PERMANENT RULES
SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Effective Date of Rule: February 1, 2008.
Purpose: The department is repealing the existing chapter 388-101 WAC, Certified community residential services and support and is adopting new chapter 388-101 WAC, Certified community residential services and support.
The purpose of adopting these rules was 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 certified community residential service 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.
The effective date of this rule is February 1, 2008.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-101-1010, 388-101-1020, 388-101-1101, 388-101-1106, 388-101-1111, 388-101-1116, 388-101-1121, 388-101-1126, 388-101-1131, 388-101-1136, 388-101-1141, 388-101-1146, 388-101-1180, 388-101-1190, 388-101-1200, 388-101-1205, 388-101-1210, 388-101-1220, 388-101-1230, 388-101-1240, 388-101-1250, 388-101-1260, 388-101-1400, 388-101-1410, 388-101-1420, 388-101-1430, 388-101-1440, 388-101-1460, 388-101-1470, 388-101-1480, 388-101-1490, 388-101-1500, 388-101-1510, 388-101-1520, 388-101-1530, 388-101-1540, 388-101-1550, 388-101-1600, 388-101-1610, 388-101-1620, 388-101-1630, 388-101-1640, 388-101-1650, 388-101-1660, 388-101-1670, 388-101-1680, 388-101-1690, 388-101-1700, 388-101-1710, 388-101-1720, 388-101-1730, 388-101-1740, 388-101-1750, 388-101-1760, 388-101-1770, 388-101-1780, 388-101-1790, 388-101-1800, 388-101-1810, 388-101-1820, 388-101-1830, 388-101-1840, 388-101-1850, 388-101-1860, 388-101-1870, 388-101-1880, 388-101-1890, 388-101-1900, 388-101-2000, 388-101-2010, 388-101-2020, 388-101-2030, 388-101-2040, 388-101-2050, 388-101-2060, 388-101-2070, 388-101-2080, 388-101-2090, 388-101-2100, 388-101-2110, 388-101-2120, 388-101-2130, 388-101-2140, 388-101-2150, 388-101-2160, 388-101-2300, 388-101-2330, 388-101-2340, 388-101-2350, 388-101-2360, 388-101-2370, 388-101-2380, 388-101-2400, 388-101-2410, 388-101-2420, 388-101-2430, 388-101-2440, 388-101-2450, 388-101-2460, 388-101-2470, 388-101-2480, 388-101-2490, 388-101-2500, 388-101-2510, 388-101-2520, 388-101-2530, and 388-101-2540.
Statutory Authority for Adoption: Chapter 71A.12 RCW.
Adopted under notice filed as WSR 07-18-094 on September 5, 2007.
Changes Other than Editing from Proposed to Adopted Version: The changes, other than editing changes, follow:
NEW SECTIONS
WAC 388-101-3000 Definitions.
"Group home" means a residence that is licensed as either
a boarding home or an adult family home by the department
under chapters 388-78A or 388-76 WAC. Group homes provide
residential services community residential instruction,
supports, and services to two or more clients who are
unrelated to the provider.
"Qualified professional" means a person with at least
three years' experience working with individuals with
developmental disabilities. and as required by RCW 71A.12.220(12).
"Residential service" means services provided to clients
by a service provider.
"Risk assessment" means an assessment done by a qualified
professional and as required by RCW 71A.12.230. to determine
the likelihood that a community protection program client will
offend or reoffend.
"Service provider" means a person or entity certified by the department who delivers services and supports to meet a client's identified needs. The term includes the state operated living alternative (SOLA) program.
"Supported living" means residential services
instruction, supports, and services provided by service
providers to clients living in homes that are owned, rented,
or leased by the client or their legal representative.
WAC 388-101-3080 The department may deny--Application. The
department may deny the application for initial certification
or change of ownership if any person named in the application:
(1) Has shown a lack of understanding, ability or emotional stability to meet the identified needs of vulnerable adults;
(2) Had a department contract, or certification, or
license withdrawn or denied by the department, or has been
subjected to enforcement actions;
(3) Had a contract, certification, or license withdrawn
or denied or was subjected to enforcement action from in
another state; withdrawn or denied;
(4) Obtained or attempted to obtain a license or certification by fraudulent means or misrepresentation;
(5) Has relinquished or been denied a license or license renewal to operate a home or facility that was licensed for the care of children or vulnerable adults;
(6) Refused to permit authorized department representatives to interview clients or to have access to client records;
(7) Has been convicted of a drug related conviction within the past five years without evidence of rehabilitation; or
(8) Has been convicted of an alcohol related conviction within the past five years without evidence of rehabilitation.
WAC 388-101-3120 Certification--Other. If a service provider
does not comply with the certification requirements, the
department may provisionally certify or decertify a service
provider.
WAC 388-101-3130 Certification evaluation. (1) The department
may conduct an on-site certification evaluation of each
service provider at any time, but at least once every two
years.
(2) During certification evaluations the service provider's administrator or designee must:
(a) Cooperate with department representatives during the on-site visit;
(b) Provide all contractor records, client records, and other relevant information requested by the department representatives;
(c) Ensure the service provider's administrator or designee is available during any visit to respond to questions or issues identified by department representatives; and
(d) Ensure the service provider's administrator or designee is present at the exit conference.
WAC 388-101-3150 State and federal Department access to
program. The service provider must:
(1) Allow any state or federal department or agency to conduct audits, evaluations, or complaint investigations related to this program or to clients served in this program;
(2) Allow department representatives to review a client's records and activities at any time to see if the service provider continues to address the clients' needs for instruction and support activities;
(3) Allow the department representatives' access to clients, the client's legal representative and family members; and
(4) Cooperate with department representatives in the
performance of official duties; and.
(5) Allow access to clients and client records by an advocacy group if the advocacy group has access authority under state or federal law.
WAC 388-101-3200 Staffing requirements. The service provider
must ensure each staff meets the following minimum
requirements:
(1) Have a high school diploma or GED equivalent, unless the employees were hired before September 1, 1991;
(2) Be at least eighteen years of age or older when employed as a direct care staff, or at least twenty-one years of age or older when employed as an administrator;
(3) Have a clear understanding of job responsibilities and knowledge of individual support plans and client needs; and
(4) Passed the department criminal background check as
required by WAC 388-101-3250.; and have no criminal
convictions listed in RCW 43.43.830 or 43.43.842 and no state
or federal findings of abandonment, abuse, neglect or
financial exploitation.
WAC 388-101-3230 Group homes. A service provider who is a
licensed adult family home or boarding home must:
(1) Provide care and services in accordance with this chapter and with licensing requirements under chapters 388-76 and 388-78A WAC respectively;
(2) Comply with client rights requirements in Chapter 70.129 RCW and this chapter;
(23) Comply with the home's licensing requirements if
there is a conflict with requirements in this chapter; and
(34) Comply with this chapter if the requirement is over
and above the home's licensing requirements.
WAC 388-101-3250 Criminal history bBackground checks. (1) The
service provider must obtain criminal history background
checks including, but not limited to background inquiries and
criminal history disclosure from the department for all
administrators, employees, volunteers, and subcontractors who
may have unsupervised access to clients.
(2) The service provider must not allow the following
persons to have unsupervised access to clients until the
service provider receives successful background check results
from the criminal history background check from the
department:
(a) Administrators;
(b) Employees;
(c) Volunteers or students; and
(d) Subcontractors.
(3) Service providers or applicants who have lived in Washington state less than three years or who are otherwise required to complete a fingerprint-based background check may be hired for a one hundred twenty-day provisional period as allowed under law when:
(a) The applicant or service provider is not disqualified based on the initial result of the background check from the department; and
(b) A fingerprint-based background check is pending.
(4) The service provider must notify the person, within
ten days of receiving the result, that he or she may request a
copy of the background check. result within ten days of
receiving the result.
(5) The service provider must renew the background check at least every thirty-six months and keep current department background checks for each administrator, employee, volunteer or subcontractor of a service provider.
(6) Licensed boarding homes or adult family homes must adhere to the current regulations in this chapter and in the applicable licensing laws.
(7) Service providers must follow the requirements of RCW 43.43.830 through 43.43.842 and 74.15.030.
WAC 388-101-3310 Approval of staff-coverage schedules. (1)
The service provider must obtain division of developmental
disabilities approval of schedules to provide twenty-four hour
support, at the following times:
(a) Prior to certification review;
(b) When household configuration changes affect staff coverage; or
(c) When additional staffing is requested or needed by the client.
(2) The service provider must retain copies of the staff
coverage schedules. for a minimum of three months.
WAC 388-101-3320 Client rights. (1) Clients have the same
legal rights and responsibilities guaranteed to all other
individuals by the United States Constitution, federal and
state law unless limited through legal processes.
(2) Service providers must promote and protect all of the
following client rights, including but not limited to:
(a1) The right to be free from discrimination;
(b2) The right to be reasonably accommodated in
accordance with state and federal law; the Americans with
Disabilities Act;
(c3) The right to privacy, including the right to receive
and send private mail and telephone calls;
(d4) The right to participate in an appropriate program
of publicly supported education;
(e5) The right to be free from harm, including
unnecessary physical restraint, isolation, excessive
medication, abuse, neglect, abandonment, and financial
exploitation; and
(f6) The right to refuse health services, medications,
restraints, and restrictions.
(3) For group homes that have a boarding home or adult
family home license, refer to chapter 388-78A or 388-76 WAC
respectively for additional rights.
WAC 388-101-3370 Client health services support. The service
provider must:
(1) Pprovide instruction and/or support as identified in
the individual support plan and as required in this chapter to
assist the client in with:
(a1) Accessing health, mental health, and dental
services; and
(b2) Medication management, administration, and
assistance;.
(23) Maintaining health records;
(34) Assist the client in aArranging appointments with
health professionals;
(45) Monitoring medical treatment prescribed by health
professionals;
(56) Communicatinge directly with health professionals
when needed; and
(67) Ensure that the client rReceivinges an annual
physical and dental examination unless the appropriate medical
professional gives a written exception.
WAC 388-101-3440 Changes in client service needs--Emergent.
(1) The service provider must promptly notify the department
to ask for emergency assistance when a the client's needs
change and the actions or continued presence of the a client
endangers the health, safety and/or personal property of other
clients, the client, those working with the client, or other
public citizens.; and
(2) If further assistance is needed following the department's initial response, the service provider must confirm in writing to the client's case manager on the first working day after initiating a verbal request for such assistance:
(a) The nature of the emergency; and
(b) The need for immediate assistance; and
(c) tThe specific type of assistance needed.
(3) When the emergency cannot be resolved and the service provider wants to terminate services to the client, the service provider must:
(a) Notify the department in writing;
(b) Specify the reasons for terminating services to the client; and
(c) Ensure that the department receives the notice at least seventy-two hours before moving the client from the program.
WAC 388-101-3450 Service provider refusal to serve a client.
Before terminating services to the client, the service
provider must:
(1) The service provider may refuse services to a client when the service provider has determined and documented:
(1) Notify the department in writing ten working days
before termination of services and include:
(a) Why the provider cannot meet the client's needs; or
and
(b) How the provider's refusal to serve the client would be in the best interest of the client or other clients.
(2) Before terminating services to the client, the
service provider must Nnotify the department, the client and
the client's legal representative in writing ten working days
before terminating services.; and
(3) Notify the department immediately if the situation is urgent and the client or other clients are at risk.
WAC 388-101-3470 Development of the individual instruction and
support plan. (1) The service provider must develop and
implement an individual instruction and support plan for each
client that incorporates the department's residential
guidelines in developing instruction and support activities.
(2) In developing the individual instruction and support plan, the service provider must:
(a) Work with the client and select to develop goals
based on the individual support plan that will be worked on
during the implementation of the individual instruction and
support plan for the upcoming year;
(b) Identify how the instruction and/or support activities will be provided to meet the assessed needs of the client as described in the individual support plan;
(c) Ensure that the individual instruction and support plan contains or refers to other applicable support and/or service information; and
(d) Include the participation and agreement of the client and other individuals the client wants included.
(3) The service provider must send a copy of the individual instruction and support plan goals together with a list of applicable support and service information and where the information is located to the case manager for review.
WAC 388-101-3690 Medication refusal. (1) When a client who is
receiving medication support from the service provider chooses
to not take his or her medications, the service provider must:
(a) Respect the client's right to choose not to take the medication(s) including psychoactive medication(s); and
(b) Document the time, date and medication the client did not take.
(2) The service provider must take the appropriate action, including notifying the prescriber or primary care practitioner, when the client chooses to not take his or her medications and the client refusal could cause harm to the client or others.
WAC 388-101-3710 Medication organizers. (1) Service providers
may allow medication organizers maintained by the individual
when the organizers are filled by:
(a) The client;
(b) A licensed pharmacist;
(c) An RN; or
(d) The client's legal representative or a family member.
(2) Service providers providing medication assistance or
administration to a client must ensure assure that the
medication organizers are labeled.
(3) The client, a pharmacist, an RN, or the client's legal representative or family member may label the medication organizer.
(4) When there is a change in medications by the prescriber, the individual filling the medication organizers must replace labels with required updated information immediately.
WAC 388-101-3790 Charging for searching and duplicating
records. (1) The service provider:
(1a) Must not charge the department or the client for any
searching or duplication of records requested or needed; and
(2b) May charge the client's legal representative acting
on behalf of the client for searching and duplication of
records at a cost not to exceed twenty-five cents a page.
(2) The service provider must not charge the client's legal representative acting on behalf of the client for searching and duplication of records if the client is incapable of making the request.
WAC 388-101-3850 Functional assessment. (1) The service
provider must conduct and document a functional assessment
before developing and implementing a client's positive
behavior support plan.
(2) The service provider must start the functional
assessment when the client begins to engage in challenging
behaviors that interfere with the client's ability to have
positive life experiences and form and maintain relationships.
are considered challenging or are of concern.
(3) The service provider must ensure that a client's written functional assessment addresses:
(a) A description of the client and pertinent history;
(b) The client's overall quality of life;
(c) The behaviors that are considered challenging and/or are of concern;
(d) The factors or events which increase the likelihood of challenging behaviors;
(e) When and where the challenging behavior(s) occurs most frequently;
(f) The factors or events which increase the likelihood of appropriate behavior;
(g) An analysis and assessment of the possible functions or purpose the challenging behavior(s) serve for the client including what he or she obtains or avoids by engaging in the behavior(s); and
(h) A concluding summary of the functions or purpose that each challenging behavior serves for the client.
(4) The service provider must include the following sections in the format of each client's written functional assessment:
(a) Description and pertinent history;
(b) Definition of challenging behaviors;
(c) Data analysis/assessment procedures; and
(d) Summary statement(s).
WAC 388-101-3890 Restrictive procedures. (1) The service
provider may:
(a) Only use restrictive procedures for the purpose of protecting the client, others, or property; and
(b) Not use restrictive procedures for the purpose of changing behavior in situations where no need for protection is present.
(12) The service provider must have documentation on the
proposed intervention strategy before implementing restrictive
procedures including:
(a) A description of the behavior(s) that the restrictive procedures address;
(b) A functional assessment of the challenging behavior(s);
(c) The positive behavior support strategies that will be used;
(d) A description of the restrictive procedure that will be used including:
(i) When and how it will be used; and
(ii) Criteria for termination of the procedure; and
(e) A plan to document the use of the procedure and its effect.
(23) The service provider must terminate implementation
of the restrictive procedures as soon as the need for
protection is over.
WAC 388-101-3920 Physical interventions. (1) The service
provider must use the least restrictive intervention needed to
protect each client, others, and property.
(2) The service provider may only use physical interventions with a client when positive or less restrictive techniques have been tried and determined to be insufficient to:
(a) Protect the client;
(b) Protect others; or
(c) Prevent property damage.
(3) The service provider must:
(a) Terminate the intervention for the client as soon as the need for protection is over; and
(b) Only use restrictive physical interventions for the client as part of a positive behavior support plan except:
(i) In an emergency when a client's behavior presents an immediate risk to the health and safety of the client or others, or a threat to property; or
(ii) When an unknown, unpredicted response from a client jeopardizes the client's or others safety.
WAC 388-101-3960 Monitoring physical and mechanical
restraints. (1) The service provider must ensure that monitor
any client who is being physically or mechanically restrained
is continuously observed to ensure that risks to the client's
health and safety are minimized.
(2) The service provider must keep documentation that includes:
(a) A description of events immediately preceding the client's behavior which led to the use of the restraint;
(b) The type of restraint used;
(c) Length of time the client was restrained;
(d) The client's reaction to the restraint;
(e) Staff that were involved; and
(f) Injuries sustained by anyone during the intervention.
WAC 388-101-4030 Community protection--Client transportation.
In addition to the other client transportation requirements
defined in this chapter, community protection service
providers must provide or ensure supervised transportation as
needed, including but not necessarily limited to, medical
emergencies, appointments, to and from the day program site,
and community activities. supervision of the client during
transportation.
WAC 388-101-4150 Mandated reporting to the department.
Service providers, administrators, owners, and staff:
(1) Are mandated reporters and must meet the requirements of chapter 74.34 RCW;
(2) Must make mandated reports to the department's centralized toll free complaint telephone number or FAX number immediately when:
(a) There is reasonable cause to believe that a vulnerable adult, as defined in chapter 74.34 RCW, has been abandoned, abused, neglected, or financially exploited; or
(b) There is a reason to suspect physical or sexual assault.
(3) Must also make written and oral reports to the department as specified in the provider's residential services contract;
(4) Must protect the alleged victim and others from further abuse, neglect, abandonment, and financial exploitation; and
(5) May have their certification and/or contract terminated if they fail to report such incidents.
WAC 388-101-4160 Mandated reporting to law enforcement. The
Sservice providers, administrators, owners, and staff must
immediately report to the appropriate law enforcement agency
if there is reason to suspect that any of the following has
occurred:
(1) Sexual Assault: Any alleged or suspected sexual assault;
(2) Physical Assault (nonclient to client): Any suspected physical assault as well as any act that causes fear of imminent harm; and
(3) Physical Assault (client to client): Any suspected physical assault that causes bodily injury requiring more than first aid, or in the event of:
(a) Injuries that appear on the back, face, head, neck, chest, breasts, groin, inner thigh, buttock, genital, or anal area;
(b) Fractures;
(c) Choking attempts;
(d) Patterns of physical assault between the same vulnerable adults or involving the same vulnerable adults;
(e) A reasonable cause to believe that an act has caused fear of imminent harm; and
(f) Any incident, regardless of injury, if requested by the client, his/her legal representative, or family member.
WAC 388-101-4180 Investigation of reports. (1) The department
will determine whether a report of client abandonment, abuse,
neglect, or financial exploitation needs to be investigated.
(2) The department investigation will include an investigation of allegations about one or more of the following:
(a) A service provider;
(b) Anyone associated with a service provider; or
(c) A client receiving services under this chapter.
(3) If, after completing an investigation under this chapter, the department concludes that it is more likely than not that the alleged perpetrator abandoned, abused, neglected, or financially exploited a client, the department will make a preliminary finding against the perpetrator, as defined in WAC 388-101-4270 through 388-101-4340.
WAC 388-101-4265 Investigation of reports. (1) The department
may investigate allegations of abandonment, abuse, neglect, or
financial exploitation of a client.
(2) The department investigation may include an investigation of allegations about one or more of the following:
(a) A service provider;
(b) Anyone associated with a service provider; or
(c) A client receiving services under this chapter.
WAC 388-101-4270 Notice of preliminary finding. The
department will:
(1) The department will Nnotify the alleged perpetrator
in writing within ten working days of making a preliminary
finding of abandonment, abuse, neglect or financial
exploitation of a client. The written notice:
(a) wWill not include the identities of the alleged
victim, reporter and witnesses; and
(b) Will include the necessary information for the alleged perpetrator to ask for an administrative hearing to challenge the preliminary finding.
(2) The department must Mmake a reasonable, good faith
effort to determine the last known address of the alleged
perpetrator.; and
(3) The department will Sserve notice of the preliminary
finding as provided in chapter 388-02 WAC.
(4) The department may extend the time frame for written
notification beyond ten working days for good cause. to
include the time needed to translate the notification letter
or make provisions for the safety of the alleged victim.
WAC 388-101-4280 Reporting preliminary findings. (1) In a
manner consistent with confidentiality requirements concerning
the client, witnesses, and reporter, the department may
provide notification of a preliminary finding to:
(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 or contractor;
(c) The employer or program that is currently associated with the individual alleged to have abandoned, abused, neglected, or financially exploited a client, if known;
(cd) Law enforcement; and
(de) Other investigative authorities consistent with
chapter 74.34 RCW.
(2) The notification will identify the finding as a preliminary finding.
WAC 388-101-4290 Disputing a preliminary finding. (1) An
alleged perpetrator of abandonment, abuse, neglect, or
financial exploitation of a client may request an
administrative hearing to challenge a preliminary finding made
by the department.
(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 written on the individual was
served with the notice of the preliminary 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 preliminary finding;
(c) A description of any assistance needed in the administrative appeal process by the alleged perpetrator, including a foreign language or sign language interpreter or any reasonable accommodation for a disability; and
(d) The alleged perpetrator's signature.
WAC 388-101-4300 Disclosure of investigative and finding
information. (1) Confidential information about clients and
mandated reporters received from provided by the department
may only be used by to the alleged perpetrator may only be
used to challenge preliminary findings through the appeal
process.
(2) Confidential information such as the name and other
personal identifying information of the reporter, witnesses,
or the client will be redacted from documents unless release
of that information is otherwise ordered by the administrative
law judge consistent with chapter 74.34 RCW and other
applicable state and federal laws.
WAC 388-101-4340 Reporting final findings. (1) The department
will report a final finding of abandonment, abuse, neglect and
financial exploitation within ten working days to the
following:
(a) The perpetrator;
(b) The service provider that was associated with the perpetrator during the time of the incident;
(c) The service provider that is currently associated with the perpetrator, if known;
(d) The appropriate licensing, contracting, or certification authority; and
(e) The federal or state department's or agency list of
findings of individuals found to have abandoned,ment, abused,
neglected, or and financially exploitedation. a vulnerable
adult.
(2) The findings may be disclosed to the public upon request subject to applicable public disclosure laws.
| SUMMARY OF COMMENTS RECEIVED | THE DEPARTMENT CONSIDERED ALL THE COMMENTS. THE ACTIONS TAKEN IN RESPONSE TO THE COMMENTS, OR THE REASONS NO ACTIONS WERE TAKEN, FOLLOW. |
| WAC 388-101-3000 Definitions. | |
| (1) Delete the term "qualified professional" because it is never used in the chapter. | (1) No change was made in response to this comment. The term "qualified professional" was used twice, once in the definition of "risk assessment" and once in WAC 388-101-4010. |
| (2) The definition for "qualified professional" is too broad and is not consistent with statutory guidance in RCW 71A.12.220(12). This definition would allow any person with three years experience working with people with developmental disabilities to evaluate potential community protection clients. The proposed rules definition does not include any requirement that the person have any specialized knowledge, training, expertise, or credentials as required by the statute. | (2) A change was made in response to this comment. The definition of "qualified professional" was changed to clarify that the requirements of RCW 71A.12.220(12) apply. |
| (3) The definition of "risk assessment" in the proposed rules does not reflect or include the statutory requirements found in RCW 71A.12.230. The proposed definition focuses on the client's risk of reoffending but the statute requires that the risk assessment contain a determination by the qualified professional whether a person can be managed successfully in the community with reasonably available safeguards and that lesser restrictive residential placement alternatives have been considered and would not be reasonable for the person seeking services. The definition of "risk assessment" should be changed to conform to the governing statute. | (3) A change was made in response to this comment. The definition of "risk assessment" was changed to clarify that the assessment meets the requirements of RCW 71A.12.230. |
| (4) The definition for "residential service" is too broad. | (4) Changes were made in response to this comment. In response to a review of the definitions referred to, it was found that the term "residential services" was used in two definitions. For clarity, the term "residential services" has been deleted. In addition, we have clarified the definitions for "group home" and "supported living" to be consistent with terms used within the chapter. |
| WAC 388-101-3080 The department may deny--Application. | |
| (1) In subsection (1), who determines if a potential provider "has shown a lack of understanding, ability or emotional stability" and on what basis is the determination made? Clarify or remove this subsection. | (1) and (3) No changes were made in response to these comments. The department's processes for applications include a review of all information received in order to make an informed decision about whether or not to certify the applicant. Chapter 43.43 RCW directs the department to assess an applicant's background and history to determine the applicant's ability to meet the needs of vulnerable adults. |
| (2) Amend subsection (3) to give DSHS discretion to deny certification for applicants who have been subjected to intermediate enforcement actions by other states. This change would achieve consistency with subsection (3). | (2) Changes were made in response to this comment. Subsections (2) and (3) were clarified to provide consistency in the information the department considers for in state and out of state applicants for certification. |
| (3) In subsections (7) and (8), what is considered "evidence of rehabilitation"? Clarify or remove these subsections. | (3) See the response under (1) above. |
| WAC 388-101-3120 Certification--Other. | |
| (1) This section is a repeat of WAC 388-101-3110(2) and should be removed. | (1) A change was made in response to this comment. This section was duplicative of WAC 388-101-3110(2) and was deleted. |
| WAC 388-101-3130 Certification evaluation. | |
| (1) The term "all records" in subsection (2)(b) needs to be clarified. As written, it exposes providers to voluminous requests for irrelevant information. Clarify by specifying "relevant" or "necessary" records. | (1) A change was made in response to this comment. The department changed subsection (2)(b) to clarify that contractor records, client records, and other relevant information be available to department representatives during certification evaluations. The change provided greater consistency with requirements found in the community residential services contract. |
| WAC 388-101-3150 Department access to program. | |
| (1) Amend the section title to reflect the content of the proposed rule. The rule provides access authority for state and federal agencies which is broader than the "department." | (1) A change was made in response to this comment. The department amended the title of this section to more accurately and clearly reflect the content of the proposed rule. |
| The rule should also be expanded to reference the federal authority of Disability Rights of Washington to have program and client access. | A subsection was added to clarify that any advocacy group must be given access to clients and client records if the advocacy group has state or federal authority for that access. |
| WAC 388-101-3160 Plan of correction. | |
| (1) Two comments both stated that a plan of correction should not be required until after the resolution of any dispute regarding evaluation findings. | (1) No changes were made in response to this comment. Under the department's current certification evaluation process, providers must complete a plan of correction for all findings on the final day of the on-site evaluation. |
| WAC 388-101-3170 Group training home. | |
| (1) Why is this section limited only to nonprofit providers? This could exclude for-profit providers from receiving contracts. It is a potential loss of revenue for providers. The requirement should be removed. | (1) No changes were made in response to this comment. RCW 71A.22.020(2) specifies that group training homes must be nonprofit. |
| WAC 388-101-3190 Service provider responsibilities. | |
| (1) The individual support plan (ISP) is not functioning as directed in WAC. Providers might have to provide more supports than intended by the division of developmental disabilities (DDD) or the supports intensity scale assessment. Thousands of hours could be added to clients who might not want the services identified in the ISP. (This comment included no specific recommendation.) | (1) No changes were made in response to this comment. The proposed rule is consistent with current WAC 388-101-1870 which states that the individual service plan or plan of care (now called the "individual support plan"): 1) outlines the support needs and interests of the client; and 2) identifies the service provider responsibilities to support the client. The proposed rule clarified the intent of the existing regulation and is consistent with the DDD assessment implemented in July 2007. |
| WAC 388-101-3200 Staffing requirements. | |
| (1) Two comments requested that this section be amended to allow provisional hires as allowed in proposed WAC 388-101-3250. This proposed rule would have a negative fiscal impact on providers already plagued by high staff turnover. | (1) A change was made in response to this comment. The change clarified that background checks must occur in accordance with WAC 388-101-3250 which spelled out specific background check requirements and delineated when an applicant may be hired provisionally. This change was consistent with current WAC and with chapter 43.43 RCW. |
| WAC 388-101-3240 Policies and procedures. | |
| (1) A substantive policy cannot be developed describing how to protect clients when there have been allegations of abandonment (subsection (1)(d)). The requirement to protect clients under WAC 388-101-4150 is sufficient. | (1) No change was made in response to this comment. The proposed rule was consistent with the provider's obligation to protect each client's health and safety. It was also consistent with the current community residential services contract requirements found in attached DDD Policy 6.12, Residential Reporting Requirements Including Abuse/Neglect Reporting. |
| (2) It is not necessary to have a blanket policy for monitoring clients who are self-medicating. It's not clear how a provider is expected to monitor clients who take their own medication. It will have a fiscal impact because DDD does not include this activity in the provider's payment rate. Clarify or delete this requirement. | (2) No change was made in response to this comment. This requirement was taken directly from DDD Policy 6.19, Residential Medication Management, currently attached to the community residential services contract. |
| (3) This rule should require providers to have policies and train staff about their obligations to document incidents that they must report to DDD. This is necessary so DDD can obtain incident reports for quality assurance programs required under the Allen settlement and coordinate changes to services that may be necessary to protect the client from further abuse or neglect. | (3) No change was made in response to this comment. The community residential services contract by attached DDD Policy 6.12, Residential Reporting Requirements Including Abuse/Neglect Reporting, requires providers to have written policies and procedures for reporting incidents to DDD. |
| WAC 388-101-3250 Criminal history background checks. | |
| (1) Staffing and background check requirements should go beyond criminal history to include findings of abandonment, abuse, neglect, or financial exploitation. | (1) Changes were made in response to this comment. To clarify that background checks included more than criminal history, the title was changed to "Background check." Terminology within the section was revised as needed to reflect that findings of abandonment, abuse, neglect, or financial exploitation are part of the department's background check process. |
| (2) Remove volunteers from subsection (1) of this section. Some volunteers do not have client contact. Volunteers are correctly covered under the requirements of subsection (2). | (2) A change was made in response to this comment. To be consistent with current WAC and Chapter 43.43 RCW, the change clarified that volunteers who will have unsupervised access to clients must have background checks. |
| WAC 388-101-3270 Staff training before working alone with clients. | |
| (1) Staff should receive training on client rights before working alone with clients. This should include the right to be free from unnecessary physical restraint, isolation, excessive medication, abuse, neglect, abandonment, and financial exploitation. WAC 388-101-3280 is not sufficient to protect client safety. Before working alone with clients, staff should be trained on policies related to responding to emergencies; protecting clients from abuse; and reporting to DDD, RCS, and APS. | (1) No changes were made in response to this
comment. WAC 388-101-3320 requires service
providers to promote and protect all client rights at all
times. WAC 388-101-3260(3) requires that service
providers provide staff training sooner than required
by WAC if it is necessary to meet the client's identified
needs, and to meet state and federal laws regarding
training. This section does require service providers to train staff on emergency procedures and reporting requirements before working alone with clients. |
| WAC 388-101-3310 Approval of staff-coverage schedules. | |
| (1) Why keep copies of schedules for three months (as required in subsection (2))? | (1) A change was made in response to this comment. To be consistent with current WAC, the department deleted the three month time frame requirement. The service provider may need to keep copies of the schedule for other purposes. |
| WAC 388-101-3320 Client rights. | |
| (1) The subsection (2) requirement to promote and
protect clients is a great idea but is simply not practical
to require this level of responsibility. (2) How far is an agency expected to go to "protect all of the following client rights, including but not limited to..."? This rule has the potential for legal fees and countless hours of staff support to fight any perceived violation of a client's rights. Remove the requirement to "protect" and clarify the subsection. |
(1) and (2) No changes were made in response to these comments. Current law, under RCW 71A.10.030 and [71A.10].040 requires that a client be protected from discrimination and not deprived of any civil rights. Service providers must comply with state and federal laws to the extent that they are involved with the client. Service providers are not responsible for the behavior and actions of outside entities or businesses. |
| (3) It is demeaning and unnecessary to list specific rights of developmentally disabled citizens as it infers their rights are different. Delete subsection (2). | (3) No changes were made in response to this comment. The list provided examples of typical rights granted by current state and/or federal law that must be followed. |
| (4) Subsection (3) may wrongly imply that only adult family home and boarding home residents have the "additional rights" that are referenced. To avoid confusion and unequal protection of group home residents, the rule should eliminate reference to "additional rights" and include all the rights listed in those regulations or state that the additional rights apply to all group home residents receiving services from service providers. | (4) A change was made in response to this comment. In order to clarify, the department deleted subsection (3) because adult family home and boarding home requirements were already covered under proposed WAC 388-101-3230. |
| (5) One comment suggested that this rule should
advise providers of additional client rights related to
personal choices; activities, food, and personal
appearance; privacy and visitations; participation in
community activities; access to services from the long
term care ombudsman and DRW; and the exercise of
rights without interference, coercion, or reprisal. The comment said if these rights are not listed in rule, providers and clients may not be aware that they exist. |
(5) No changes were made in response to these comments. The residential guidelines developed by DDD include quality of life elements such as personal choices, activities, personal appearance, relationships with family and friends, and participation in community activities. WAC 388-101-3470 requires service providers to use the residential guidelines in developing instruction and support activities for each client in their individual instruction and support plan. |
| (6) This rule should require the provider to regularly inform clients of their rights and the processes for enforcing them as many DDD clients may have no other means of learning about their rights. | (6) No changes were made in response to this comment. The individual instruction and support plan, which incorporate the residential guidelines, must be reviewed at least semi-annually and include documentation of the client's agreement to the plan. |
| (7) The proposed rule provides for the right to be reasonably accommodated in accordance with the Americans with Disabilities Act. The rule should be amended to also require reasonable accommodations in accordance with all state and federal laws, including but not limited to, the Rehabilitation Act, the Washington Law Against Discrimination, and the Fair Housing Act. | (7) A change was made in response to this comment. The department clarified subsection (2)(b) to specify that the reasonable accommodation be done in accordance with state and federal law. |
| WAC 388-101-3370 Client health services support. | |
| (1) As written, subsections (2) through (6) would be required for all clients regardless of need. Unnecessary support could be provided to clients not needing help with some activities. Attach these subsections to subsection (1) which link instruction and support to needs identified in the ISP. | (1) Changes were made to this section in response to the comment. The department changed language in the section to clarify that the service provider must provide health services instruction and support to the client as identified in the individual support plan and as otherwise required in this chapter. |
| WAC 388-101-3380 Client transportation. | |
| (1) The potential need to charge a client for transportation costs is not addressed by the ISP. Providers would have to provide unlimited transportation without reimbursement. This requirement should be clarified or removed. | (1) No changes were made in response to this comment. The language in this section clarified the ways that client transportation can be paid for. Under the WAC section, service providers would not be required to provide unlimited client transportation without reimbursement. |
| WAC 388-101-3390 Physical and safety requirements. | |
| (1) The tasks listed in subsections (2) through (5) are not specifically addressed in the ISP. Providers would have to increase hours of support to clients independent in the addressed activities. Clarify or remove the requirement. | (1) No changes were made in response to this comment. Service providers are currently required to ensure that the physical and safety requirements specified in this section are met for each client, unless the individual support plan says the client is capable of meeting their own physical and safety needs and no support is needed. The client always has the right to refuse services. |
| WAC 388-101-3420 Client refusal to participate in services. | |
| (1) If a client is refusing to participate in services, providers should be required to attempt and document attempts to find and offer alternative services that would be acceptable to the client so that clients do not unnecessarily forego services to ensure their health and welfare. | (1) No changes were made in response to this comment. The proposed rule incorporated the requirements of current WAC 388-101-1400 which required providers to notify the case manager if a client's refusal of service if the refusal adversely affects the client's health and safety. Providers must also document their efforts to give or acquire services for the client. Proposed WAC 388-101-3430 further required providers to notify the department when the client's service needs change and the current support plan does not address the client's needs. |
| WAC 388-101-3450 Service provider refusal to serve a client. | |
| (1) The language in this section does not provide adequate protection for DDD or its clients. Subsection (1) should be amended to read, "Except as provided in subsection (3) of this rule, the department will not authorize termination of client services unless the department receives written notice from the service provider 10 working days prior to the proposed termination date and the department determines that such notice demonstrates a) the provider cannot meet the client's needs; and b) the refusal to serve the client would be in the best interest of the client or other clients." | (1) and (2) Changes were made in response to these comments. The department made clarifying changes to this section and WAC 388-101-3440 in order to be consistent with the requirements found in the current community residential services contract. The changes incorporated current community residential services contract requirements for notification, process, and documentation that must occur before terminating client services. |
| (2) More protections should be in place to prevent service providers from terminating services to clients. | |
| (3) To clearly protect the department and clients from unwarranted immediate terminations, subsection (3) should be amended to state: "Service providers must immediately notify the department of urgent situations in which the health and safety of the client or other clients are at immediate risk. The department will only authorize immediate terminations of services in these situations if the department determines that the service provider is unable to ensure the immediate health and safety of the client or other clients and the department can provide an alternative community placement that will ensure the health and safety of the client whose services are being terminated." | (3) No changes were made in response to this comment. WAC 388-101-3440(1) requires providers to promptly notify the department to ask for emergency assistance when a client's actions or continued presence causes a health or safety danger. The purpose of these rules is to specify requirements that service providers must follow. The intent is not to define department processes. |
| (4) What if the reason for a provider terminating services is not in the client's best interest but because the client refuses to allow health or safety supports? The rule should include more than the two options given as reasons for terminating services. | (4) No change was made in response to this comment. Termination of client services involves case management processes. The service provider must meet the requirements in the community residential services contract. The proposed rule is consistent with and reflects the requirements found in that contract. |
| WAC 388-101-3460 Individual support plan. | |
| (1) The term in this section is very close to the term "individual instruction and support plan." Change it to "individual client support guidelines." | (1) No change was made in response to this comment. "Individual support plan" is the term used in Chapter 388-828 WAC, The division of developmental disabilities (DDD) assessment. |
| WAC 388-101-3470 Development of the individual instruction and support plan. | |
| (1) The ISP does not refer to goals. Clarify or remove. | (1) A change was made in response to this comment. The department clarified subsection (2)(a) to include that individual instruction and support plan goals are developed based on the information and needs identified in the individual support plan. |
| (2) The term in this section is very close to the term "individual support plan." Change in some way to make clearer and less confusing. | (2) No change was made in response to this comment. The term "individual instruction and support plan" is the term used in current WAC and DDD policies. The term has been known to and used by service providers and the department for numerous years. |
| WAC 388-101-3480 Documentation of the individual instruction and support plan. | |
| (1) What does subsection (2) mean? Required support? Needs to be more specific. | (1) No change was made in response to this comment. Subsection (2) gives service providers flexibility in the organization of individual instruction and support plan goals and information as long as those documents are available to authorized persons when needed. All goals and information do not have to be kept in a single document. |
| WAC 388-101-3510 Ongoing updating of the individual instruction and support plan. | |
| (1) The ISP does not refer to goals as indicated in subsection (2). Clarify or remove. | (1) No change was made in response to this comment. Goals have always been a part of the individual instruction and support plan. The individual support plan provided information on the client's assessed needs from which goals are to be developed with the client. |
| WAC 388-101-3530 Individual financial plan. | |
| (1) The ISP does not indicate what portion of client funds necessary to support as referenced in subsection (1)(c). Clarify or remove. | (1) No change was made in response to this comment. The proposed rule was consistent with requirements existing in current rule. Subsection (1)(c) does not require that the individual support plan identify the specific portion of client funds where support is needed. Subsection (3) does require the individual financial plan to specify what client funds and income will be managed by the provider and which will be managed by the client and the client's legal representative. |
| WAC 388-101-3540 Managing client funds. | |
| (1) Two comments said listing staff names in the client record as required by subsection (8) is impractical. Having staff sign as needed is more reasonable. Clarify or remove. | (1) No changes were made in response to these comments. The proposed rule reflected no substantive change from current rules governing service provider management of client funds that have been in place for a number of years. |
| WAC 388-101-3690 Medication refusal. | |
| (1) Two comments stated this is not practical for every missed medication. Documentation through incident reports has been successful. Eliminate this requirement. | (1) No changes were made in response to these comments. The proposed rule did not require the service provider to report every missed medication to the prescriber. It required the service provider to take appropriate action which may include notifying the prescriber or practitioner when the client's refusal to take medication could cause harm to the client or others. |
| WAC 388-101-3700 Storage of medications. | |
| (1) It is not reasonable to monitor medication location if clients take their own medications. Remove this requirement. | (1) No change was made in response to this comment. The proposed language came directly from DDD Policy 6.19, Residential Medication Management attached to the current community residential services contract. |
| WAC 388-101-3710 Medication organizers and 388-101-3720 Medications--Documentation. | |
| (1) It is unreasonable to ask a provider to assure medication organizers are labeled when they are managed by either the client or family member. Delete this requirement. | (1) A change was made in response to this comment. The department clarified this language to be consistent with the current community residential services contract and attached DDD Policy 6.19, Residential Medication Management. |
| WAC 388-101-3750 Psychoactive medication treatment plan. | |
| (1) The proposed rules do not clearly advise providers of clients' rights to refuse psychotropic medications. | (1) A change was made in response to this comment. The department clarified WAC 388-101-3690 to indicate that the client's right to refuse medication included the right to refuse psychoactive medications. |
| WAC 388-101-3780 Confidentiality of client records. | |
| (1) The requirement in subsection (1)(c) could be costly to providers. There is no limit to what a client, family member, or the department may request. Add a reasonable limit and specify it only applies to relevant information. | (1) No change was made in response to this comment. Current WAC 388-101-1730 required service providers to make copies of client records available to the department, the client, and/or legal representative upon their request. |
| WAC 388-101-3790 Charging for searching and duplicating. | |
| (1) This section discriminates against clients who are incapable of requesting their own records and who must rely on a guardian or attorney to request records on the client's behalf. | (1) A change was made in response to this comment. The change clarified that the service provider may not charge the client's legal representative for copying records if the representative is acting on behalf of a client incapable of making such a request. |
| WAC 388-101-3810 Contents of client records. | |
| (1) Please clarify the WAC to make sure that the provider has copies of legal guardianship papers, regardless of who provides the document. | (1) No change was made in response to this comment. The case management program has always had the responsibility for giving copies of legal guardianship papers to the service provider. |
| WAC 388-101-3850 Functional assessment. | |
| (1) The requirement for beginning a functional assessment under subsection (2) is too soon. The standard should be when behaviors "are currently interfering with the client's ability to have positive life experiences." | (1) A change was made in response to this comment. Clarifying language was added to be consistent with functional assessment requirements found in the community residential services contract and attached DDD Policy 5.14, Positive Behavior Support. |
| WAC 388-101-3920 Physical interventions. | |
| (1) Subsection (3)(b)(i) to include additional language to allow physical interventions in emergencies "only if absolutely necessary to protect the client or others from injury." This change would be consistent with federal requirements for ICF/MR facilities. | (1) A change was made in response to this comment. Clarifying language from DDD Policy 5.15 was added to say that emergency restrictive procedures may be used when a client's behavior presents an immediate risk to the health and safety of the client or others, or a threat to property. Clarifying language was also added to WAC 388-101-3890 stating that restrictive procedures may only be used for purposes of protecting clients, others, and property. These changes were consistent with the requirements of the community residential services contract and attached DDD Policy 5.15, Use of Restrictive Procedures. |
| WAC 388-101-3960 Monitoring physical and mechanical restraints. | |
| (1) When using physical or mechanical restraints, providers should be required to document checks on the client at least every thirty minutes and to allow clients the opportunity for motion and exercise for at least ten minutes every two hours. | (1) A change was made in response to this comment. The change clarified that the service provider must ensure that any client in restraints is continuously observed. The clarifying language was consistent with DDD Policy 5.15, Use of Restrictive Procedures. |
| WAC 388-101-4150 Mandated reporting to the department. | |
| (1) Subsection (4) should require documentation of what steps the provider took to protect and examples of protective measures that must be taken to protect the client from abuse, neglect, and exploitation. | (1) No changes were made in response to this comment. This proposed rule was consistent with the current residential services contract requirements and attached DDD Policy 6.12, Residential Reporting Requirements Including Abuse/Neglect Reporting. |
| (2) Providers should be required to conduct their own internal investigation of alleged abuse or neglect to ensure the health and welfare of clients. Add that provider investigations should not interfere with, substitute for, or be relied upon by external state investigations. | (2) No changes were made in response to this comment. Proposed WAC 388-101-4150(4) required providers to protect the alleged victim and others. Proposed WAC 388-101-3240 required service providers to develop, implement, and train staff on policies and procedures related to protecting clients when there's been an allegation of abuse, neglect, financial exploitation, or abandonment. In order to meet their obligation to protect, providers would need to gather sufficient information to allow them to meet their obligation to protect clients. WAC 388-101-3150 required service providers to allow the department to conduct program related audits, evaluations, or complaint investigations; and to cooperate with department representatives in the performance of official duties. |
| WAC 388-101-4180 Investigation of mandated reports. | The specific responses to the comments are found in (1) and (2) below. After review and analysis, the department determined to move the pertinent parts of the language to a new section WAC 388-101-4265 where it is placed more appropriately under the Abuse-neglect finding - Individual. |
| (1) This section should be amended to include guidelines for determining whether a complaint should be investigated. | (1) A change was made in response to this comment. The department determined that this subsection referred to department processes which do not belong in WAC, therefore, the subsection was deleted. |
| (2) The proposed rule limits investigations to allegations about service providers, individuals associated with a service provider, and clients receiving services under this chapter. It should be amended to clarify that the department has authority to investigate all allegations involving any client receiving services from a certified provider but that the procedures in WAC 388-101-4270 through 388-101-4340 apply to allegations against the provider, anyone associated with the provider or another client. | (2) No change was made in response to this comment. This chapter applies only to the certified community residential service and support program and those associated with the program. Other areas of the department would investigate other allegations. |
| WAC 388-101-4030 Community protection--Client transportation. | |
| (1) A blanket requirement that all transportation be supervised infringes on the rights of participants to live in the least restrictive setting possible and their right to reduce current restrictions over time. | (1) A change was made in response to this comment. The change was consistent with the current community residential services contract and attached DDD Policy 15.04, Community Protection Intensive Supported Living Services. The department clarified that the provider must ensure or provide transportation supervision as needed by the CPP client. |
| WAC 388-101-3990 Community
protection--Treatment team meetings, 388-101-4010
Community protection--Written individual plan,
388-101-4050 Community protection--Reducing a
client's restrictions, and 388-101-4060 Community
protection--Leaving the program against treatment
team advice. Comments were made about the above proposed sections that included recommendations regarding rules governing the community protection program. |
No changes were made in response to these
comments. The purpose of these rules is to clarify the requirements that certified community residential services and support providers are responsible to follow. It is not within the scope of these rules to define the standards and requirements of the community protection program. Comments and recommendations regarding these sections have been forwarded to the appropriate Division of Developmental Disabilities program staff for review and consideration. |
| No mention of appeal rights for CPP clients. The proposed WAC includes no reference to the administrative appeal rights for CPP clients and no mention of the process for providing notice and a forum for the CPP clients to exercise these rights. | No change was made in response to this comment. This comment pertains to rules governing the community protection program and has been forwarded to appropriate Division of Developmental Disabilities program staff for review and consideration. |
| No mention of the availability of attorneys for CPP clients. The department should promulgate rules which ensure that CPP clients are informed of the availability of attorneys at critical times where their rights may be in jeopardy. | No change was made in response to this comment. This comment pertains to rules governing the community protection program and has been forwarded to appropriate Division of Developmental Disabilities program staff for review and consideration. |
A final cost-benefit analysis is available by contacting John Gaskell, P.O. Box 45600, Olympia, WA 98504-5600, phone (360) 725-3210, fax (360) 438-7903, e-mail gaskejw@dshs.wa.gov. The cost-benefit analysis was not changed.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 136, Amended 0, Repealed 107.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 136, Amended 0, Repealed 107.
Date Adopted: December 21, 2007.
Robin Arnold-Williams
Secretary
3914.8DEFINITIONS"Abuse" means:
(1) The willful action or inaction that inflicts injury, unreasonable confinement, intimidation, or punishment of 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 it is consensual.
(b) "Physical abuse" means the willful action of inflicting bodily injury or physical mistreatment. Physical abuse includes, but is not limited to, striking with or without an object, slapping, pinching, choking, kicking, shoving, prodding, or the use of chemical restraints or physical restraints unless the restraints are consistent with licensing and certification 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, 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.
"Case manager" means the division of developmental disabilities case resource manager or social worker assigned to a client.
"Certification" means a process used by the department to determine if an applicant or service provider complies with the requirements of this chapter and is eligible to provide certified community residential services and support to clients.
"Chaperone agreement" means a plan or agreement that describes who will supervise a community protection program client when service provider staff is not present. This plan or agreement is negotiated with other agencies and individuals who support the client, including the client's legal representative and family.
"Chemical restraint" means the use of psychoactive medications for discipline or convenience and not prescribed to treat the client's medical symptoms.
"Client" means a person who has a developmental disability as defined in RCW 71A.10.020(3) and who also has been determined eligible to receive services by the division of developmental disabilities under chapter 71A.16 RCW. For purposes of informed consent and decision making requirements, the term "client" includes the client's legal representative to the extent of the representative's legal authority.
"Client services" means instruction and support services that service providers are responsible to provide as identified in the client's individual support plan.
"Crisis diversion" means temporary crisis residential services and supports provided to clients at risk of psychiatric hospitalization and authorized by the division of developmental disabilities.
"Crisis diversion bed services" means crisis diversion that is provided in a residence maintained by the service provider.
"Crisis diversion support services" means crisis diversion that is provided in the client's own home.
"Department" means the Washington state department of social and health services.
"Financial exploitation" means the illegal or improper use of the property, income, resources, or trust funds of the vulnerable adult by any person for any person's profit or advantage other than the vulnerable adult's profit or advantage.
"Functional assessment" means a comprehensive evaluation of a client's challenging behavior(s). This evaluation is the basis for developing a positive behavior support plan.
"Group home" means a residence that is licensed as either a boarding home or an adult family home by the department under chapters 388-78A or 388-76 WAC. Group homes provide community residential instruction, supports, and services to two or more clients who are unrelated to the provider.
"Group training home" means a certified nonprofit residential facility that provides full-time care, treatment, training, and maintenance for clients, as defined under RCW 71A.22.020(2).
"Immediate" or "Immediately" means within twenty-four hours for purposes of reporting abandonment, abuse, neglect, or financial exploitation of a vulnerable adult.
"Individual financial plan" means a plan describing how a client's funds will be managed when the service provider is responsible for managing any or all of the client's funds.
"Individual instruction and support plan" means a plan developed by the service provider and the client. The individual instruction and support plan:
(1) Uses the information and assessed needs documented in the individual support plan to identify areas the client would like to develop;
(2) Includes client goals for instruction and support that will be formally documented during the year; and
(3) Must contain or refer to other applicable support or service information that describes how the client's health and welfare needs are to be met (e.g. individual financial plan, positive behavior support plan, cross system crisis plan, individual support plan, individual written plan, client-specific instructions).
"Individual support plan" means a document that authorizes and identifies the division of developmental disabilities paid services to meet a client's assessed needs.
"Instruction" means goal oriented teaching that is designed for acquiring and enhancing skills.
"Legal representative" means a person's legal guardian, a person's limited guardian when the subject matter is within the scope of the limited guardianship, a person's attorney at law, a person's attorney in fact, or any other person who is authorized by law to act for another person.
"Managing client funds" means that the service provider:
(1) Has signing authority for the client;
(2) Disperses the client's funds; or
(3) Limits the client's access to funds by not allowing funds to be spent.
"Mechanical restraint" means a device or object, which the client cannot remove, applied to the client's body that restricts his/her free movement.
"Medication administration" means the direct application of a prescribed medication whether by injection, inhalation, ingestion, or other means, to the body of the client by an individual legally authorized to do so.
"Medication assistance" means assistance with self-administration of medication rendered by a non-practitioner to a client receiving certified community residential services and supports in accordance with chapter 69.41 RCW and chapter 246-888 WAC.
"Medication service" means any service provided by a certified community residential services and support provider related to medication administration or medication assistance provided through nurse delegation and medication assistance.
"Neglect" means:
(1) A pattern of conduct or inaction by a person or entity with a duty of 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.42.100.
"Physical intervention" means the use of a manual technique intended to interrupt or stop a behavior from occurring. This includes using physical restraint to release or escape from a dangerous or potentially dangerous situation.
"Physical restraint" means physically holding or restraining all or part of a client's body in a way that restricts the client's free movement. This does not include briefly holding, without undue force, a client in order to calm him/her, or holding a client's hand to escort the client safely from one area to another.
"Psychoactive" means possessing the ability to alter mood, anxiety level, behavior, cognitive processes, or mental tension, usually applied to pharmacological agents.
"Psychoactive medications" means medications prescribed to improve or stabilize mood, mental status or behavior. Psychoactive medications include anti-psychotics/neuroleptics, atypical anti-psychotics, antidepressants, stimulants, sedatives/hypnotics, and anti-mania and anti-anxiety drugs.
"Qualified professional" means a person with at least three years' experience working with individuals with developmental disabilities and as required by RCW 71A.12.220(12).
"Restrictive procedure" means any procedure that restricts a client's freedom of movement, restricts access to client property, requires a client to do something which he/she does not want to do, or removes something the client owns or has earned.
"Risk assessment" means an assessment done by a qualified professional and as required by RCW 71A.12.230.
"Service provider" means a person or entity certified by the department who delivers services and supports to meet a client's identified needs. The term includes the state operated living alternative (SOLA) program.
"Support" means assistance a service provider gives a client based on needs identified in the individual support plan.
"Supported living" means instruction, supports, and services provided by service providers to clients living in homes that are owned, rented, or leased by the client or their legal representative.
"Treatment team" means the program participant and the group of people responsible for the development, implementation, and monitoring of the person's individualized supports and services. This group may include, but is not limited to, the case manager, therapist, the service provider, employment/day program provider, and the person's legal representative and/or family, provided the person consents to the family member's involvement.
"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; or
(2) Found incapacitated under chapter 11.88 RCW; or
(3) Who has a developmental disability as defined under RCW 71A.10.020; or
(4) Admitted to any facility; or
(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 an individual provider.
"Willful" means the deliberate, or non-accidental, action or inaction by an alleged perpetrator that he/she knew or reasonably should have known could cause a negative outcome, harm, injury, pain, and anguish.
"Written individual plan" means a plan developed for clients in the community protection program that includes:
(1) An assessment of the client's emotional and behavioral issues as related to community protection risks;
(2) Specific intervention strategies and techniques related to community protection risks;
(3) Specific restrictions and measures, including security precautions, both in-home and out-of-home; and
(4) Signatures of the client's case manager and the client.
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CERTIFICATION AND MONITORING(1) Be certified by the department; and
(2) Be granted a contract by the department.
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(1) All the requirements of this chapter. Except that, the licensing requirements for adult family homes and boarding homes supersede this chapter if the requirements under respective chapters 388-76 and 388-78A WAC conflict with this chapter;
(2) The laws governing this chapter, including chapter 71A.12 and 71A.22 RCW;
(3) The requirements of chapter 74.34 RCW;
(4) The department's residential services contract. Except that, the requirements of this chapter supersede any conflicting requirements with the contract, or appendices to the contract; and
(5) Other relevant federal, state and local laws, requirements, and ordinances.
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(2) The service provider must complete an application before the department will consider a request for change of ownership as detailed in WAC 388-101-3060.
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(2) The service provider must have a separate contract for each region where they receive referrals to serve clients.
(3) The service provider's residential services contract will be terminated by the department upon termination of certification.
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(a) A letter of intent that includes:
(i) Contact information;
(ii) Geographical area of service; and
(iii) Type of service provided, including group home, supported living, community protection, or group training home.
(b) A completed and signed application on forms designated by the department;
(c) All attachments specified in the application and any other information the department may request including but not limited to:
(i) Administrator resumes;
(ii) Statements of financial stability;
(iii) Professional references;
(iv) Relevant experiences and qualifications of the individual or agency; and
(v) Assurances the applicant will not discriminate against any client or employee.
(d) A copy of the license if applying for certification as a group home;
(e) The name of the administrator of the program; and
(f) Department criminal history background check on forms designated by the department for the individual or individuals designated to serve as administrator of the proposed program.
(2) The applicant must submit a revised application, if any information on the application changes before the initial certification is issued.
(3) The department will only process a completed application.
(4) Each person named in the application for initial certification is considered separately and jointly by the department.
(5) Based on the documentation received, the department will notify the applicant in writing regarding the department's certification decision.
(6) The applicant must comply with additional requirements identified in this chapter if intending to support community protection clients.
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(a) The business entity ownership; or
(b) The form of legal organization.
(2) The service provider applying for a change of ownership may be required to provide any or all items listed in WAC 388-101-3050.
(3) If the applicant is not a current service provider, the applicant must apply for initial certification.
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(1) The department in writing sixty days before a change of ownership; and
(2) Clients or their legal representatives in writing thirty days before a change of ownership.
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(1) Has shown a lack of understanding, ability or emotional stability to meet the identified needs of vulnerable adults;
(2) Had a department contract, certification, or license withdrawn or denied by the department, or has been subjected to enforcement actions;
(3) Had a contract, certification, or license withdrawn or denied or was subjected to enforcement action in another state;
(4) Obtained or attempted to obtain a license or certification by fraudulent means or misrepresentation;
(5) Has relinquished or been denied a license or license renewal to operate a home or facility that was licensed for the care of children or vulnerable adults;
(6) Refused to permit authorized department representatives to interview clients or to have access to client records;
(7) Has been convicted of a drug related conviction within the past five years without evidence of rehabilitation; or
(8) Has been convicted of an alcohol related conviction within the past five years without evidence of rehabilitation.
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(1) Convicted of a crime against children or other persons or crimes relating to financial exploitation as defined under RCW 43.43.830 or 43.43.842;
(2) Found by a court in a protection proceeding or in a civil damages lawsuit under chapter 74.34 RCW to have abused, neglected, abandoned or financially exploited a vulnerable adult;
(3) Found in any dependency action under chapter 13.34 RCW to have sexually assaulted, neglected, exploited, or physically abused any minor;
(4) Found by a court in a domestic relations proceeding under Title 26 RCW to have sexually abused, exploited, or physically abused any minor;
(5) Found in any final decision issued by a disciplinary board to have sexually or physically abused or exploited any minor or have abused, neglected, abandoned, or financially exploited any vulnerable adult as defined under chapter 74.34 RCW; or
(6) The subject of a stipulated finding of fact, conclusion of law, an agreed order, finding of fact, 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, financial exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW.
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(a) Grant initial certification for up to one hundred and eighty days of the effective date of the residential services contract; and
(b) Extend initial certification for an additional period up to one hundred and eighty days.
(2) If an applicant does not receive a residential services contract, initial certification will be valid for up to one year.
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(a) Grant certification to a service provider for up to two years; and
(b) Extend regular certification for an additional period up to one hundred and eighty days.
(2) If a service provider does not comply with the certification requirements, the department may provisionally certify or decertify a service provider.
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(2) During certification evaluations the service provider's administrator or designee must:
(a) Cooperate with department representatives during the on-site visit;
(b) Provide all contractor records, client records, and other relevant information requested by the department representatives;
(c) Ensure the service provider's administrator or designee is available during any visit to respond to questions or issues identified by department representatives; and
(d) Ensure the service provider's administrator or designee is present at the exit conference.
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(1) Allow any state or federal department or agency to conduct audits, evaluations, or complaint investigations related to this program or to clients served in this program;
(2) Allow department representatives to review a client's records and activities at any time to see if the service provider continues to address the clients' needs for instruction and support activities;
(3) Allow the department representatives' access to clients, the client's legal representative and family members;
(4) Cooperate with department representatives in the performance of official duties; and
(5) Allow access to clients and client records by an advocacy group if the advocacy group has access authority under state or federal law.
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(1) Submit a signed plan of correction to the department according to established department processes and timelines; and
(2) Include in the plan of correction:
(a) What the service provider did or will do to correct each deficiency;
(b) How the service provider will prevent future problems of this type;
(c) Who will be responsible for monitoring the corrections to ensure the problems do not recur; and
(d) When lasting correction will be achieved.
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(1) Complete an application on forms and attachments designated by the department; and
(2) Currently be:
(a) Certified as a community residential services and support provider;
(b) Licensed as an adult family home under chapter 70.128 RCW; and
(c) A nonprofit business in accordance with state and federal law.
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(1) The needs of the program;
(2) Available funding;
(3) The information received from the applicant;
(4) The certification history of the applicant;
(5) The licensing history of the applicant; and
(6) The capacity of the home.
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ADMINISTRATIVE REQUIREMENTS(a) This chapter;
(b) Each contract and statement of work entered into with the department;
(c) Each client's individual support plan when the individual support plan identifies the service provider as responsible; and
(d) Each client's individual instruction and support plan.
(2) The service provider must:
(a) Have a designated administrator and notify the department when there is a change in administrator;
(b) Ensure that clients have immediate access to staff, or the means to contact staff, at all times;
(c) Provide adequate staff within contracted hours to administer the program and meet the needs of clients;
(d) Not routinely involve clients in the unpaid instruction and support of other clients;
(e) Not involve clients receiving crisis diversion services in the instruction and support of other clients; and
(f) Retain all records and other material related to the residential services contract for six years after expiration of the contract.
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(1) Have a high school diploma or GED equivalent, unless the employees were hired before September 1, 1991;
(2) Be at least eighteen years of age or older when employed as a direct care staff, or at least twenty-one years of age or older when employed as an administrator;
(3) Have a clear understanding of job responsibilities and knowledge of individual support plans and client needs; and
(4) Passed the department background check as required by WAC 388-101-3250.
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(1) A mission statement;
(2) A program description;
(3) An organizational chart and description showing all supervisory relationships;
(4) Description of staff roles and responsibilities, including the person designated to act in the absence of the administrator; and
(5) Staffing schedules.
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(1) Overseeing all aspects of staffing, such as recruitment, staff training, and performance reviews;
(2) Developing and maintaining policies and procedures that give staff direction to provide appropriate services and support as required by this chapter and the department contract; and
(3) Maintaining and securely storing client, personnel, and financial records.
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(1) Provide care and services in accordance with this chapter and with licensing requirements under chapters 388-76 and 388-78A WAC respectively;
(2) Comply with client rights requirements in chapter 70.129 RCW and this chapter;
(3) Comply with the home's licensing requirements if there is a conflict with requirements in this chapter; and
(4) Comply with this chapter if the requirement is over and above the home's licensing requirements.
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(a) Related to client rights, including a client's right to file a complaint or suggestion without interference;
(b) Related to soliciting client input and feedback on instruction and support received;
(c) Related to reporting suspected abuse, neglect, financial exploitation, or abandonment;
(d) To protect clients when there have been allegations of abuse, neglect, financial exploitation, or abandonment;
(e) In emergent situations that may pose a danger or risk to the client or others, such as in the event of death or serious injury to a client;
(f) In responding to missing persons and client emergencies;
(g) Related to emergency response plans for natural or other disasters;
(h) When accessing medical, mental health, and law enforcement resources for clients;
(i) Related to notifying a client's legal representative, and/or relatives in case of emergency;
(j) When receiving and responding to client grievances; and
(k) To respond appropriately to aggressive and assaultive clients.
(2) The service provider must develop, implement, and train staff on policies and procedures in all aspects of the medication support they provide, including but not limited to:
(a) Supervision;
(b) Client refusal;
(c) Services related to medications and treatments provided under the delegation of a registered nurse consistent with chapter 246-840 WAC;
(d) The monitoring of a client who self-administers their own medications;
(e) Medication assistance for clients needing this support; and
(f) What the service provider will do in the event they become aware that a client is no longer safe to take their own medications.
(3) The service provider must maintain current written policies and procedures and make them available to all staff; and to clients and legal representatives upon request.
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(2) The service provider must not allow the following persons to have unsupervised access to clients until the service provider receives successful background check results from the department:
(a) Administrators;
(b) Employees;
(c) Volunteers or students; and
(d) Subcontractors.
(3) Service providers or applicants who have lived in Washington state less than three years or who are otherwise required to complete a fingerprint-based background check may be hired for a one hundred twenty-day provisional period as allowed under law when:
(a) The applicant or service provider is not disqualified based on the initial result of the background check from the department; and
(b) A fingerprint-based background check is pending.
(4) The service provider must notify the person, within ten days of receiving the result, that he or she may request a copy of the background check.
(5) The service provider must renew the background check at least every thirty-six months and keep current department background checks for each administrator, employee, volunteer or subcontractor of a service provider.
(6) Licensed boarding homes or adult family homes must adhere to the current regulations in this chapter and in the applicable licensing laws.
(7) Service providers must follow the requirements of RCW 43.43.830 through 43.43.842 and RCW 74.15.030.
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(1) Provide and document required training to staff;
(2) Within the first six months, ensure that staff receives a minimum of thirty-two total hours of training that meets the training requirements of this chapter;
(3) Provide staff training sooner if required by the client's identified needs; and
(4) Meet state and federal laws regarding training; such as, bloodborne pathogens training referenced in WAC 296-823-120.
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(1) Current individual instruction and support plans of each client with whom the employee works;
(2) Emergency procedures for clients;
(3) The reporting requirements for abuse and neglect under chapter 74.34 RCW; and
(4) Client confidentiality.
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(1) The service provider's mission statement;
(2) Policies and procedures; and
(3) On-the-job training.
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(1) First aid and CPR;
(2) Bloodborne pathogens with HIV/AIDS information;
(3) Client services;
(4) Residential guidelines; and
(5) Positive behavior support.
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(a) Prior to certification review;
(b) When household configuration changes affect staff coverage; or
(c) When additional staffing is requested or needed by the client.
(2) The service provider must retain copies of the staff coverage schedules.
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CLIENT RIGHTS AND TREATMENT(1) The right to be free from discrimination;
(2) The right to be reasonably accommodated in accordance with state and federal law;
(3) The right to privacy, including the right to receive and send private mail and telephone calls;
(4) The right to participate in an appropriate program of publicly supported education;
(5) The right to be free from harm, including unnecessary physical restraint, isolation, excessive medication, abuse, neglect, abandonment, and financial exploitation; and
(6) The right to refuse health services, medications, restraints, and restrictions.
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CLIENT SERVICES
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(1) Health and safety;
(2) Personal power and choice;
(3) Competence and self-reliance;
(4) Positive recognition by self and others;
(5) Positive relationships; and
(6) Integration in the physical and social life of the community.
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(1) Home living activities;
(2) Community living activities;
(3) Life-long learning activities;
(4) Health and safety activities;
(5) Social activities;
(6) Employment;
(7) Protection and advocacy activities;
(8) Exceptional medical support needs; and
(9) Exceptional behavioral support needs.
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(1) Accessing health, mental health, and dental services;
(2) Medication management, administration, and assistance;
(3) Maintaining health records;
(4) Arranging appointments with health professionals;
(5) Monitoring medical treatment prescribed by health professionals;
(6) Communicating directly with health professionals when needed; and
(7) Receiving an annual physical and dental examination unless the appropriate medical professional gives a written exception.
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(2) The service provider must not allow an employee to perform any nursing task that violates applicable statutes and rules, including:
(a) Chapter 18.79 RCW, Nursing care;
(b) Chapter 18.88A RCW, Nursing assistants;
(c) Chapter 246-840 WAC, Practical and registered nursing;
(d) Chapter 246-841 WAC, Nursing assistants; and
(e) Chapter 246-888 WAC, Medication assistance.
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(a) Not charging the client for transportation costs except as specified in the client's individual support plan;
(b) Using the client's Medicaid coupons for covered transportation, if available; and
(c) Ensuring that other transportation is provided as specified in the client's individual support plan.
(2) The service provider must provide transportation or ensure that clients have a way to get to and from:
(a) Emergency medical care;
(b) Medical appointments; and
(c) Therapies.
(3) As specified in the client's individual support plan, the service provider must provide necessary assistance with transportation to and from:
(a) School or other publicly funded services;
(b) Work;
(c) Leisure or recreation activities; and
(d) Client-requested activities.
(4) A vehicle that the service provider uses to transport clients must be insured as required by chapters 46.29 and 46.30 RCW.
(5) The service provider must maintain a business automobile insurance policy on service provider owned vehicles used to transport clients.
(6) The service provider must maintain non-owned vehicle insurance coverage for vehicles not owned by the service provider but used to transport clients.
(7) Service providers, employees, subcontractors, and volunteers who transport clients must have a valid driver's license as required by chapter 46.20 RCW.
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(2) The service provider must ensure that the following home safety requirements are met for each client unless otherwise specified in the client's individual support plan:
(a) A safe and healthy environment;
(b) Accessible telephone equipment and a list of emergency contact numbers;
(c) An evacuation plan developed and practiced with the client;
(d) Unblocked door and window for emergency exit;
(e) A safe storage area for flammable and combustible materials;
(f) An operating smoke detector, with a light-alarm for clients with hearing impairments;
(g) An accessible flashlight or other safe accessible light source in working condition; and
(h) Basic first-aid supplies.
(3) The service provider must assist clients in regulating household water temperature unless otherwise specified in the client's individual support plan as follows:
(a) Maintain water temperature in the household no higher than one hundred and twenty degrees Fahrenheit;
(b) Check water temperature when the client first moves into the household and at least once every three months from then on; and
(c) Regulate water temperature for clients who receive twenty-four hour support, and for other clients as specified in the individual support plan.
(4) The service provider must document and keep records that indicate that physical safety requirements are met for each client.
(5) A client may independently document these requirements are met when the client's individual support plan specifies this level of client involvement.
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(1) Provide the department with a written description of the household composition;
(2) Obtain written approval from the division of developmental disabilities; and
(3) Obtain written consent from each client in the household or the client's legal representative if the client is unable to consent.
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(1) Provide the department with a written description of the household composition;
(2) Participate with the treatment team during the household composition review;
(3) Obtain written approval from the division of developmental disabilities; and
(4) Obtain written consent from each client in the household or the client's legal representative if the client is unable to consent.
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(2) Service providers must document each client's refusal to participate in:
(a) Physical and safety requirements, as outlined in WAC 388-101-3390; and
(b) Client health services support under WAC 388-101-3370.
(3) Service providers must document the following:
(a) A description of events relating to the client's refusal to participate in these services;
(b) That the client was informed of the benefits of these services and the possible risks of refusal;
(c) A description of the service provider's efforts to give or acquire the services for the client; and
(d) Any health or safety concerns that the refusal may pose.
(4) The service provider must:
(a) Review this documentation with the client or the client's legal representative at least every six months; and
(b) Request that the client or client's legal representative sign and date the document after reviewing it.
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(1) When a client's service needs change and the individual support plan no longer addresses the client's needs; and
(2) May request in writing, assistance from the department's case manager in setting up an assessment meeting.
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(2) If further assistance is needed following the department's initial response, the service provider must confirm in writing to the client's case manager on the first working day after initiating a verbal request for such assistance:
(a) The nature of the emergency;
(b) The need for immediate assistance and the specific type of assistance needed; and
(c) The specific type of assistance needed.
(3) When the emergency cannot be resolved and the service provider wants to terminate services to the client, the service provider must:
(a) Notify the department in writing;
(b) Specify the reasons for terminating services to the client; and
(c) Ensure that the department receives the notice at least seventy-two hours before moving the client from the program.
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(a) Why the provider cannot meet the client's needs; or
(b) How the provider's refusal to serve the client would be in the best interest of the client or other clients.
(2) Before terminating services to the client, the service provider must notify the department, the client and the client's legal representative in writing ten working days before terminating services.
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INDIVIDUAL INSTRUCTION AND SUPPORT PLAN
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(2) In developing the individual instruction and support plan, the service provider must:
(a) Work with the client to develop goals based on the individual support plan that will be worked on during the implementation of the individual instruction and support plan for the upcoming year;
(b) Identify how the instruction and/or support activities will be provided to meet the assessed needs of the client as described in the individual support plan;
(c) Ensure that the individual instruction and support plan contains or refers to other applicable support and/or service information; and
(d) Include the participation and agreement of the client and other individuals the client wants included.
(3) The service provider must send a copy of the individual instruction and support plan goals together with a list of applicable support and service information and where the information is located to the case manager for review.
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(1) Develop and keep a written record of the individual instruction and support plan that includes the elements required in WAC 388-101-3470;
(2) Include a section or page in the individual instruction and support plan that provides or references all applicable support or service information pertaining to the client;
(3) Review and update the plan to reflect changes in the assessed needs as described in the individual support plan;
(4) Sign and date the plan's documents; and
(5) Document the client's agreement with the plan as well as the client's legal representative if applicable.
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(1) Oversee the progress made on each client's individual instruction and support plan;
(2) Coordinate with other staff, and other providers serving the client, and other interested persons as needed, in implementing the individual instruction and/or support plan; and
(3) Revise and update the plan as the client's assessed needs change.
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(1) Staff to provide direction on what they are to do to instruct and/or support the client;
(2) The client receiving service;
(3) The client's legal representative; and
(4) Representatives of the department.
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(1) Review and revise the individual instruction and support plan as goals are achieved or as client assessed needs change in order to reflect the client's current needs, goals, and preferences:
(a) At least semi-annually; and
(b) At any time requested by the client or the client's legal representative.
(2) Send an updated copy of the instruction and support goals of the individual instruction and support plan and the list of applicable support and service information and where the information is located to the case manager for review.
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CLIENT FINANCES(1) Given to the client or the client's legal representative;
(2) Deposited to the client's account; or
(3) Used only for the client.
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(a) Identifies that the client needs support to manage funds; and
(b) Designates the service provider as responsible for that support; or
(c) Indicates the service provider manages any portion of the client's funds.
(2) The service provider must obtain signatures from the client and the client's legal representative on the individual financial plan.
(3) The service provider must include the following in the client's individual financial plan:
(a) Client funds and income managed by the service provider;
(b) Client funds and income managed by the client and the client's legal representative;
(c) The type of accounts containing client funds;
(d) A description of how the client's funds will be spent during a typical month;
(e) Money management instruction or support provided to the client; and
(f) If applicable, asset management including such things as personal property, burial plan, retirement funds, stock, and vehicles.
(4) The service provider must review the individual financial plan with the client at least every twelve months.
(5) The service provider must send a copy of each client's individual financial plan to:
(a) The client's legal representative; and
(b) The client's case manager upon request.
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(a) Obtain written consent from the client or the client's legal representative; or
(b) Become the representative payee.
(2) For any client funds managed by the service provider, the service provider must:
(a) Separately track each client's money, even when several clients reside together;
(b) Maintain a current running balance of each client account;
(c) Make deposits to the client's bank account within one week of receiving the client's money;
(d) Prevent the client's bank account from being overdrawn;
(e) Ensure that client cash funds do not exceed seventy-five dollars per client unless specified differently in the individual financial plan; and
(f) Retain receipts for each purchase over twenty-five dollars.
(3) Social Security Administration requirements for managing the client's social security income take precedence over these rules if:
(a) The service provider is the client's representative payee; and
(b) The Social Security Administration requirement conflicts with these rules.
(4) When the service provider manages the client's funds and receives a check made out to the client, the service provider must:
(a) Get the client's signature and designation "for deposit only,"; or
(b) Get the client's "x" mark in the presence of a witness and cosign the check with the designation "for deposit only,"; and
(c) Deposit the check in the client's bank account as required under subsection (2)(c) of this section.
(5) If a check for the client is made out to a payee other than the client, the service provider must ask the payee to sign the check.
(6) The service provider must not ask the client to sign a blank check.
(7) The service provider may only assist the client to make purchases by check when the client signs the check at the time of the purchase unless:
(a) Otherwise specified in the client's individual financial plan; or
(b) The service provider is the client's representative payee.
(8) The service provider must document in the client's record the name of each staff that may assist the client with financial transactions.
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(1) Must notify the case manager of the denial in writing; and
(2) May use client funds for the client's health services if no other funding is available.
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(a) Reconcile the client's bank accounts to the client's bank statements each month;
(b) Reconcile the client's cash account each month; and
(c) Verify the accuracy of the reconciliation.
(2) The service provider must not allow the same staff person to do both the verification and reconciliation of the client's account.
(3) The service provider must ensure that the verification or reconciliation is done by a staff person who did not:
(a) Make financial transactions on the client's behalf; or
(b) Assist the client with financial transactions.
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(2) When the service provider holds the client's bankcards or bankbooks as requested by the client:
(a) It is not assumed that the service provider is managing the client's funds; and
(b) The client must continue to have access to his or her own funds.
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(2) The service provider must also keep the following documentation for client financial transactions:
(a) Monthly bank statements and reconciliations;
(b) Checkbook registers and bankbooks;
(c) Deposit receipts;
(d) Receipts for purchases over twenty-five dollars;
(e) A ledger showing deposits, withdrawals, and interest payments to each client; and
(f) A control journal for trust accounts.
(3) The service provider must keep the following documentation for cash and debit transactions:
(a) A detailed ledger signed by the staff who withdrew any of the client's money;
(b) A detailed accounting of the funds received on behalf of the client including:
(i) Cash received from writing checks over the purchase amount; and
(ii) A list of where the money was spent.
(c) Receipts for purchases over twenty-five dollars when service provider staff withdrew the money.
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(2) When transferring funds, the previous provider must:
(a) Have an agreement with the client regarding the amount of money to be withheld to pay bills;
(b) Inform the client's case manager about any agreement in subsection (2)(a) of this section;
(c) Give the client and the client's legal representative a written accounting of all known client funds;
(d) When applicable, give the new service provider a written accounting of all transferred client funds;
(e) Obtain a written receipt from the client and legal representative for all transferred funds; and
(f) When applicable, obtain the new service provider's written receipt for the transferred funds.
(3) When the client moves to another living arrangement without supported living services or the client's whereabouts are unknown, the service provider must transfer the client's funds within one hundred eighty days to:
(a) The client's legal representative;
(b) The department; or
(c) The requesting governmental entity.
(4) When the client dies, the service provider must transfer the client's funds within ninety days to:
(a) The client's legal representative;
(b) The requesting governmental entity; or
(c) The department if the client does not have a legal heir.
(5) Social Security Administration requirements for managing the client's social security income take precedence over these rules for transferring client funds if:
(a) The service provider is the client's representative payee; and
(b) The Social Security Administration requirement conflicts with these rules.
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(2) The client's service provider must not:
(a) Charge the client interest for any money loaned; or
(b) Borrow funds from the client.
(3) The provider must keep the following loan documentation for each loan:
(a) A loan agreement signed by the client or the client's legal representative;
(b) Amount of the loan;
(c) Payments on the loan balance; and
(d) The current balance owed.
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(1) The service provider or staff has stolen, misplaced, or mismanaged client funds; or
(2) Service charges are incurred on a trust account that the service provider manages for the client.
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(1) At least the current minimum wage; and
(2) According to state and federal requirements.
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CLIENT MEDICATIONS(a) Have systems in place to ensure that medications are given as ordered and in a manner that safeguards the client's health and safety;
(b) Ensure that each client receives their medication as prescribed, except as provided for in the medication refusal section or in the medication assistance section regarding altering medication; and
(c) Have a legible prescription label completed by a licensed pharmacy before providing medication assistance or medication administration to a client for prescribed medications.
(2) Group homes licensed as a boarding home or adult family home must meet the medication management requirements of chapter 388-78A or 388-76 WAC. For any difference in requirements the boarding home or adult family home medication rules take precedence over the medication rules of this chapter.
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(1) Self-administration of medication;
(2) Medication assistance;
(3) Nurse delegated medication administration; and
(4) Medication administration by a practitioner.
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(1) Communicating the prescriber's order to the client in such a manner that the client self-administers his/her medication properly;
(2) Reminding or coaching the client when it is time to take a medication;
(3) Opening the client's medication container;
(4) Handing the client the medication container;
(5) Placing the medication in the client's hand;
(6) Transferring medication from one container to another for the purpose of an individual dose (e.g., pouring a liquid medication from the container to a calibrated spoon or medication cup or using adaptive devices);
(7) Altering a medication by crushing or mixing:
(a) Only if the client is aware that the medication is being altered or added to food or beverage; and
(b) A pharmacist or other qualified practitioner has determined it is safe to alter medication; and
(c) It is documented on the prescription container or in the client's record.
(8) Guiding or assisting the client to apply or instill skin, nose, eye and ear preparations. Hand-over-hand administration is not allowed; and
(9) For group homes that have a boarding home or adult family home license, refer to chapter 388-78A or 388-76 WAC for additional tasks that may be allowed.
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(2) Service providers may only administer medication under the order of a physician or a health care professional with prescriptive authority.
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(a) Respect the client's right to choose not to take the medication(s) including psychoactive medication(s); and
(b) Document the time, date and medication the client did not take.
(2) The service provider must take the appropriate action, including notifying the prescriber or primary care practitioner, when the client chooses to not take his or her medications and the client refusal could cause harm to the client or others.
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(2) The service provider must store medications:
(a) Under proper conditions for sanitation, temperature, moisture and ventilation, and separate from food or toxic chemicals; and
(b) In the original medication containers with pharmacist-prepared or manufacturer's label, or in medication organizers which are clearly labeled with the:
(i) Name of the client for whom the medication is prescribed;
(ii) Name of the medications; and
(iii) Dosage and frequency.
(3) Group homes must:
(a) Keep all medications in locked storage; and
(b) Use medication organizers only when filled by a pharmacist.
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(a) The client;
(b) A licensed pharmacist;
(c) An RN; or
(d) The client's legal representative or a family member.
(2) Service providers providing medication assistance or administration to a client must ensure that the medication organizers are labeled.
(3) The client, a pharmacist, an RN, or the client's legal representative or family member may label the medication organizer.
(4) When there is a change in medications by the prescriber, the individual filling the medication organizers must replace labels with required updated information immediately.
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(2) When disposing client medications the service provider must list the:
(a) Medication;
(b) Amount; and
(c) Date that it was disposed.
(3) Two people, one of whom may be the client, must verify the disposal by signature.
(4) For group homes that have a boarding home or adult family home license, refer to chapters 388-78A or 388-76 WAC for medication disposal requirements.
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PSYCHOACTIVE MEDICATIONS(1) Refer the client for a professional assessment;
(2) Prior to the referral, prepare a psychiatric referral summary, including the frequency and severity of the symptoms or behaviors, and take or send this document to the treatment professional conducting the assessment;
(3) Respect the client's preference to visit the treatment professional independently; and
(4) If drugs are prescribed, have the prescribing professional assess the client at least annually to review the continued need for the medication(s) and possible dosage reduction.
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(a) A description of the behaviors, symptoms or conditions for which the medication is prescribed and a mental health diagnosis, if available;
(b) The name, dosage, and frequency of the medication and subsequent changes in dosage must be documented in the person's medical record;
(c) The length of time considered sufficient to determine if the medication is effective;
(d) The behavioral criteria to determine whether the medication is effective and what changes in behavior, mood, thought, or functioning are considered evidence that the medication is effective; and
(e) The anticipated schedule of visits with the prescribing professional.
(2) The service provider must make sure the treatment plan is updated when there is a change in psychoactive medication type, including intraclass changes.
(3) The service provider must:
(a) Review the name, purpose, potential side effects and any known potential drug interactions of the psychoactive medication(s) with the client and his/her legal representative and document the review in the client record; and
(b) Have available to staff and clients an information sheet for each psychoactive medication that is being used by each client served by the provider.
(4) The service provider must assist the client in obtaining and taking the medication when:
(a) The client's legal representative if any, is unavailable; and
(b) In the prescribing professional's opinion, medication is needed and no significant risks are associated with the use of the medication.
(5) If a client takes psychoactive medications to reduce challenging behaviors or to treat symptoms of a mental illness that are interfering with the client's ability to have positive life experiences and form and maintain relationships, the service provider must develop and implement a positive behavior support plan.
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(1) Monitor the client to help determine if the medication is effective based on criteria identified in the psychoactive medication treatment plan; and
(2) Report to the prescribing professional when:
(a) The medication does not appear to have the desired effects; and
(b) Any changes in client behavior or health that might be adverse side effects of the medication(s).
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CLIENT AND PROGRAM RECORDS(a) Keep all client record information confidential;
(b) Ensure the department's right to have access to and copies of any records as requested or needed; and
(c) Provide access to and copies of client records to the client, or the client's legal representative upon their request.
(2) The service provider must have an authorized release of information form for any transfer or inspection of records, other than those specified in subsection (1) of this section. The authorization form must:
(a) Be specific to the type of information about the transfer or inspection; and
(b) Be signed by the client or client's legal representative.
(3) A signed release of information is valid for up to one year from the date of signature.
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(a) Must not charge the department or the client for any searching or duplication of records requested or needed; and
(b) May charge the client's legal representative acting on behalf of the client for searching and duplication of records at a cost not to exceed twenty-five cents a page.
(2) The service provider must not charge the client's legal representative acting on behalf of the client for searching and duplication of records if the client is incapable of making the request.
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(2) After a client's participation with a service provider ends, the service provider must keep the client's records for at least six years.
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(2) Service providers must keep, in each client's record, information including but not limited to the following:
(a) Client's name, address, and Social Security number;
(b) Name, address, and telephone number of the client's involved family members, guardian or legal representative;
(c) Copies of legal guardianship papers, if provided;
(d) Client health records, including:
(i) Name, address, and telephone number of the client's physician, dentist, mental health service provider, and any other current health care service provider;
(ii) Current health care service providers' instructions about health care needed, including appointment dates and date of next appointment if appropriate;
(iii) Written documentation that the health care service providers' instructions have been followed; and
(iv) Record of major health events and surgeries when known.
(e) Copy of the client's most recent individual support plan;
(f) Client's individual instruction and support plan including:
(i) Instruction and support activities for each client as a basis for review and evaluation of client's progress;
(ii) Semiannual review of the individual instruction and support plan;
(iii) Consultation with other service providers and other interested persons;
(iv) Individual instruction and support plan revisions and changes; and
(v) Other activities relevant to the client that the client wants included.
(g) Progress notes and incident reports;
(h) The client's financial records for funds managed by the service provider, including:
(i) Receipts, ledgers and records of the client's financial transactions; and
(ii) Client's related bankbooks, checkbooks, bank registers, tax records and bank statements.
(i) Burial plans and wills.
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(2) The service provider must assist clients in maintaining current, written property records unless otherwise specified in the individual support plan. The record must consist of:
(a) A list of personal possessions with a value of at least twenty-five dollars that the client owns when moving into the program;
(b) A list of personal possessions with a value of seventy-five dollars or more per item after the client moves into the program;
(c) Description and identifying numbers, if any, of the property;
(d) The date the client purchased the items after moving into the program;
(e) The date and reason for addition or removal from the record; and
(f) The signature of the staff or client making the entry.
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(1) Documented in ink;
(2) Written legibly at the time of or immediately following the occurrence of the event recorded; and
(3) Signed and dated by the person making the entry.
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POSITIVE BEHAVIOR SUPPORTS
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(2) The service provider must start the functional assessment when the client begins to engage in challenging behaviors that interfere with the client's ability to have positive life experiences and form and maintain relationships.
(3) The service provider must ensure that a client's written functional assessment addresses:
(a) A description of the client and pertinent history;
(b) The client's overall quality of life;
(c) The behaviors that are considered challenging and/or are of concern;
(d) The factors or events which increase the likelihood of challenging behaviors;
(e) When and where the challenging behavior(s) occurs most frequently;
(f) The factors or events which increase the likelihood of appropriate behavior;
(g) An analysis and assessment of the possible functions or purpose the challenging behavior(s) serve for the client including what he or she obtains or avoids by engaging in the behavior(s); and
(h) A concluding summary of the functions or purpose that each challenging behavior serves for the client.
(4) The service provider must include the following sections in the format of each client's written functional assessment:
(a) Description and pertinent history;
(b) Definition of challenging behaviors;
(c) Data analysis/assessment procedures; and
(d) Summary statement(s).
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(a) The client takes psychoactive medications to reduce challenging behavior or treat a mental illness currently interfering with the client's ability to have positive life experiences and form and maintain personal relationships; or
(b) Restrictive procedures, including physical restraints, identified in the residential services contract are planned or used.
(2) The service provider must:
(a) Base each client's positive behavior support plan on the functional assessment required in WAC 388-101-3850; and
(b) Complete and implement the client's positive behavior support plan within ninety days of identifying the client's symptoms and challenging behavior.
(3) The service provider must develop and implement a positive behavior support plan that is consistent with the client's cross system crisis plan, if any.
(4) The service provider must include the following sections in the format of each client's written positive behavior support plan:
(a) Prevention strategies;
(b) Teaching and training supports;
(c) Strategies for responding to challenging behaviors; and
(d) Data collection and monitoring methods.
(5) If data indicates that progress is not occurring after a reasonable time, but not longer than six months, the service provider must:
(a) Evaluate the positive behavior support plan and the data collected;
(b) Conduct a new functional assessment when necessary; and
(c) Develop and implement revisions as needed.
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(1) Protect the client and others; and
(2) Document in the client's record how the protection is being done.
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RESTRICTIVE INTERVENTIONS(2) When considering restrictive procedures, group home providers licensed as adult family homes must comply with all requirements in chapter 388-76 WAC regarding restraints.
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(a) Only use restrictive procedures for the purpose of protecting the client, others, or property; and
(b) Not use restrictive procedures for the purpose of changing behavior in situations where no need for protection is present.
(2) The service provider must have documentation on the proposed intervention strategy before implementing restrictive procedures including:
(a) A description of the behavior(s) that the restrictive procedures address;
(b) A functional assessment of the challenging behavior(s);
(c) The positive behavior support strategies that will be used;
(d) A description of the restrictive procedure that will be used including:
(i) When and how it will be used; and
(ii) Criteria for termination of the procedure; and
(e) A plan to document the use of the procedure and its effect.
(3) The service provider must terminate implementation of the restrictive procedures as soon as the need for protection is over.
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(a) Lists the risks of the challenging behavior(s);
(b) Lists the risks of the proposed restrictive procedure(s);
(c) Explains why less restrictive procedures are not recommended;
(d) Indicates non-restrictive alternatives to the recommendation that have been tried but were unsuccessful; and
(e) Includes space for the client and/or the client's legal representative to write comments and opinions regarding the plan and the date of those comments.
(2) The service provider must consult with the division of developmental disabilities if:
(a) The client and/or the client's legal representative disagree with parts of the proposed restrictive procedure; and
(b) An agreement cannot be reached.
(3) Before the service provider implements restrictive procedures they must be approved in writing by:
(a) The service provider's administrator; or
(b) Someone designated by the service provider to have approval authority; and
(c) Someone designated by the division of developmental disabilities, when required by the residential services contract.
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(1) Discussion of the need for positive behavior support;
(2) Communication styles that help the client to calm down and resolve problems;
(3) Techniques to prevent escalation of behavior before it reaches the stage of physical assault;
(4) Techniques for staff to use in response to clients and their own fear, anger, aggression, or other negative feelings;
(5) Cautions that physical intervention technique(s) may not be changed except as needed for individual disabilities, medical, health, and safety issues. A healthcare professional and a program trainer must approve all modifications;
(6) Evaluation of the safety of the physical environment;
(7) Issues of respect and dignity of the client;
(8) Use of the least restrictive physical interventions depending upon the situation;
(9) Identification of division of developmental disabilities approved and prohibited physical intervention techniques;
(10) The need to release clients from physical restraint as soon as possible;
(11) Instruction on how to support physical interventions as an observer, recognizing signs of:
(a) Distress by the client; and
(b) Fatigue by the staff; and
(12) Discussion of the importance of complete and accurate documentation.
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(2) The service provider may only use physical interventions with a client when positive or less restrictive techniques have been tried and determined to be insufficient to:
(a) Protect the client;
(b) Protect others; or
(c) Prevent property damage.
(3) The service provider must:
(a) Terminate the intervention for the client as soon as the need for protection is over; and
(b) Only use restrictive physical interventions for the client as part of a positive behavior support plan except:
(i) In an emergency when a client's behavior presents an immediate risk to the health and safety of the client or others, or a threat to property; or
(ii) When an unknown, unpredicted response from a client jeopardizes the client's or others safety.
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(1) Provide documentation to the division of developmental disabilities regarding the proposed intervention;
(2) Involve the client and the client's legal representative in discussion regarding the need for physical intervention;
(3) Determine the kind of notification the client's legal representative wants to receive when physical interventions are used; and
(4) Comply with the requirements defined under WAC 388-101-3890.
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(a) The use of physical interventions;
(b) Crisis prevention techniques; and
(c) Positive behavior support.
(2) Each staff designated to supervise or observe restraint use must be trained in:
(a) The observation and supervision of physical restraints; and
(b) The recognition of potential risks or negative outcomes related to the use of physical restraints.
(3) The service provider must ensure that staff receiving physical intervention techniques training:
(a) Complete the course of instruction;
(b) Demonstrate competency before being authorized to use the techniques with clients; and
(c) Review de-escalation and physical intervention techniques annually.
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(2) The service provider must use the least restrictive alternatives needed to protect the client, others, or property.
(3) If needed, mechanical restraints may only be used for needed medical or dental treatment and only under the direction of a licensed physician or dentist.
(4) Restraints used as allowed by subsection (3) of this section must be justified and documented in the client's record.
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(2) The service provider must keep documentation that includes:
(a) A description of events immediately preceding the client's behavior which led to the use of the restraint;
(b) The type of restraint used;
(c) Length of time the client was restrained;
(d) The client's reaction to the restraint;
(e) Staff that were involved; and
(f) Injuries sustained by anyone during the intervention.
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COMMUNITY PROTECTION(1) Be approved by the division of developmental disabilities to serve community protection clients;
(2) Have security precautions reasonably available to enhance protection of neighbors, children, vulnerable adults, animals, and others;
(3) Have for each client an integrated treatment plan with goals, objectives, and therapeutic interventions to assist the client to avoid offending or re-offending; and
(4) Collaborate and coordinate between division of developmental disabilities staff, the treatment team, and community agencies and members.
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(1) Client security and supervision;
(2) Use of a chaperone agreement that describes who will supervise the client when the client is not under the direct supervision of the community protection service provider;
(3) Compliance with state laws requiring sex offender registration with law enforcement;
(4) Reporting to the division of developmental disabilities the client's refusal to comply with the treatment plan; and
(5) Reporting to the division of developmental disabilities and law enforcement client actions that violate the law or a court order.
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(1) Community protection within ninety calendar days of working with a community protection client; and
(2) The needs, supports, and services for clients to whom they are assigned.
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(a) A qualified professional's risk assessment of emotional and behavioral issues related to community protection risks; or
(b) A written risk assessment and treatment recommendations by:
(i) A sexual offender treatment provider or sexual offender treatment provider affiliate if the client has a sexual offense history; or
(ii) A licensed psychologist or psychiatrist with specialized training in the treatment of or three or more years' experience treating violent or aggressive behavior when the person being assessed has demonstrated violent, dangerous, or aggressive behavior.
(2) In addition to the requirements in WAC 388-101-3460 through 388-101-3510, the community protection service provider must include the following in the client's written individual plan:
(a) Intervention strategies and techniques related to community protection risks;
(b) Restrictions and measures, including security precautions; and
(c) A therapist's approval of the written individual plan.
(3) For community protection clients with a history of sexual offending, the assessment by a certified sexual offender treatment provider or sexual offender treatment provider affiliate may serve as the functional assessment and treatment recommendations related to the sexual behaviors.
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(1) Psychosexual and/or psychological evaluations and risk assessments;
(2) Plans and assessments including:
(a) The written individual plan;
(b) The functional assessment;
(c) The positive behavior support plan; and
(d) A therapist approved treatment plan.
(3) The client's sex offender registration with law enforcement authorities when required by law;
(4) Notice to the division of developmental disabilities of the client's sex offender registration; and
(5) Agreements, requirements, and plans, including the chaperone agreement, with individuals who support the client.
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(1) Conduct and document site checks of the proposed residence at different days and times of the week;
(2) Consider the client's specific offense patterns;
(3) Determine appropriate and necessary restrictive procedures, including security precautions; and
(4) Obtain written approval for the residential site from the division of developmental disabilities.
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(2) Document the client's departure in the client's record.
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CRISIS DIVERSION BED AND SUPPORT SERVICES(1) Be approved by the department to provide crisis diversion services; and
(2) Make crisis diversion services available to clients twenty-four hours per day.
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(1) Provide those services in a residence that is maintained by the crisis diversion bed services provider;
(2) Provide a private, furnished bedroom for each crisis diversion client; and
(3) Support only one client in each residence.
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(1) Support staff, twenty-four hour per day, seven days a week, to meet the client's needs as identified in the client's assessment;
(2) Access to the instruction and support services identified in the client's individual support plan;
(3) Three meals per day plus snacks;
(4) The following items at no cost to the client:
(a) Toiletries and personal care items;
(b) Bedding and towels;
(c) Access to laundry facilities; and
(d) Access to local telephone calls.
(5) Therapeutic interventions aimed at improving the client's functioning;
(6) Medication monitoring as needed;
(7) Transportation to and from the crisis diversion bed location and other necessary appointments or services;
(8) Referral to health care services as needed;
(9) Supports for performing personal hygiene routines and activities of daily living if needed by the client; and
(10) An accessible site for clients with physical disabilities.
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(2) The treatment plan must include:
(a) The supports and services that must be provided; and
(b) Client discharge goals.
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(a) Client's name, address, and Social Security number;
(b) Name, address, and telephone number of the client's relative or legal representative; and
(c) Progress notes and incident reports on clients.
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(2) The client record must include the following information when available:
(a) Basic demographic information;
(b) Referral process and intake information;
(c) Medication records;
(d) Psychiatric records;
(e) Crisis diversion bed services provider notes;
(f) The crisis services treatment plan;
(g) Cross systems crisis plan;
(h) Disposition at the client's discharge;
(i) Dates of admission and discharge;
(j) Incident reports;
(k) Copies of legal representative and guardianship papers;
(l) Health records including the name, address, and telephone number of the client's:
(i) Physician;
(ii) Dentist;
(iii) Mental health service provider; and
(iv) Any other health care service providers.
(m) Health care service providers' instructions, if any, about health care tasks and date of next appointment;
(n) Written documentation that the health care service providers' instructions have been followed; and
(o) A record of known major health events, including surgeries.
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(1) Therapeutic interventions to help stabilize the client's behavioral symptoms;
(2) Assistance with referral to mental health services if needed; and
(3) Technical assistance to the client's caregivers on support strategies.
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INCIDENT REPORTING(1) Are mandated reporters and must meet the requirements of chapter 74.34 RCW;
(2) Must make mandated reports to the department's centralized toll free complaint telephone number or FAX number immediately when:
(a) There is reasonable cause to believe that a vulnerable adult, as defined in chapter 74.34 RCW, has been abandoned, abused, neglected, or financially exploited; or
(b) There is a reason to suspect physical or sexual assault.
(3) Must also make written and oral reports to the department as specified in the provider's residential services contract;
(4) Must protect the alleged victim and others from further abuse, neglect, abandonment, and financial exploitation; and
(5) May have their certification and/or contract terminated if they fail to report such incidents.
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(1) Sexual Assault: Any alleged or suspected sexual assault;
(2) Physical Assault (nonclient to client): Any suspected physical assault as well as any act that causes fear of imminent harm; and
(3) Physical Assault (client to client): Any suspected physical assault that causes bodily injury requiring more than first aid, or in the event of:
(a) Injuries that appear on the back, face, head, neck, chest, breasts, groin, inner thigh, buttock, genital, or anal area;
(b) Fractures;
(c) Choking attempts;
(d) Patterns of physical assault between the same vulnerable adults or involving the same vulnerable adults;
(e) A reasonable cause to believe that an act has caused fear of imminent harm; and
(f) Any incident, regardless of injury, if requested by the client, his/her legal representative, or family member.
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(a) Immediately reporting mandated reporting incidents to:
(i) The department and law enforcement;
(ii) Appropriate persons within the service provider's agency as designated by the service provider; and
(iii) The alleged victim's legal representative.
(b) Protecting clients;
(c) Preserving evidence when necessary; and
(d) Initiating an outside review or investigation.
(2) The service provider must not have or implement any policies or procedures that interfere with a mandated reporter's obligation to report.
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REMEDIES(2) At the end of provisional certification the department may:
(a) Approve the service provider for regular certification if the service provider has complied with certification requirements; or
(b) Revoke the service provider's certification and terminate the residential services contract if the service provider has not complied with all certification requirements.
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(2) The department is authorized to impose the enforcement remedies described in chapter 71A.12 RCW when the service provider has:
(a) Failed or refused to comply with the requirements of chapter 71A.12 RCW and the rules adopted under the chapter;
(b) Failed or refused to comply with the certification process;
(c) Prevented or interfered with the department's certification evaluation or complaint investigation by the department;
(d) Failed to comply with any applicable requirements regarding vulnerable adults under chapter 74.34 RCW; or
(e) Knowingly, or with reason to know, made a false statement of material fact related to certification or contracting with the department, or in any matter under investigation by the department.
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(2) Whenever circumstances in WAC 388-101-4210 are present the department may impose any enforcement remedies authorized by chapter 71A.12 RCW and any rules adopted under it. The department may:
(a) Decertify or refuse to renew the certification of a service provider;
(b) Impose conditions on a service provider's certification status;
(c) Suspend department referrals to the service provider;
(d) Require a service provider to implement a plan of correction developed by the department and to cooperate with subsequent monitoring of the service provider's progress;
(e) Impose civil penalties of not more than one hundred fifty dollars per day per violation in the event a service provider fails to implement the plan of correction developed by the department or fails to cooperate with any subsequent monitoring; and
(f) Impose a separate violation each day during which the same or similar action or inaction occurs.
(2) The provisions of chapter 34.05 RCW apply to enforcement actions under this section. Except for the imposition of civil penalties, the effective date of enforcement actions will not be delayed or suspended pending any hearing or informal review.
(3) The enforcement actions and penalties authorized in this section are not exclusive or exhaustive and nothing in this section prohibits the department from taking any action authorized in statue or rule or under the terms of a contract with the service provider.
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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 388-101-4230
Community protection
program--Considerations for imposing remedies.
(1) This
section applies only to service providers providing services
to community protection clients.
(2) When determining the appropriate enforcement action under WAC 388-101-4220, the department will select actions in proportion to the seriousness of the harm or threat of harm to clients being served by the service provider.
(3) The department may take enforcement actions that are more severe for violations that are uncorrected, repeated, or pervasive or which present a serious threat of harm to the health, safety or welfare of clients served by the service provider.
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INFORMAL DISPUTE RESOLUTION AND APPEALS(2) The service provider must make a written request to the department for an informal dispute resolution meeting within ten working days of receipt of the written notice of the department's final report of findings and/or certification action.
(3) The service provider must submit a written statement identifying the challenged action, and include specifically the issues and regulations involved.
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(2) The service provider must make the request in writing and must:
(a) Sign the request;
(b) Identify the challenged decision and the date it was made;
(c) State specifically the issues and regulations involved and the grounds for the disagreement; and
(d) Include with the request copies of any supporting documentation for the service provider's position.
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(a) May contest a decision made by the department pursuant to chapter 71A.12 RCW and according to the provisions of chapter 34.05 RCW and chapter 388-02 WAC;
(b) Must file any request for a hearing with the office of administrative hearings at the mailing address specified in the notice of imposition of an enforcement remedy; and
(c) Must make the request within twenty-eight days of receipt of the written notice of the department's certification action.
(2) Certification actions are effective immediately upon notice and will continue pending any hearing.
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ABUSE-NEGLECT FINDING - INDIVIDUAL(2) The department investigation may include an investigation of allegations about one or more of the following:
(a) A service provider;
(b) Anyone associated with a service provider; or
(c) A client receiving services under this chapter.
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(a) Will not include the identities of the alleged victim, reporter and witnesses; and
(b) Will include the necessary information for the alleged perpetrator to ask for an administrative hearing to challenge the preliminary finding.
(2) The department must make a reasonable, good faith effort to determine the last known address of the alleged perpetrator.
(3) The department will serve notice of the preliminary finding as provided in chapter 388-02 WAC.
(4) The department may extend the time frame for written notification beyond ten working days for good cause.
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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 or contractor;
(c) The employer or program that is currently associated with the individual alleged to have abandoned, abused, neglected, or financially exploited a client, if known;
(d) Law enforcement; and
(e) Other investigative authorities consistent with chapter 74.34 RCW.
(2) The notification will identify the finding as a preliminary 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 written on the notice of the preliminary 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 preliminary finding;
(c) A description of any assistance needed in the administrative appeal process by the alleged perpetrator, including a foreign language or sign language interpreter or any reasonable 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 client will be redacted from documents unless release of that information is consistent with chapter 74.34 RCW and other applicable state and federal laws.
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(2) The administrative law judge shall determine whether a preponderance of the evidence supports the preliminary finding that the alleged perpetrator abandoned, abused, neglected, or financially exploited a vulnerable adult, and shall issue a preliminary order.
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(2) If the department appeals the administrative law judge's decision, the department will not modify 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 preliminary finding pursuant to WAC 388-101-4270 and the alleged perpetrator does not request an administrative hearing;
(b) The administrative law judge:
(i) Dismisses the hearing following withdrawal of the appeal or default; or
(ii) Issues a preliminary order upholding the finding and the alleged perpetrator fails to appeal the preliminary 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 only be removed from the department's records if:
(a) It is rescinded following judicial review; or
(b) The department may decide to remove the single finding of neglect from its records based upon a written petition by the alleged perpetrator provided that no further findings have occurred, and at least one calendar year has passed since the finding was finalized and recorded.
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(a) The perpetrator;
(b) The service provider that was associated with the perpetrator during the time of the incident;
(c) The service provider that is currently associated with the perpetrator, if known;
(d) The appropriate licensing, contracting, or certification authority; and
(e) The federal or state department or agency list of individuals found to have abandoned, abused, neglected, or financially exploited a vulnerable adult.
(2) The findings may be disclosed to the public upon request subject to applicable public disclosure laws.
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The following sections of the Washington Administrative Code are repealed:
| WAC 388-101-1010 | What is the purpose of this chapter? |
| WAC 388-101-1020 | What definitions apply to this chapter? |
| WAC 388-101-1101 | Abuse and neglect reporting requirements. |
| WAC 388-101-1106 | Investigation of mandated reports. |
| WAC 388-101-1111 | Notice of an initial finding. |
| WAC 388-101-1116 | Reporting initial findings. |
| WAC 388-101-1121 | Disputing an initial finding. |
| WAC 388-101-1126 | Disclosure of investigative and finding information. |
| WAC 388-101-1131 | Hearing procedures to dispute an initial finding. |
| WAC 388-101-1136 | Appeal of the administrative law judge's initial order on a finding. |
| WAC 388-101-1141 | Finalizing an initial finding. |
| WAC 388-101-1146 | Reporting final findings. |
| WAC 388-101-1180 | What are residential services? |
| WAC 388-101-1190 | Who certifies residential services? |
| WAC 388-101-1200 | Where are residential services provided? |
| WAC 388-101-1205 | Where are crisis diversion services provided? |
| WAC 388-101-1210 | Who may receive residential services? |
| WAC 388-101-1220 | What physical and safety requirements exist for residential services? |
| WAC 388-101-1230 | How must service providers assist clients in regulating water temperature? |
| WAC 388-101-1240 | What are supported living services? |
| WAC 388-101-1250 | What are crisis diversion services? |
| WAC 388-101-1260 | What are group homes? |
| WAC 388-101-1400 | When must a service provider document a client's refusal to participate in services? |
| WAC 388-101-1410 | May a service provider offer services to nonclients in the same household as clients? |
| WAC 388-101-1420 | Who pays for a client's residential services? |
| WAC 388-101-1430 | When may a service provider receive initial set-up funds from DSHS? |
| WAC 388-101-1440 | What are the different types of certification? |
| WAC 388-101-1460 | When may RCS grant initial certification to an agency? |
| WAC 388-101-1470 | How does an agency apply for initial certification? |
| WAC 388-101-1480 | What happens after an agency receives initial certification? |
| WAC 388-101-1490 | May initial certification be extended for a service provider? |
| WAC 388-101-1500 | How does a service provider receive regular certification? |
| WAC 388-101-1510 | How often are reviews and evaluations done for service providers? |
| WAC 388-101-1520 | What occurs during review and evaluation? |
| WAC 388-101-1530 | May service providers disagree with evaluation findings? |
| WAC 388-101-1540 | May a service provider receive provisional certification? |
| WAC 388-101-1550 | When may RCS decertify a service provider? |
| WAC 388-101-1600 | What are administrators of service providers required to do? |
| WAC 388-101-1610 | What type of administrative documents are service providers required to have? |
| WAC 388-101-1620 | What are the requirements for personnel policies? |
| WAC 388-101-1630 | What nondiscrimination requirements must agencies and service providers meet? |
| WAC 388-101-1640 | What staffing requirements must service providers meet? |
| WAC 388-101-1650 | May clients instruct and support other clients? |
| WAC 388-101-1660 | Who needs background checks? |
| WAC 388-101-1670 | What are the minimum requirements for staff employed by service providers? |
| WAC 388-101-1680 | What staff training is required? |
| WAC 388-101-1690 | How often must performance reviews be conducted for staff of service providers? |
| WAC 388-101-1700 | When must service providers have staff-coverage schedules approved by DDD? |
| WAC 388-101-1710 | What happens when a service provider's ownership changes? |
| WAC 388-101-1720 | When may a client's service provider change? |
| WAC 388-101-1730 | Are clients' records considered confidential? |
| WAC 388-101-1740 | How long does a service provider need to keep client records? |
| WAC 388-101-1750 | What information do service providers need to keep in client records? |
| WAC 388-101-1760 | What information do crisis diversion service providers need to keep in client records? |
| WAC 388-101-1770 | Do service providers need to keep client's property records? |
| WAC 388-101-1780 | Are there requirements for record entries? |
| WAC 388-101-1790 | Who must service providers notify in emergencies? |
| WAC 388-101-1800 | What are client services? |
| WAC 388-101-1810 | What health and safety support may a service provider offer to a client? |
| WAC 388-101-1820 | What support may a service provider offer to a client to increase personal power and choices? |
| WAC 388-101-1830 | What support may a service provider offer to increase a client's competence and self-reliance? |
| WAC 388-101-1840 | How may service providers assist clients in gaining positive recognition? |
| WAC 388-101-1850 | What support may a service provider offer to increase the positive relationships in the client's life? |
| WAC 388-101-1860 | How may a service provider assist clients with becoming integrated into their community? |
| WAC 388-101-1870 | What is an individual service plan/plan of care (ISP/POC) for clients? |
| WAC 388-101-1880 | Who is responsible for completing and overseeing a client's ISP/POC? |
| WAC 388-101-1890 | Who may participate in creating a client's ISP/POC? |
| WAC 388-101-1900 | How often must the ISP/POC be reviewed? |
| WAC 388-101-2000 | What plans must crisis diversion service providers develop? |
| WAC 388-101-2010 | What is an individual instruction and support plan (IISP) for clients? |
| WAC 388-101-2020 | Who may participate in developing the IISP for each client? |
| WAC 388-101-2030 | Who oversees the IISP for each client? |
| WAC 388-101-2040 | May a service provider manage a client's funds? |
| WAC 388-101-2050 | May a service provider hold bankbooks and bankcards for a client? |
| WAC 388-101-2060 | May a service provider combine agency and client funds? |
| WAC 388-101-2070 | Does the service provider need to develop an individual financial plan (IFP) for clients? |
| WAC 388-101-2080 | What information must the IFP include? |
| WAC 388-101-2090 | How does a service provider manage client funds? |
| WAC 388-101-2100 | What documentation must service providers keep to protect a client's financial interests? |
| WAC 388-101-2110 | How are a client's funds transferred when they are managed by a service provider? |
| WAC 388-101-2120 | How does a service provider handle loans to a client? |
| WAC 388-101-2130 | When must a service provider pay a client? |
| WAC 388-101-2140 | What must service providers do to support a client's health? |
| WAC 388-101-2150 | May a client refuse health care services? |
| WAC 388-101-2160 | When may client funds be used for health services? |
| WAC 388-101-2300 | Client transportation. |
| WAC 388-101-2330 | May an agency or service provider contest a RCS decision? |
| WAC 388-101-2340 | When does an administrative review conference occur? |
| WAC 388-101-2350 | May an administrative review conference be conducted by telephone? |
| WAC 388-101-2360 | What happens during the administrative review conference? |
| WAC 388-101-2370 | May an agency or service provider contest the decision from the administrative review conference? |
| WAC 388-101-2380 | Does RCS make exceptions to the requirements in this chapter? |
| WAC 388-101-2400 | Who may delegate nursing care tasks? |
| WAC 388-101-2410 | What training is required before staff are qualified to perform delegated tasks? |
| WAC 388-101-2420 | Do nursing assistants need to comply with department of health requirements? |
| WAC 388-101-2430 | Who is authorized to provide consent for a client's receiving health care? |
| WAC 388-101-2440 | What rights do nursing assistants have concerning the delegation of nursing care tasks? |
| WAC 388-101-2450 | Are nursing assistants liable for errors while doing nursing care tasks? |
| WAC 388-101-2460 | What happens if unqualified staff do a nursing task? |
| WAC 388-101-2470 | What technical assistance may service providers get from DSHS for nurse delegation requirements? |
| WAC 388-101-2480 | What happens when DSHS finds a service provider in violation of nurse delegation requirements? |
| WAC 388-101-2490 | May a service provider have a chance to correct violations before being fined? |
| WAC 388-101-2500 | May civil fines be imposed during technical assistance visits? |
| WAC 388-101-2510 | How does DSHS impose a civil fine? |
| WAC 388-101-2520 | When is payment due for a civil fine? |
| WAC 388-101-2530 | May a service provider disagree with DSHS findings of a violation? |
| WAC 388-101-2540 | May a service provider contest a civil fine? |