible to residents, such as:
(a) Tubs;
(b) Showers; and
(c) Sinks.
(5) Provide storage for toxic substances, poisons, and other hazardous materials that is only accessible to residents under direct supervision, unless the resident is assessed for and the negotiated care plan indicates it is safe for the resident to use the materials unsupervised;
(6) Provide rapid access for all staff to any bedroom, toilet room, shower room, bedroom, closet, other room occupied by each resident;
(7) Keep all firearms locked and accessible only to authorized persons; and
(8) Keep the home free from:
(a) Rodents;
(b) Flies;
(c) Cockroaches, and
(d) Other vermin.
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(1) A public sewer system; or
(2) An independent sewage system approved by the local health authority.
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(1) Is on a well drained site free from:
(a) Hazardous conditions;
(b) Excessive noise;
(c) Dust; and
(d) Smoke or odors.
(2) Has a road accessible at all times to emergency vehicles.
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(1) Supply each resident with adequate and reasonable storage space for:
(a) Clothing;
(b) Personal possessions; and
(c) Upon request, lockable container or storage space for small items, unless the:
(i) Resident has a private room; and
(ii) The resident room can be locked by the resident.
(2) Provide locked storage for all prescribed and over-the-counter medications as per WAC 388-76-10485.
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(1) At least one working non-pay telephone in the home;
(2) Residents reasonable access to the telephone; and
(3) Privacy for the resident when making or receiving calls.
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(1) Keep room temperature at:
(a) Sixty-eight degrees Fahrenheit or more during waking hours;
(b) Sixty degrees Fahrenheit or more during sleeping hours; and
(c) Not more than seventy-eight degrees Fahrenheit day or night.
(2) Provide ventilation in the home to ensure the health and comfort of each resident is met.
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(a) One indoor flush toilet for each five persons including residents and household members in the home;
(b) Sinks with hot and cold running water.
(2) Homes licensed after July 1, 2007, must ensure each resident has access to a toilet, shower and tub without going through another resident's room.
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(a) In-ground, above-ground, and on-ground pools;
(b) Hot tubs, spas; or
(c) Fixed-in-place wading pools.
(2) The adult family home must:
(a) Protect each resident from risks of bodies of water of any depth and water hazards;
(b) Ensure that water hazard protection complies with this section and the requirements of the:
(i) International Residential Code (IRC); and
(ii) Washington state amendments to the Internal Residential Code (IRC).
(b) Provide each area which allows direct access to a water hazard with:
(i) A minimum of forty-eight inch high fences and gates to enclose or protect each resident from the water hazard;
(ii) Alarms that produce an audible warning when opened on all doors and screens, if present and gates.
(c) After July 1, 2007, existing adult family homes are required to meet the requirements of this section when installing or making construction changes to the following:
(i) In-ground, above-ground and on-ground pools;
(ii) Hot tubs, spas;
(iii) Decorative water features; or
(iv) Fixed-in-place wading pools.
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(1) Obtain local health authority approval to use a private water supply;
(2) Provide a clean and healthy drinking water supply for the home; and
(3) Label any non-potable water to avoid use as a drinking water source.
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(2) For homes licensed after July 1, 2007, the department will not approve alternatives to the sill height requirement such as step(s), raised platform(s) or other devices placed by or under the window openings.
(3) The bedroom window must have the following:
(a) A minimum opening area of 5.7 square feet except a grade level floor window openings may have a minimum clear opening of 5.0 square feet;
(b) A minimum opening height of twenty-four inches;
(c) A minimum opening width of twenty inches; and
(d) The home must ensure the bedroom window can be opened from inside the room without keys or tools.
(4) When resident bedroom windows are fitted with storm windows, the home must equip the storm windows will release mechanisms that are:
(a) Easily opened from the inside; and
(b) Do not require a key or special knowledge or effort to open.
(5) The home must ensure that each basement and each resident bedroom window, that meets the requirements of subsection (1), (2) and (3) of this section, are kept free from obstructions that might block or interfere with access for emergency escape or rescue.
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FIRE PROTECTION
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(1) Installed, at a minimum, in the following locations:
(a) Every bedroom used by a resident;
(b) In proximity to the area where the resident or adult family home staff sleeps; and
(c) On every level of a multilevel home.
(2) Installed in a manner so that the fire warning is heard in all parts of the home upon activation of a single detector; and
(3) Kept in working condition at all times.
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(2) The home must ensure the fire extinguishers are:
(a) Installed according to manufacturer recommendations;
(b) Inspected and serviced annually;
(c) In proper working order; and
(d) Readily available for use at all times.
(2) If required by the local fire authority, the home must provide different fire extinguishers as required in subsection (1) of this section.
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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 388-76-10815
Notice required -- Compliance with
building code and fire protection.
Before a resident is
admitted, the adult family home must disclose in writing in a
language understood by the prospective resident the following:
(1) Whether or not resident bedrooms comply with the current building code including evacuation standards; and
(2) If the home is located outside a public fire district, the source and plan for on-site fire protection.
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(a) Stairs;
(b) Elevator; or
(c) Lift.
(2) The home must install alternative emergency evacuation protection equipment when serving hearing or visually impaired residents.
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(1) The following space heaters are not used in a home except during a power outage and the portable heater is only safe source of heat:
(a) Oil;
(b) Gas;
(c) Kerosene; and
(d) Electric.
(2) Stoves and heaters do not block residents, staff or household members from escaping.
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DISASTER AND EMERGENCY PREPAREDNESS
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(1) Plans for responding to natural and man-made emergencies and disasters that may reasonably occur at the home;
(2) Actions to be taken by staff and residents when an emergency or disaster strikes; and
(3) The fire drill plan for evacuation of the home.
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(1) Will last for a minimum of seventy-two hours; and
(2) Meets the dietary needs of each resident, including any specific dietary restrictions any resident may have.
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(1) Will last for a minimum of seventy-two hours for each resident;
(2) Is at least three gallons for each resident; and
(3) Is stored in containers rated for the storage of drinking water.
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(1) First aid supplies; and
(2) A first-aid manual.
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FIRE DRILL PLAN FOR EMERGENCY EVACUATION(1) Have a fire drill plan and procedures for the emergency evacuation of all residents from the adult family home; and
(2) Not admit and keep residents the provider or entity representative cannot safely evacuate from the adult family home.
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(1) From the home to a safe location outside the home; and
(2) In five minutes or less.
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(1) Level 1 - resident is capable of walking or traversing a normal pathway to safety without the physical assistance of another individual;
(2) Level 2 - resident is physically and mentally capable of traversing a normal pathway to safety with mobility aids, but unable to ascend or descend stairs without the physical assistance of another individual; and
(3) Level 3 - resident is unable to walk or transverse a normal pathway to safety without the physical assistance of another individual.
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(1) Has at least two means of exiting the bedroom; and
(2) Exiting from the bedroom does not require the use of:
(a) Stairs;
(b) Elevators; or
(c) A platform lift.
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(1) An accurate floor plan of the home, including rooms, hallways, exits (such as doorways and windows) to the outside of the home;
(2) Emergency evacuation routes showing the paths to take to exit the home; and
(3) The location for the residents to meet outside the home.
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(1) A visible location in the home; and
(2) Common areas normally used by residents, staff and visitors.
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(1) Emergency evacuation drills occur at least every two months;
(2) All residents take part in at least one emergency evacuation drill each calendar year involving full evacuation from the home to a safe location.
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(1) Names of each resident and staff involved in the drill;
(2) Name of the person conducting the drill;
(3) Date and time of the drill; and
(4) The length of time it took to evacuate all residents.
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(1) Any fire; or
(2) Emergency evacuation from the home.
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INSPECTIONS -- COMPLAINT INVESTIGATIONS -- MONITORING VISITS
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(1) Department staff have access to:
(a) The home, residents, including former residents;
(b) Resident records, includes former residents records; and
(c) Facility staff and relevant staff records.
(2) The home and staff do not willfully interfere or fail to cooperate with department staff in the performance of official duties.
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(1) Within ten working days of the inspection of the home; or
(2) Within ten calendar days of completion of complaint investigation.
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(1) Inspection and complaint investigation reports as soon as they are completed;
(2) The home's plan of correction, if a copy is available at the time of the request; and
(3) Any final written decision by the department to take an enforcement action.
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(1) Be completed by the adult family home and returned to the department within ten days of receiving the inspection report;
(2) Include an attestation statement stating:
(a) What the home did or will do to correct each deficiency;
(b) That all deficiencies are or will be corrected;
(c) The home will stay in compliance with the licensing requirements;
(d) Dates, acceptable to the department, by which each cited deficiency has been or will be corrected; and
(e) A signature by the home, certifying that the home has or will correct each deficiency.
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RESIDENT ADVOCATE ACCESS(1) Washington protection and advocacy system as defined under RCW 71A.10.080; or
(2) Long-term care ombudsman as defined under chapter 43.190 RCW, the state regulations for the long-term care ombudsman and under federal law.
(3) The department must impose a civil penalty as per WAC 388-76-10985 for any such willful interference with a representative of the long-term care ombudsman program.
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REMEDIES(1) Denial of an application for a license;
(2) Impose reasonable conditions on a license;
(3) Impose civil penalties;
(4) Order stop placement; and/or
(5) Suspension or revocation of a license.
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(1) Applicant;
(2) Provider;
(3) Entity representative;
(4) Person affiliated with the applicant;
(5) Resident manager;
(6) A partner, officer, director or managerial employee of the entity;
(7) Spouse of the provider or entity representative;
(8) An owner:
(a) Of fifty-one percent or more of the entity;
(b) Who exercises control over the daily operations of the home.
(9) A caregiver; or
(10) Any person who:
(a) Has unsupervised access to residents in the home; and
(b) Lives in the home but who is not a resident.
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(1) A history of prior violations of chapter 70.128 RCW or any law regulating to residential care facilities within the past five years that resulted in revocation, suspension, or non-renewal of a license or contract with the department;
(2) When providing care or services to children or vulnerable adults:
(a) Been found to be in significant noncompliance with federal or state regulations; or
(b) Had a license for the care of children or vulnerable adults suspended or revoked.
(3) Been enjoined from operating a facility for the care and services of children or adults;
(4) A stipulated finding of fact, conclusion of law, an agreed order, finding of fact, conclusion of law, final order issued by a disciplining authority or final decision by any federal or state agency or department, a court of law, or entered into a state registry or department or agency list with a finding of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW;
(5) Had a revocation or suspension of a license for the care of children or adults;
(6) Had a revocation, cancellation, suspension or nonrenewal of:
(a) A Medicaid or Medicare provider agreement by the contracting agency; or
(b) Any agreement with a public agency for the care and treatment of children or vulnerable adults, when the action was taken by the public agency.
(7) Been convicted of any crime listed in RCW 43.43.830 or 43.43.842;
(8) Been found by a court:
(a) In a protection proceeding under chapter 74.34 RCW to have abandoned, neglected, abused, or financially exploited a vulnerable adult; or
(b) In a domestic relations proceeding under Title 26 RCW to have sexually or physically abused, neglected or exploited any minor.
(9) Been found in any final decision issued by a disciplinary board to have:
(a) Sexually or physically abused, neglected or exploited any minor or a person with a developmental disability; or
(b) Abandoned, abused, neglected or financially exploited any vulnerable adult.
(10) Found in any dependency action under RCW 13.34.030 (5)(b) to have sexually or physically abused, neglected or exploited any minor; or
(11) Failed to pay the annual licensing fee.
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(1) Been convicted of a crime:
(a) As defined under RCW 43.43.830 or 43.43.842;
(b) Relating to financial exploitation as defined under RCW 43.43.830 or 43.43.842;
(c) Or a felony against a person if the conviction reasonably relates to the competency of the person to own or operate an adult family home;
(d) Involving a firearm used in the commission of a felony or in any act of violence against a person;
(e) Or engaged in illegally selling or distributing drugs illegal use of drugs or excessive use of alcohol within the past five years without the evidence of rehabilitation.
(2) Found by a court in a protection proceeding under chapter 74.34.RCW to have abandoned, abused, neglected, or financially exploited a vulnerable adult;
(3) Found in a final decision issued by a disciplinary board to have sexually or physically abused, neglected or exploited any minor person or a person with a developmental disability or to have abused or financially exploited any vulnerable adult;
(4) Found in any dependency action under RCW 13.34.030(5) to have sexually abused, neglected or exploited any minor or to have physically abused any minor;
(5) Found in a court in a domestic relations proceeding under Title 26 RCW to have:
(a) Sexually abused, neglected or exploited any minor or to have physically abused any minor;
(b) Committed an act of domestic violence toward a family or household member.
(6) Had a sanction, 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;
(7) Obtained or attempted to obtain a license by fraudulent means or misrepresentation;
(8) Knowingly, or with reason to know, made a false statement of material fact on his or her application for a license or any data attached to the application or in any matter under investigation by the department;
(9) Permitted, aided, or abetted the commission of any illegal act on the adult family home premises;
(10) Willfully prevented or interfered with or failed to cooperate with any inspection, investigation or monitoring visit made by the department;
(11) Failed or refused to comply with:
(a) A condition imposed on a license or a stop placement order;
(b) The applicable requirements of chapters 70.128, 70.129, 74.34 RCW or this chapter.
(12) Misappropriated property of a resident;
(13) Denied a license or license renewal to operate a facility that was licensed to care for children or vulnerable adults;
(14) Exceeded licensed capacity in the operation of an adult family home;
(15) Operated a facility for the care of children or adults without a license or revoked license;
(16) Relinquished or returned a license in connection with the operation of any facility for the care of children or adults, or did not seek license renewal following written notification of the licensing agency's intention of denial, suspension, cancellation or revocation of a license;
(17) Had resident trust funds or assets of an entity providing care to children or vulnerable adults seized by the Internal Revenue Service or a state entity for failure to pay income or payroll taxes;
(18) Failed to meet financial obligations as the obligations fell due in the normal course of business, thereby impeding the ability to provide care and services to residents;
(19) Refused to permit authorized department representatives to interview residents or to have access to resident records or home;
(20) Interfered with a long-term care ombudsman or department staff in the performance of his or her duties; or
(21) Found to be in non-compliance with the requirements established in chapters 70.128, 70.129, 74.34 RCW, this chapter or other applicable laws and regulations.
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(1) WAC 388-76-10115;
(2) WAC 388-76-10120;
(3) WAC 388-76-10125; and
(4) WAC 388-76-10940.
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(2) Conditions the department may impose on a license include, but are not limited to the following:
(a) Correction within a specified time;
(b) Training related to the deficiencies;
(c) Limits on the type of residents the provider or entity representative may admit or serve;
(d) Discharge of any resident when the department finds discharge is needed to meet that resident's needs or for the protection of other residents;
(e) Change in license capacity;
(f) Removal of the adult family home's designation as a specialized home;
(g) Prohibition of access to residents by a specified person; and
(h) Demonstration of ability to meet financial obligations necessary to continue operation.
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(a) Fines up to one thousand dollars can be issued for willful interference with a representative of the long-term care ombudsman per RCW 70.129.150; and
(b) Fines up to three thousand dollars can be issued for retaliation against a resident, employee, or any other person making a complaint, providing information to, or cooperating with, the ombudsman, the department, the attorney's general office, or a law enforcement agency per RCW 74.34.060(7).
(2) When the provider or entity provider fails to pay a fine when due under this chapter, the department may, in addition to other remedies, withhold an amount equal to the fine plus interest, if any, from any contract payment due to the provider or entity provider from the department.
(3) Civil monetary penalties are due twenty-eight days after the provider, entity representative or the owner or operator of an unlicensed adult family home is served with notice of the penalty unless the provider or entity representative requests a hearing in compliance with chapter 34.05 RCW and RCW 43.20A.215. If the hearing is requested, the penalty becomes due ten days after a final decision in the department's favor is issued. Interest accrues beginning thirty days after the department serves the provider or entity provider with notice of the penalty at a rate of one percent per month as per RCW 43.20B.695.
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(2) Once imposed, the adult family home must not admit any person until the stop placement order is terminated.
(3) If the home requests, the department may approve readmission of a resident to the home from a hospital or nursing home during the stop placement.
(4) The department must end the stop placement when the department finds the:
(a) Deficiencies necessitating the stop placement have been corrected; and
(b) Home can show it has the capacity to maintain adequate care and service.
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(2) When the department finds that violations existing in an adult family home are of such nature as to present a serious risk or harm to residents of other homes operated by the same provider or entity representative, and after the department investigates other homes licensed by the same provider or entity representative the department may impose remedies on those other homes.
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INFORMAL DISPUTE RESOLUTION, NOTICE AND APPEALS(2) The purpose of the review is to give the provider or entity representative an opportunity to present information which might warrant modification or deletion of a finding of a violation.
(3) The provider or entity representative may submit a written statement for review.
(4) In addition to a written statement, the provider or entity representative may ask to present the information in person to a department designee.
(5) Requests for review must be made in writing to the department at the address provided in the department's certified letter within ten working days of receipt of the written finding of a violation.
(6) When requested by the provider or entity representative, the department must expedite the dispute resolution process to review violations upon which a department order imposing license suspension, revocation, stop placement, or condition on a license is based.
(7) Orders of the department imposing license suspension, stop placement, or conditions on a license are effective immediately upon notice and shall continue pending dispute resolution.
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(2) A provider contesting any decision by the department to impose a remedy must within twenty-eight days of receipt of the decision:
(a) File a written application for an adjudicative proceeding by a method showing proof of receipt with the board of appeals at the mailing address contained in WAC 388-02-0030; and
(b) Include in or with the application:
(i) The reasons for contesting the department decision; and
(ii) A copy of the contested department decision.
(4) Administrative proceedings are governed by chapter 34.05 RCW, RCW 43.20A.215, where applicable, this section, and chapter 388-02 WAC. If any provision in this section conflicts with chapter 388-02 WAC, the provision in this section governs.
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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.RESIDENT PROTECTION PROGRAM
NEW SECTION
WAC 388-76-11000
Resident protection program -- Abuse and
neglect reporting -- Required.
(1) In accordance with chapter 74.34 RCW, all adult family home providers, entity
representatives, resident managers, owners, caregivers, staff,
and students if the students provide care and services to
residents; are mandated reporters and must report to the
department when there is:
(a) A reasonable cause to believe that a vulnerable adult has been abandoned, abused, neglected, exploited or financially exploited, or
(b) Suspected abandonment, abuse, neglect, exploitation or financial exploitation of a vulnerable adult.
(2) Reports must be made to:
(a) The centralized toll free telephone number for reporting abandonment, abuse, neglect, exploitation or financial exploitation of vulnerable adults, provided by the department; and
(b) Law enforcement agencies, as required under chapter 74.34 RCW.
(3) The home must have policies and procedures complying with state law that specify reporting requirements for abandonment, abuse, neglect, exploitation, and financial exploitation of vulnerable adults.
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(2) The department investigation will include an investigation of allegations about one or more of the following:
(a) A provider;
(b) Entity representative;
(c) Anyone affiliated with a provider;
(d) Caregiver;
(e) Student or volunteer;
(f) Person living in the home who is not a resident; and
(g) A resident receiving care and services under this chapter.
(3) If, after completing an investigation, the department concludes that more likely than not the alleged perpetrator abandoned, abused, neglected, exploited, or financially exploited a resident, the department will make an initial finding against the perpetrator.
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(2) The department must make a reasonable, good faith effort to find the last known address of the alleged perpetrator.
(3) The time frame for notification can be extended beyond ten working days to include the time needed to translate the notification letter or make provisions for the safety of the alleged victim.
(4) Notice of the initial finding will be served as provided in chapter 388-02 WAC.
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(a) Other divisions within the department;
(b) The agency or program identified under RCW 74.34.068 with which the alleged perpetrator is associated as an employee, volunteer, student or contractor;
(c) Law enforcement; and
(d) Other investigative authorities consistent with chapter 74.34 RCW.
(2) The notification will identify the finding as an initial finding.
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(2) The request must be made in writing to the office of administrative hearings.
(3) The office of administrative hearings must receive the alleged perpetrator's written request for a hearing within thirty calendar days of the date the individual was served with notice of the initial finding.
(4) The written request for a hearing must include:
(a) The full legal name, current address and phone number of the alleged perpetrator;
(b) A brief explanation of why the alleged perpetrator disagrees with the initial finding;
(c) A description of any assistance needed in the administrative appeal process by the alleged perpetrator, including a foreign or sign language interpreter or any accommodation for a disability; and
(d) The alleged perpetrator's signature.
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(2) Confidential information such as the name and other personal identifying information of the reporter, witnesses, or the resident will be redacted from documents by the department unless otherwise ordered by the administrative law judge consistent with chapter 74.34 RCW and other applicable state and federal laws.
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(2) If a conflict between the provisions of this chapter and chapter 388-02 WAC, the provisions of this chapter prevail.
(3) The administrative law judge must decide whether a preponderance of the evidence supports the initial finding that the alleged perpetrator abandoned, abused, neglected, exploited, or financially exploited a vulnerable adult, and must issue an initial order.
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(2) If the department appeals the administrative law judge's decision, the department will not change the finding in the department's records until a final hearing decision is issued.
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(a) The department gives the alleged perpetrator notice of the initial finding pursuant to WAC 388-101-1110 and the alleged perpetrator does not ask for an administrative hearing;
(b) The administrative law judge:
(i) Dismisses the hearing following withdrawal of the appeal or default; or
(ii) Issues an initial order upholding the finding and the alleged perpetrator fails to appeal the initial order to the department's board of appeals; or
(c) The board of appeals issues a final order upholding the finding.
(2) The final finding is permanent and will not be removed from the department's records unless:
(a) Rescinded following judicial review; or
(b) The department decides to remove a single finding of neglect from its records based upon a written petition by the alleged perpetrator provided that at least one calendar year has passed since the finding was finalized and recorded.
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(1) The perpetrator;
(2) The provider or entity representative that was associated with the perpetrator during the time of the incident;
(3) The adult family home that is currently associated with the perpetrator, if known;
(4) The appropriate licensing authority; and
(5) The department's list of findings of abandonment, abuse, neglect, exploitation and financial exploitation.
(6) The findings may be disclosed to the public upon request.
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The following sections of the Washington Administrative Code are repealed:
| WAC 388-76-535 | Authority. |
| WAC 388-76-540 | Definitions. |
| WAC 388-76-545 | License required. |
| WAC 388-76-550 | License application. |
| WAC 388-76-555 | License fees. |
| WAC 388-76-560 | License eligibility. |
| WAC 388-76-565 | Resident manager and live-in requirements. |
| WAC 388-76-570 | Additional license requirements--Multiple facility providers. |
| WAC 388-76-575 | Licensing of state employees. |
| WAC 388-76-580 | License capacity. |
| WAC 388-76-585 | Change of provider or provider address. |
| WAC 388-76-590 | Specialty adult family homes. |
| WAC 388-76-59000 | What authority does the department have to adopt rules related to specialty homes? |
| WAC 388-76-59010 | What types of specialty adult family home designations are there? |
| WAC 388-76-59050 | What is required in order to obtain the specialty designation? |
| WAC 388-76-59060 | Are adult family home providers required to obtain more than one specialty designation if an individual resident has more than one specialty need? |
| WAC 388-76-59070 | Are adult family home providers required to obtain more than one specialty designation if they serve two or more residents with different specialty needs? |
| WAC 388-76-59080 | When will providers be required to become specialty adult family homes in order to serve persons with mental illness or dementia? |
| WAC 388-76-59090 | When will providers be required to become specialty adult family homes in order to serve persons with developmental disabilities? |
| WAC 388-76-595 | Inspections and ombudsman visits. |
| WAC 388-76-600 | General resident rights. |
| WAC 388-76-60000 | What are resident rights? |
| WAC 388-76-60010 | Why do providers need to know resident rights? |
| WAC 388-76-60020 | Is the provider required to supply information to potential residents and current residents, or the resident's representative? |
| WAC 388-76-60030 | When must this information be supplied? |
| WAC 388-76-60040 | Must the information be updated and supplied again in advance of changes? |
| WAC 388-76-60050 | What information is the provider required to supply to potential residents and current residents? |
| WAC 388-76-60060 | Do residents have rights that are not listed here? |
| WAC 388-76-60070 | What are some of the other resident rights that must be considered? |
| WAC 388-76-605 | Restraints. |
| WAC 388-76-610 | Resident assessment. |
| WAC 388-76-61000 | Is an assessment needed before a person can be admitted to an adult family home? |
| WAC 388-76-61010 | Under what circumstances can a provider admit or continue services for a person? |
| WAC 388-76-61020 | What must be included in the resident assessment? |
| WAC 388-76-61030 | How does the preliminary service plan fit within the resident assessment? |
| WAC 388-76-61040 | Is the use of an approved form required for the assessment? |
| WAC 388-76-61050 | Who can do the assessment? |
| WAC 388-76-61060 | In emergency situations, can a provider admit a resident without an assessment? |
| WAC 388-76-61070 | Does the assessment have to be updated? |
| WAC 388-76-61080 | Who is qualified to update the assessment? |
| WAC 388-76-615 | Negotiated care plan. |
| WAC 388-76-61500 | What is a negotiated care plan? |
| WAC 388-76-61510 | When must the negotiated care plan be developed? |
| WAC 388-76-61520 | How does the negotiated care plan fit in with the assessment and preliminary service plan? |
| WAC 388-76-61530 | Who must be involved in the development of the negotiated care plan? |
| WAC 388-76-61540 | Who must sign the negotiated care plan? |
| WAC 388-76-61550 | How often must the negotiated care plan be reviewed and revised? |
| WAC 388-76-61560 | When does the department's case manager get a copy of the negotiated care plan? |
| WAC 388-76-61570 | How are payment rate changes authorized for residents receiving services paid for fully or partially by the department? |
| WAC 388-76-620 | Provision of services and care. |
| WAC 388-76-625 | Nurse delegation--Training and registration. |
| WAC 388-76-630 | Performance of delegated nursing care tasks. |
| WAC 388-76-635 | Nurse delegation--Penalties. |
| WAC 388-76-64010 | What are the rules the provider must follow in all situations involving resident medications? |
| WAC 388-76-64015 | What defines the type of help a resident may need when taking their medication? |
| WAC 388-76-64020 | What must the provider include in the negotiated care plan for residents who are independent with self-administration? |
| WAC 388-76-64025 | How do a resident and provider initiate self-administration with assistance? |
| WAC 388-76-64030 | What must the provider monitor when implementing self-administration with assistance? |
| WAC 388-76-64035 | What other situations must the provider monitor when self-administration with assistance occurs for a resident? |
| WAC 388-76-64040 | What must the provider do when there is a need to alter medications during self-administration with assistance? |
| WAC 388-76-64045 | What other types of assistance can a nonpractitioner provide? |
| WAC 388-76-64050 | Who can fill medication organizers and what is required? |
| WAC 388-76-64055 | What documentation is the provider required to include in the resident's daily medication log? |
| WAC 388-76-645 | Resident activities. |
| WAC 388-76-650 | Food services. |
| WAC 388-76-655 | General management and administration. |
| WAC 388-76-660 | Training. |
| WAC 388-76-665 | Resident records. |
| WAC 388-76-670 | Disaster and emergency preparedness. |
| WAC 388-76-675 | Reporting requirements. |
| WAC 388-76-680 | Infection control and communicable disease. |
| WAC 388-76-685 | Criminal history disclosure and background inquiries. |
| WAC 388-76-690 | Advance directives, guardianship, and decision making. |
| WAC 388-76-695 | Protection of resident funds--Liquidation or transfer. |
| WAC 388-76-700 | Resident relocation due to closure. |
| WAC 388-76-705 | Remedies. |
| WAC 388-76-710 | Notice, hearing rights, and effective dates relating to imposition of remedies. |
| WAC 388-76-715 | Dispute resolution. |
| WAC 388-76-720 | Common use areas. |
| WAC 388-76-725 | Bedrooms. |
| WAC 388-76-730 | Toilets and bathing facilities. |
| WAC 388-76-735 | Kitchen facilities. |
| WAC 388-76-740 | Telephones. |
| WAC 388-76-745 | Storage. |
| WAC 388-76-750 | Laundry. |
| WAC 388-76-755 | Local ordinances. |
| WAC 388-76-760 | Site. |
| WAC 388-76-76505 | What physical structure requirements must the provider ensure that the home meets? |
| WAC 388-76-76510 | What are the resident emergency evacuation requirements that providers must address? |
| WAC 388-76-76515 | What fire safety and emergency requirements must the provider have in the home? |
| WAC 388-76-76520 | What is required of the provider for emergency evacuation drills? |
| WAC 388-76-770 | Safety and maintenance. |
| WAC 388-76-775 | Pets. |
| WAC 388-76-780 | Lighting. |
| WAC 388-76-785 | Temperature and ventilation. |
| WAC 388-76-790 | Water supply. |
| WAC 388-76-795 | Sewage and liquid wastes. |