Original Notice.

Preproposal statement of inquiry was filed as WSR 98-06-089.

Title of Rule: Chapter 388-97 WAC, Nursing homes.

Purpose:

TITLE OF RULE	PURPOSE, SUMMARY AND EFFECT
Subchapter I
WAC 388-97-005 Definitions.	Amended. Added definitions of abandonment, abuse, entity, financial exploitation, misappropriation of resident property, neglect, and reasonable accommodation. Deleted some definitions and added them to specific sections.
WAC 388-97-010 License--Application.	Repealed. Revised and rewritten under Subchapter III, sections 550 and 555.
WAC 388-97-012 Nursing facility care.	New section. Moved from repealed section 225. Revised.
WAC 388-97-015 License--Qualification.	Repealed. Revised and rewritten under Subchapter III, section 560.
WAC 388-97-017 Discrimination prohibited.	New section. Moved from repealed section 230. Revised for clarity.
WAC 388-97-020 Nursing home fees.	Repealed. Rewritten under Subchapter III, sections 550 and 555.
WAC 388-97-022 Medical eligibility for nursing facility care.	New section. Moved from repealed section 235. Revised for clarity and expanded the definition to follow federal direction for skilled nursing facility care as well as nursing facility care.
WAC 388-97-025 License capacity.	Repealed. Rewritten under Subchapter III, section 585.
WAC 388-97-027 Nursing facility admission and payment requirements.	New section. Moved from repealed section 240. Revised and clarified.
WAC 388-97-030 Change of ownership.	Repealed. Revised and rewritten under new section 580.
WAC 388-97-032 Discharge planning.	New section. Moved from repealed section 100. Revised and clarified.
WAC 388-97-035 Change in administrator or director of nursing services.	Repealed. Rewritten under new section 162.
WAC 388-97-037 Utilization review.	New section. Moved from 265. Revised and rewritten for clarity.
WAC 388-97-040 Name of nursing home.	Repealed. Rewritten under new section 162.
WAC 388-97-042 Individual transfer and discharge rights and procedures.	New section. Revised and rewritten from section 270. Included "reasonable accommodation" issue from 1997 revision of chapter 74.42 RCW.
WAC 388-97-043 Transfer and discharge appeals for residents in Medicare certified and Medicaid certified facilities.	New section. Revised and rewritten from section 270.
WAC 388-97-045 License relinquishment upon closure.	Repealed. Rewritten as new section 595.
WAC 388-97-047 Discharge or leave of a nursing facility resident.	New section. Moved, rewritten, revised from section 280.
WAC 388-97-050 License denial, modification, nonrenewal, revocation.	Repealed. Rewritten as new section 565.
WAC 388-97-051 Resident rights.	New section. Previous subsection in section 070, revised, and updated.
WAC 388-97-052 Free choice.	New section. Previous subsection of section 070, revised and updated.
WAC 388-97-053 Statutes implemented in resident decision making, informed consent, advance directives.	New section. This language was in the previous WAC version but not as a section.
WAC 388-97-055 Resident decision making.	Amended. Revised for clarity.
WAC 388-97-060 Informed consent.	Amended. Revised for clarity.
WAC 388-97-065 Advance directives.	Amended. Revised for clarity.
WAC 388-97-070 Resident rights.	Repealed. This long section was divided into seventeen smaller sections for ease of use. Sections 051, 052, 053 and 07005 through 07070.
WAC 388-97-07005 Notice of rights and services.	New section. Previous subsection in section 070, revised, and updated with changes from chapters 70.129 and 74.42 RCW.
WAC 388-97-07010 Notification of changes.	New section. Previous subsection in section 070, revised for clarity.
WAC 388-97-07015 Protection of resident funds.	New section. Previous subsection in section 070, revised for clarity.
WAC 388-97-07020 Privacy and confidentiality.	New section. Previous subsection in section 070, revised for clarity.
WAC 388-97-07025 Work.	New section. Previous subsection in section 070, revised for clarity.
WAC 388-97-07030 Self administration of drugs.	New section. Previous subsection in section 070, revised for clarity.
WAC 388-97-07035 Grievance rights.	New section. Previous subsection in section 070, revised for clarity, and added a referral to chapter 74.39A RCW for forms of reprisal.
WAC 388-97-07040 Examination of survey results.	New section. Previous subsection in section 070, revised for clarity.
WAC 388-97-07045 Resident mail.	New section. Previous subsection in section 070, revised for clarity.
WAC 388-97-07050 Access and visitation rights.	New section. Previous subsection in section 070, revised for clarity.
WAC 388-97-07055 Telephone.	New section. Previous subsection in section 070, revised for clarity.
WAC 388-97-07060 Personal property.	New section. Previous subsection in section 070, revised for clarity.
WAC 388-97-07065 Roommates/rooms.	New section. Previous subsection in section 070, revised for clarity.
WAC 388-97-07070 Refusal of certain transfers.	New section. Previous subsection in section 070, revised for clarity.
WAC 388-97-075 Chemical and physical restraints.	Amended. Revised for clarity. Moved abuse requirements into new section 076.
WAC 388-97-076 Prevention of abuse.	New section. Moved abuse requirements from section 075 and revised for clarity.
WAC 388-97-077 Resident protection program.	New section. Written to implement the processes required by 42 C.F.R. § 488.335.
WAC 388-97-080 Quality of life.	Repealed. This long section was repealed and rewritten for clarity and ease of use to seven new sections, 08010 through 08070.
WAC 388-97-08010 Resident dignity and accommodation of needs.	New section. Previous subsection in 080, revised for clarity.
WAC 388-97-08020 Environment.	New section. Previous subsection in section 080, revised for clarity.
WAC 388-97-08030 Self-determination and participation.	New section. Previous subsection in section 080, revised for clarity.
WAC 388-97-08040 Participation in resident and family groups.	New section. Previous subsection in section 080, revised for clarity.
WAC 388-97-08050 Activities.	New section. Previous subsection in section 080, revised for clarity.
WAC 388-97-08060 Social services.	New section. Previous subsection in section 080, revised for clarity.
WAC 388-97-08070 Pets.	New section. Previous subsection in section 080, revised for clarity.
WAC 388-97-085 Resident assessment.	Amended. Revised for clarity. Added revised language for skilled nursing facility/nursing facility assessment requirements from repealed section 275 to consolidate the assessment requirements.
WAC 388-97-090 Comprehensive plan of care.	Amended. Revised for clarity.
WAC 388-97-095 Dementia care unit.	Repealed. Revised and rewritten as section 097 to reflect changes in resident populations.
WAC 388-97-097 Dementia care.	New section. Rewritten to reflect the changes in the nursing home population and address concerns accordingly.
WAC 388-97-100 Discharge planning.	Repealed. Revised and rewritten under section 032.
WAC 388-97-105 Relocation due to decertification, license revocation, closure, evacuation.	Repealed. Rewritten under Subchapter III, section 590.
WAC 388-97-110 Quality of care.	Amended. Revised to reflect changes in 42 C.F.R. § 483.20, and for clarity.
WAC 388-97-115 Nursing services.	Amended. Added from the definition section "directly supervising." Deleted reference to ICF/MR facilities requirements. Revised for clarity.
WAC 388-97-120 Dietary services.	Amended. Reorganized and revised for clarity. Subsections broken into seven additional sections 12010 through 12070 for ease of use.
WAC 388-97-12010 Meal provision.	See comments in section 120 above.
WAC 388-97-12020 Individual dietary needs.	See comments for section 120 above.
WAC 388-97-12030 Dietary personnel.	See comments for section 120 above.
WAC 388-97-12040 Dietary menus.	See comments for section 120 above.
WAC 388-97-12050 Diet orders.	See comments for section 120 above.
WAC 388-97-12060 Modified diets.	See comments for section 120 above.
WAC 388-97-12070 Tube feedings.	See comments for section 120 above.
WAC 388-97-125 Physician services.	Amended. Revised for clarity.
WAC 388-97-130 Specialized habilitative and rehabilitative services.	Amended. Revised for clarity.
WAC 388-97-135 Pharmacy services.	Amended. Revised for clarity.
WAC 388-97-140 Infection control.	Amended. Revised for clarity.
WAC 388-97-145 Early identification of persons with active tuberculosis.	Repealed. See new section 147.
WAC 388-97-147 Surveillance, management and early identification of persons with active tuberculosis.	New section. The section contains updated information regarding tuberculosis and combines sections 145 and 150. It requires nursing homes to follow national tuberculosis standards.
WAC 388-97-150 Surveillance and management of tuberculosis.	Repealed. See new section 147.
WAC 388-97-155 Care of residents with active tuberculosis.	Amended. Revised for clarity.
WAC 388-97-160 General administration.	Amended. Revised for clarity. Added language regarding nursing homes temporarily without an administrator. Also updated with "whistleblower" requirements from chapter 74.34 RCW.
WAC 388-97-162 Required notification and reporting.	New section. This new section combines in one section many of the notification requirements that may have been found elsewhere in the chapter.
WAC 388-97-165 Staff and equipment.	Amended. Revised for clarity.
WAC 388-97-170 Staff development.	Amended. Revised for clarity.
WAC 388-97-175 Medical director.	Amended. Revised for clarity.
WAC 388-97-180 Clinical records.	Amended. Revised for clarity. Added "authenticated" from the definition section.
WAC 388-97-185 Disaster and emergency preparedness.	Amended. Revised for clarity.
WAC 388-97-190 Quality assessment and assurance.	Amended. Revised for clarity.
WAC 388-97-195 Policies and procedures.	Amended. Revised for clarity.
WAC 388-97-200 Criminal history disclosure and background inquiries.	Repealed. Rewritten as new section 202.
WAC 388-97-202 Criminal history disclosure and background inquiries.	New section. Reworked section 200 to clarify and make more concise.
WAC 388-97-205 Laundry services.	Amended. Clarified.
WAC 388-97-210 Respite services.	Repealed. See new section 212.
WAC 388-97-212 Short term care, respite services and adult day and night care.	New section. Combined sections 210 and 215. Language rewritten for clarity and ease of use.
WAC 388-97-215 Adult day or night care.	Repealed. See new section 212.
WAC 388-97-220 Dialysis services.	Amended. Clarified.
WAC 388-97-225 Nursing facility care.	Repealed. Rewritten under new section 012.
WAC 388-97-230 Discrimination prohibited.	Repealed. Rewritten under new section 017.
WAC 388-97-235 Medical eligibility for nursing facility care.	Repealed. Rewritten under new section 022.
WAC 388-97-240 Nursing facility admission.	Repealed. Rewritten under new section 027.
WAC 388-97-245 Pre-admission screening.	Repealed. Sections 245, 250, and 255 were rewritten in new sections 247, 249, 251 and 253.
WAC 388-97-247 Pre-admission screening: Level I.	New section. Sections 247, 249, 251 and 253 are clarifications of repealed sections 245, 250 and 255. The new sections provide clearer direction to providers and implement 42 C.F.R. § 483. Subpart C.
WAC 388-97-249 Advance categorical determinations, not subject to pre-admission screening, Level II.	New section. See comment under new section 247.
WAC 388-97-250 Identification screening for current residents.	Repealed. See comment under section 245.
WAC 388-97-251 Pre-admission screening: Level II.	New section. See comment under new section 247.
WAC 388-97-253 Resident review.	New section. See comment under section 247.
WAC 388-97-255 Pre-admission screening and annual resident review (PASARR).	Repealed. See comment under section 245.
WAC 388-97-260 PASRR determination and appeal rights.	Amended. Clarified.
WAC 388-97-265 Utilization review.	Repealed. Rewritten under new section 037.
WAC 388-97-270 Individual transfer and discharge rights, procedures, appeals.	Repealed. Rewritten under new section 042.
WAC 388-97-275 Resident assessment instrument.	Repealed. Added to section 085.
WAC 388-97-280 Discharge or leave of a nursing facility resident.	Repealed. Rewritten under new section 047.
WAC 388-97-285 Intermediate care facilities for the mentally retarded.	New section. Compiled from ICF/MR issues covered in sections 115 and 175. It was felt that it would be easier for ICF/MR issues in Subchapter I to be in their own section as they are in Subchapter II.
Subchapter II
WAC 388-97-295 Design.	Amended. Placed general design requirements in this section.
WAC 388-97-29510 New construction compliance.	New section. Placed major issues surrounding new construction compliance in this section.
WAC 388-97-29520 Fire standards and approval, and other standards.	New section. Consolidated repealed sections 300 and 305.
WAC 388-97-29530 Maintenance and repair.	New section. Revised language from repealed section 380 to be under the general heading.
WAC 388-97-29540 Noise.	New section. Combined noise standards from repealed section 080 and 395 into one section.
WAC 388-97-29550 Accessibility in new construction.	New section. General requirement for accessibility moved from 465.
WAC 388-97-29560 Types of new construction.	New section. Consolidated types of new construction here for ease of use.
WAC 388-97-300 Fire standards and approval.	Repealed. See new section 29520.
WAC 388-97-305 Other standards.	Repealed. See new section 29520.
WAC 388-97-310 ICF/MR exceptions to physical plant requirements.	Amended. Revised with applicable new section numbers.
WAC 388-97-315 Emergency power.	Amended. Revised, clarified.
WAC 388-97-320 Space and equipment.	Repealed. Language included elsewhere in the subchapter, some in new section 29530.
WAC 388-97-325 Location of a resident care unit.	Amended. This section was "chunked" into additional new sections, 32510 through 32580. New construction language was added to applicable resident care unit sections.
WAC 388-97-32510 Required service areas on resident care units.	New section. See section 325.
WAC 388-97-32520 Staff work stations on resident care units.	New section. See section 325.
WAC 388-97-32530 Call systems on resident care units.	New section. See section 325.
WAC 388-97-32540 Telephones on resident care units.	New section. See section 325.
WAC 388-97-32550 Utility service rooms on resident care units.	New section. See section 325.
WAC 388-97-32560 Drug facilities on resident care units.	New section. See section 325.
WAC 388-97-32570 Linen storage on resident care units.	New section. See section 325.
WAC 388-97-32580 Janitors closets on resident care units.	New section. See section 325.
WAC 388-97-330 Resident rooms.	Amended. This section was "chunked" into additional new sections, 33010 through 33050. New construction language was added to applicable resident room sections.
WAC 388-97-33010 Capacity of resident rooms.	New section. See section 330.
WAC 388-97-33020 Size of resident rooms.	New section. See section 330.
WAC 388-97-33030 Privacy in resident rooms.	New section. See section 330.
WAC 388-97-33040 Resident isolation rooms.	New section. See section 330.
WAC 388-97-33050 Resident room size variance.	New section. See section 330.
WAC 388-97-335 Resident room equipment.	Amended. This section was "chunked" into additional new sections, 33510 through 33580. New construction language was added to applicable resident room equipment sections.
WAC 388-97-33510 Resident bed and bedside equipment.	New section. See section 335.
WAC 388-97-33520 Lockable storage space in resident rooms.	New section. See section 335.
WAC 388-97-33530 Wardrobes in resident rooms.	New section. See section 335.
WAC 388-97-33540 Seating in resident rooms.	New section. See section 335.
WAC 388-97-33550 Lighting in resident rooms.	New section. See section 335.
WAC 388-97-33560 Call signal devices in resident rooms.	New section. See section 335.
WAC 388-97-33570 Cubicle curtains in resident rooms.	New section. See section 335.
WAC 388-97-33580 Miscellaneous equipment in resident rooms in a new building or addition.	New section. See section 335.
WAC 388-97-340 Resident toilet facilities or rooms.	Amended. This section was "chunked" into additional new sections, 34010 through 34020. New construction language was added to applicable resident toilet and bathing facility sections.
WAC 388-97-34010 Resident bathing facilities or rooms.	New section. See section 340.
WAC 388-97-34020 Locks in toilet and bathing facilities.	New section. See section 340.
WAC 388-97-345 Dining, health services, recreation, and program areas.	Amended. Language revised for clarity.
WAC 388-97-347 Laundry services and storage.	New section. Moved some language from section 205 to provide physical plant direction for laundry facilities.
WAC 388-97-350 Dementia care unit.	Amended. This section was "chunked" into additional new sections, 35010 through 35060. New construction language was added to applicable dementia care unit sections.
WAC 388-97-35010 Dining areas on a dementia care unit.	New section. See section 350.
WAC 388-97-35020 Outdoor areas on a dementia care unit.	New section. See section 350.
WAC 388-97-35030 Indoor areas on a dementia care unit.	New section. See section 350.
WAC 388-97-35040 Ambulation areas on a dementia care unit.	New section. See section 350.
WAC 388-97-35050 Physical plant on a dementia care unit.	New section. See section 350.
WAC 388-97-35060 Automatic door locks on a dementia care unit.	New section. See section 350.
WAC 388-97-352 Specialized rehabilitation.	New section. Separated from the section (350) that now contains only dementia care unit requirements. Language revised, clarified.
WAC 388-97-353 Outpatient rehabilitation.	New section. Separated from the section (350) that now contains only dementia care unit requirements. Language revised, clarified.
WAC 388-97-355 Food service areas.	Amended. Revised.
WAC 388-97-357 Storage.	New section. Consolidated storage requirements from three sections, 325, 435, 445, under 357 through 35720. Used heading of storage.
WAC 388-97-35710 Storage of resident room equipment in a new building or addition.	New section. See section 357.
WAC 388-97-35720 General storage in new construction.	New section. See section 357.
WAC 388-97-360 Lighting and electrical.	Amended. This section was "chunked" into additional new sections, 36010 through 36070. New construction language was added to applicable lighting and electrical sections.
WAC 388-97-36010 Natural or artificial light.	New section. See section 360.
WAC 388-97-36020 Outside lighting.	New section. See section 360.
WAC 388-97-36030 Light shields.	New section. See section 360.
WAC 388-97-36040 Illumination levels in new buildings and additions.	New section. See section 360.
WAC 388-97-36050 Night lights in new construction.	New section. See section 360.
WAC 388-97-36060 Switches in new construction.	New section. See section 360.
WAC 388-97-36070 Electrical outlets.	New section. See section 360.
WAC 388-97-365 Safety.	Amended. Some subsections "chunked" into following section.
WAC 388-97-36510 Safety related to poisons and nonmedicinal chemicals.	New section. See section 365.
WAC 388-97-36520 Safety related to storage of equipment and supplies.	New section. See section 365.
WAC 388-97-36530 Safety related to handrails.	New section. See section 365.
WAC 388-97-370 Water supply.	Amended. This section was "chunked" into additional new sections, 37010 through 37020. New construction language was added to applicable water supply sections.
WAC 388-97-37010 Hot water.	New section. See section 370.
WAC 388-97-37020 Cross connections.	New section. See section 370.
WAC 388-97-375 Pest control.	Amended. Clarified.
WAC 388-97-380 Maintenance and repair.	Repealed. Revised language moved to new section 29530.
WAC 388-97-385 Sewage and liquid waste disposal.	Amended. Clarified.
WAC 388-97-390 General.	Repealed. Revised language moved to section 295.
WAC 388-97-395 Design requirements.	Repealed. Revised language moved to section 295.
WAC 388-97-400 General new construction documents.	Amended. This section was "chunked" into additional new sections, 40010 through 403. New construction language was added to applicable new construction document sections.
WAC 388-97-40010 Preliminary new construction documents.	New section. See section 400.
WAC 388-97-401 Final new construction documents.	New section. See section 400.
WAC 388-97-402 Pre-installation submissions for new construction.	New section. See section 400.
WAC 388-97-403 New construction timelines.	New section. See section 400.
WAC 388-97-405 Exemptions to new construction requirements.	Amended. Clarified.
WAC 388-97-410 Codes and standards in new construction.	Amended. Clarified language.
WAC 388-97-415 Electrical codes and standards in new construction.	Amended. Updated and clarified language.
WAC 388-97-420 Elevator codes in new construction.	Amended. Updated and clarified language.
WAC 388-97-425 Local codes and ordinances in new construction.	Amended. Updated and clarified language.
WAC 388-97-430 Entrances and exits in new construction.	Amended. This section was "chunked" into additional new sections, 43010 through 43050.
WAC 388-97-43010 Lobbies in new construction.	New section. See section 430.
WAC 388-97-43020 Interview space in new construction.	New section. See section 430.
WAC 388-97-43030 Offices in new construction.	New section. See section 430.
WAC 388-97-43040 Inservice education space in new construction.	New section. See section 430.
WAC 388-97-43050 Staff areas in new construction.	New section. See section 430.
WAC 388-97-435 Resident care unit.	Repealed. Revised language from this section was added to the applicable new sections under the resident care unit heading.
WAC 388-97-440 Resident rooms.	Repealed. Revised language from this section was added to the applicable new sections under the resident rooms heading.
WAC 388-97-445 Resident room equipment.	Repealed. Revised language from this section was added to the applicable new sections under the resident room equipment heading.
WAC 388-97-450 Resident toilet and bathing facilities.	Repealed. Revised language from this section was added to the applicable new sections under the resident toilet and bathing facilities heading.
WAC 388-97-455 Visiting and private space in new construction.	Amended. Some subsections from this section were moved to combine with existing facility language for the areas outlined. Another was "chunked" into an additional section, 45510.
WAC 388-97-45510 Outdoor recreation space and walkways in new construction.	New section. See section 455.
WAC 388-97-460 Pools in new construction.	Amended. Some subsections from this section were moved to combine with existing facility language for the areas outlined. Another was "chunked" into an additional section, 46010.
WAC 388-97-46010 Pharmacies in new construction.	New section. See section 46010.
WAC 388-97-465 Elevators in new construction.	Amended. This section was "chunked" into additional new sections, 46510 through 46595.
WAC 388-97-46510 Stairways, ramps, and corridors in new construction.	New section. See section 465.
WAC 388-97-46520 Walking surfaces in a new building or addition.	New section. See section 465.
WAC 388-97-46530 Doors in new construction.	New section. See section 465.
WAC 388-97-46540 Floor finishes in new construction.	New section. See section 465.
WAC 388-97-46550 Carpets in new construction.	New section. See section 465.
WAC 388-97-46560 Coving in new construction.	New section. See section 465.
WAC 388-97-46570 Walls in new construction.	New section. See section 465.
WAC 388-97-46580 Accessories in new construction.	New section. See section 465.
WAC 388-97-46590 Miscellaneous in new construction.	New section. See section 465.
WAC 388-97-470 Heating systems in new construction.	Amended. This section was "chunked" into additional new sections, 47010 through 47020.
WAC 388-97-47010 Cooling systems in new construction.	New section. See section 470.
WAC 388-97-47020 Ventilation systems in new construction.	New section. See section 470.
WAC 388-97-475 Electrical.	Repealed. Subsections moved to 315, and 360 through 36070.
WAC 388-97-480 Handwashing sinks in new construction.	Amended. This section was "chunked" into additional new sections, 48010 through 48040.
WAC 388-97-48010 Drinking fountains in new construction.	New section. See section 480.
WAC 388-97-48020 Mixing valves in new construction.	New section. See section 480.
WAC 388-97-48030 Spouts in new construction.	New section. See section 480.
WAC 388-97-48040 Faucet controls in new construction.	New section. See section 480.
Subchapter III
WAC 388-97-550 Initial nursing home license.	New section. Initial license requirements in repealed section 010 revised and written here.
WAC 388-97-555 Nursing home license renewal.	New section. License renewal requirements in repealed section 010 revised and written here.
WAC 388-97-560 Department review of initial nursing home license applications.	New section. This new section contains requirements from repealed section 015, revised and written here.
WAC 388-97-565 Department review of nursing home license renewal.	New section. This new section contains requirements from repealed section 015, revised and written here.
WAC 388-97-570 Reasons for denial, suspension, modification, refusal to renew, or revocation of a nursing home license.	New section. Moved from repealed section 050, revised and written here.
WAC 388-97-575 Appeal of the department's licensing decision.	New section. This new section provides information about the appeal process as it relates to a department licensing decision.
WAC 388-97-580 Management agreements.	New section. This new section spells out the requirements related to these agreements.
WAC 388-97-585 Change of ownership.	New section. Moved from repealed section 030, revised and written here.
WAC 388-97-590 Licensed bed capacity.	New section. Moved from repealed section 025, revised and written here.
WAC 388-97-595 Relocation of residents.	New section. Moved from repealed section 105, revised and written here.
WAC 388-97-600 License relinquishment.	New section. Moved from repealed section 045, revised and written here.

Statutory Authority for Adoption: RCW 18.51.070 and 74.42.620.

Statute Being Implemented: Chapters 18.51 and 74.42 RCW.

Summary: See Purpose above.

Reasons Supporting Proposal: See Purpose above.

Name of Agency Personnel Responsible for Drafting: Irene Owens, P.O. Box 45600, Olympia, WA 98504-5600, 1-800-422-3263, or (360) 438-8978; Implementation and Enforcement: NHQA, P.O. Box 45600, Olympia, WA 98504-5600, 1-800-422-3263, or (360) 438-8978.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: See Purpose above.

Proposal Changes the Following Existing Rules: See Purpose above.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the proposed rules and has determined that there is no increase in existing costs, no imposition of a new cost and no decrease in benefit to the providers.

RCW 34.05.328 applies to this rule adoption. These rules meet the definition of a significant legislative rule and a cost benefit analysis has been prepared. To request a copy see the staff person identified above.

Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on January 25, 2000, at 10:00 a.m.; and at Children and Family Services, 1313 North Atlantic Street, Suite 2000, SW Conference Room, Spokane, WA 99201, on January 27, 2000, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Paige Wall by January 14, 2000, phone (360) 664-6094, TTY (360) 664-6178, e-mail wallpg@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, Paige Wall, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by January 27, 2000.

Date of Intended Adoption: February 23, 2000.

November 18, 1999

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

Deemed sections are indicated by a statement at the beginning of the section and by the use of small capitalized print within the section. Deeming means the state requirement is similar to the cited federal requirement and if the federal requirement is met, the facility is deemed to meet the state requirement.))2667.8SUBCHAPTER I

((LICENSE AND OPERATIONS)) RESIDENT RIGHTS, CARE AND RELATED SERVICES

DEFINITIONS
AMENDATORY SECTION(Amending Order 3782, filed 9/15/94, effective 10/16/94)

WAC 388-97-005
Definitions.

(((1))) "Abandonment" means action or inaction by an individual or entity with a duty of care for a vulnerable adult that leaves the vulnerable individual without the means or ability to obtain necessary food, clothing, shelter, or health care.

"Abuse" means the willful action or inaction that inflicts injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Further clarification of the definition of abuse, and examples of types of behavior that constitute abuse are described in RCW 74.34.020(2).

"Advanced registered nurse practitioner (ARNP)" means a registered nurse currently licensed in Washington under RCW 18.88.175((, as now or hereafter amended.

(2))) or successor laws.

"ASHRAE" means the American Society of Heating, Refrigerating, and Air Conditioning Engineers, Inc.

(((3))) "Attending physician" means the doctor responsible for a particular ((person's)) individual's total medical care.

(((4) "Authenticated" means the authorization of a written entry in a record by signature, including the first initial and last name and title, or a unique identifier allowing identification of the responsible person.

(5))) "Berm" means a bank of earth piled against a wall.

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

(((7))) "Dementia care" means a therapeutic modality or modalities designed specifically for the care of persons with dementia.

(((8))) "Department" means the state department of social and health services (DSHS).

(((9))) "Dietitian" means a qualified dietitian.      A qualified dietitian is one who is registered by the American Dietetic Association or certified by the state of Washington.

(((10) "Directly supervising" means the supervising person is on the premises and is quickly and easily available to provide necessary:

(a) Assessments and other direct care of residents; and

(b) Oversight of supervised staff.

(11))) "Disclosure statement" means a signed statement by ((a person)) an individual indicating whether or not the ((person)) individual was found by any court, state licensing board, disciplinary board, or protection proceeding to have neglected, sexually abused, financially exploited, or physically abused any minor or adult ((person)) individual.

(((12))) "Drug" means a substance:

(((a))) (1) Recognized as a drug in the official United States Pharmacopoeia, Official Homeopathic Pharmacopoeia of the United States, Official National Formulary, or any supplement to any of them; or

(((b))) (2) Intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease.

(((13))) "Drug facility" means a room or area designed and equipped for drug storage and the preparation of drugs for administration.

(((14))) "Entity" means any type of firm, partnership, corporation, company, association, or joint stock association, and the legal successor(s).

"Financial exploitation" means the illegal or improper use of the property, income, resources, or trust funds of the vulnerable adult by any individual for his or her profit or advantage.

"Habilitative services" means the planned interventions and procedures which constitute a continuing and comprehensive effort to teach ((a person)) an individual previously undeveloped skills.

(((15))) "Intermediate care facility for the mentally retarded (ICF/MR)" means an institution certified under chapter 42 C.F.R., Part 483, Subpart I((.

(16) "Lavatory" means a handwashing sink.

(17))), and licensed under chapter 18.51 RCW.

"Licensed practical nurse" means ((a person)) an individual licensed under chapter ((18.78)) 18.79 RCW;

(((18))) "Misappropriation of resident property" means the illegal or improper, patterned or deliberate misplacement, exploitation, temporary or permanent use of a resident's belongings.

"NFPA" means National Fire Protection Association, Inc.

(((19))) "Neglect" means that an individual or entity with a duty of care for nursing home residents has by:

(1) A pattern of conduct or inaction, failed to provide goods and services to maintain physical or mental health or to avoid or prevent physical or mental harm or pain; or

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

"Nursing assistant" means a nursing assistant as defined under RCW 18.88A.020 ((as now or hereafter amended)) or successor laws.

(((20))) "Nursing facility (NF)" or "Medicaid-certified nursing facility" means a nursing facility as defined in Section 1919(a) of the Federal Social Security Act and regulations ((promulgated thereunder, as now or hereafter amended.

(21))) put into effect under that law, or under successor laws.

"Nursing home" means any facility licensed to operate under chapter 18.51 RCW.

(((22))) "Pharmacist" means ((a person)) an individual licensed by the Washington state board of pharmacy under chapter 18.64 RCW.

(((23))) "Pharmacy" means a place licensed under chapter 18.64 RCW where the practice of pharmacy is conducted.

(((24))) "Physical restraint" means any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that the resident cannot remove easily, and which restricts freedom of movement or access to the resident's body.

(((25))) "Physician's assistant (PA)" means a physician's assistant as defined under chapter 18.57A or 18.71A RCW((, as now or hereafter amended)) or successor laws.

(((26))) "Reasonable accommodation" and "reasonably accommodate" has the meaning given in federal and state anti-discrimination laws and regulations. For the purpose of this chapter:

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

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

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

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

(2) Reasonable accommodations are not required if:

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

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

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

"Registered nurse" means ((a person)) an individual licensed under chapter ((18.88)) 18.79 RCW((, as now or hereafter amended)) or successor laws.

(((27))) "Rehabilitative services" means the planned interventions and procedures which constitute a continuing and comprehensive effort to restore ((a person to the person's)) an individual to the individual's former functional and environmental status, or alternatively, to maintain or maximize remaining function.

(((28))) "Resident" generally means ((a person)) an individual residing in a nursing home, and if applicable, the surrogate decision maker. The term resident excludes outpatients and ((persons)) individuals receiving adult day or night care, or respite care.

(((29))) "Resident care unit" means a functionally separate unit including resident rooms, toilets, bathing facilities, and basic service facilities.

(((30))) "Respiratory isolation" is a technique or techniques instituted to prevent the transmission of pathogenic organisms by means of droplets and droplet nuclei coughed, sneezed, or breathed into the environment.

(((31))) "Siphon jet clinic service sink" means a plumbing fixture of adequate size and proper design for waste disposal with siphon jet or similar action sufficient to flush solid matter of at least two and one-eighth inches in diameter.

(((32))) "Skilled nursing facility (SNF)" or "Medicare-certified skilled nursing facility" means a skilled nursing facility as defined in Section 1819(a) of the Federal Social Security Act and regulations ((promulgated thereunder, as now or hereafter amended)) put into effect under that law, or successors to that law.

(((33))) "Social/therapeutic leave" means leave which is for the resident's social, emotional, or psychological well being; it does not include medical leave.

(((34))) "Staff work station" means a location at which nursing and other staff perform charting and related activities throughout the day.

(((35))) "Surrogate decision maker" means a resident representative or representatives as outlined in WAC 388-97-055((, Resident representative and decision making)), and as established by law under chapter 7.70 RCW.

(((36))) "Toilet room" means a room containing at least one toilet fixture.

(((37))) "Volunteer" means ((a person)) an individual who is a regularly scheduled ((person)) individual not receiving payment for services and having unsupervised access to a nursing home resident.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-005, filed 9/15/94, effective 10/16/94.]

The nursing facility must provide items, care, and services in accordance with this chapter and with federal regulations under 42 C.F.R. § 483.1 through 483.206, or successor laws, and other applicable federal requirements.

[]

(1) A nursing facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services covered under the state Medicaid plan for all individuals regardless of source of payment.

(2) A nursing facility must not require or request:

(a) Residents or potential residents to waive their rights to Medicare or Medicaid;

(b) Oral or written assurance that residents or potential residents are not eligible for, or will not apply for Medicare or Medicaid benefits; and

(c) A third party guarantee of payment to the facility as a condition of admission or expedited admission, or continued stay in the facility. However, the facility may require an individual who has legal access to a resident's income or resources available to pay for facility care to sign a contract, without incurring personal financial liability, to provide facility payment from the resident's income or resources.

(3) A nursing facility must inform, in writing, a prospective resident, and where applicable, the resident's representative, before or at the time of admission, that a third party may not be required or requested to personally guarantee payment to the nursing home, as specified in subsection (2)(c) of this section.

(4) A nursing facility must not:

(a) Deny or delay admission or readmission of an individual to the facility because of the individual's status as a Medicaid recipient;

(b) Transfer a resident, except from a single room to another room within the facility, because of the resident's status as a Medicaid recipient;

(c) Discharge a resident from a facility because of the resident's status as a Medicaid recipient; or

(d) Charge Medicaid recipients any amounts in excess of the Medicaid rate from the date of eligibility, except for any supplementation that may be permitted by department regulation.

(5) A nursing facility must maintain only one list of names of individuals seeking admission to the facility, which is ordered by the date of request for admission, and must:

(a) Offer admission to individuals in the order they appear on the list, provided the facility can meet the needs of the individual with available staff or through the provision of reasonable accommodations required by state or federal laws;

(b) Retain the list of individuals seeking admission for one year from the month admission was requested; and

(c) Offer admission to the portions of the facility certified under Medicare and Medicaid without discrimination against persons eligible for Medicaid.

(6) A nursing facility must develop and implement written policies and procedures to ensure nondiscrimination in accordance with this section and RCW 74.42.055.

[]

(1) An individual eligible for nursing facility care is one who requires more than supervision, protection, and limited assistance with activities of daily living, because of medical, physical and/or cognitive problems.

(2) An individual will be eligible for nursing facility care if he or she is found by the department to:

(a) Have complex medical needs that require care provided by or under the supervision of a registered nurse or a licensed practical nurse on a daily basis; or

(b) Require assistance in two or more activities of daily living (ADL). Activities of daily living include bed mobility, transferring from one surface to another, walking, dressing, eating, toilet use, personal hygiene, and bathing; or

(c) Be moderately impaired in cognitive decision making regarding tasks of daily life, and require extensive assistance in at least one ADL. "Moderately impaired" means that the individual's decisions are poor, and that reminders, cues, and supervision are required to assist the individual in planning, organizing, and correcting daily routines.

[]

(1) A nursing facility must not admit any individual unless:

(a) The physician, hospital, department, or department designee screens the individual for the presence of a serious mental illness or a developmental disability as required under WAC 388-97-247;

(b) The department assesses any Medicaid applicant or recipient and determines that the individual meets financial eligibility requirements, and the medical eligibility requirements described in WAC 388-97-022; and

(c) For an individual admitted on a weekend, holiday, or after business hours, the nursing facility or hospital requests an assessment from the department.

(2) For current residents converting from another payment source to Medicaid, Medicaid payment will begin on the date of the:

(a) Financial application for nursing facility care; or

(b) Request for an assessment, whichever is earlier.

(3) For current residents converting to Medicaid, Medicaid payment will go back no more than three months prior to the date of the financial application.

(4) For new admissions, who have been determined to meet the financial and medical eligibility criteria for Medicaid nursing facility care prior to admission, Medicaid payment will begin the date Medicaid covered nursing facility care actually begins.

(5) A nursing facility must not collect payment, including a deposit or minimum stay fee, from a Medicaid-eligible individual, or that individual's family or representative, for any services provided prior to the date the nursing facility makes a request to the department for an assessment.

[]

(1) A resident has the right to attain or maintain the highest practicable physical, mental, and psychosocial well-being, and to reside in the most independent setting. Therefore, the nursing home must:

(a) Utilize a formal resident discharge planning system with identical policies and practices for all residents regardless of source of payment;

(b) Inform the resident or resident's representative in writing of the nursing home's discharge planning system when the resident is admitted or as soon as practical after the resident's admission, including:

(i) Specific resources available to assist the resident in locating a lesser care setting;

(ii) The name of the nursing home's discharge coordinator(s);

(iii) In the case of a Medicaid certified nursing facility, the address and telephone number for the department's local home and community services office; and

(iv) In the case of a resident identified through pre-admission screening and resident review (PASRR) as having a developmental disability or mental illness, the address and telephone number for the division of developmental disabilities or the mental health PASRR contractor.

(2) The nursing home must prepare a detailed, written transfer or discharge plan for each resident determined to have potential for transfer or discharge within the next three months. The nursing home must:

(a) Develop and implement the plan with the active participation of the resident and, where appropriate, the resident's representative;

(b) In the case of a Medicaid resident, coordinate the plan with the department's home and community services staff;

(c) In the case of a resident identified through PASRR as having a developmental disability or mental illness, coordinate the plan with the division of developmental disabilities or the mental health PASRR contractor;

(d) Ensure the plan is an integral part of the resident's comprehensive plan of care and, as such, includes measurable objectives and timetables for completion;

(e) Incorporate in the plan relevant factors to include, but not be limited to:

(i) The resident's preferences;

(ii) Support system;

(iii) Assessments and plan of care; and

(iv) Availability of appropriate resources to match the resident's preferences and needs.

(f) Identify in the plan specific options for more independent placement; and

(g) Provide in the plan for the resident's continuity of care, and to reduce potential transfer trauma, including, but not limited to, pre-transfer visit to the new location whenever possible.

(3) For a resident whose transfer or discharge is not anticipated in the next three months, the nursing home must:

(a) Document the specific reasons transfer or discharge is not anticipated in that time frame;

(b) Review the resident's potential for transfer or discharge at the time of the quarterly comprehensive plan of care review. If the reasons documented under subsection (3)(a) of this section are unchanged, no additional documentation of reasons is necessary at the time of plan of care review.

(4) The nursing home must initiate discharge planning on residents described in subsection (3) of this section:

(a) At the request of the resident or the resident's representative; and

(b) When there is a change in the resident's situation or status which indicates a potential for transfer or discharge within the next three months.

(5) Each resident has the right to request transfer or discharge and to choose a new location. If the resident chooses to leave, the nursing home must assist with and coordinate the resident's transfer or discharge. The Medicaid resident, resident's representative, or nursing facility may request assistance from the department's home and community services or, where applicable, the division of developmental disabilities or mental health in the transfer or discharge planning and implementation process.

(6) The nursing home must coordinate all resident transfers and discharges with the resident, the resident's representative and any other involved individual or entity.

(7) When a nursing home anticipates discharge, a resident must have a discharge summary that includes:

(a) A recapitulation of the resident's stay;

(b) A final summary of the resident's status to include items in WAC 388-97-085(1), at the time of discharge that is available for release to authorized individuals and agencies, with the consent of the resident or and surrogate decision maker; and

(c) A post-discharge plan of care that is developed with the participation of the resident and his or her family, which will assist the resident to adjust to his or her new living environment.

[]

(1) To assure appropriate use of Medicaid services, the nursing facility must determine whether each Medicaid resident's health has improved sufficiently so the resident no longer needs nursing facility care.

(a) The nursing facility must base its determination on:

(i) An accurate, comprehensive assessment process; and

(ii) Documentation by the resident's physician.

(b) The nursing facility must not make this determination for residents the department is responsible to assess under WAC 388-97-251.

(2) When the nursing facility determines a resident no longer needs nursing facility care under subsection (1) of this section, the nursing facility must initiate transfer or discharge in accordance with WAC 388-97-042, 388-97-043, and 42 C.F.R. § 483.12, or successor laws, unless the resident voluntarily chooses to transfer or discharge.

(3) When a nursing facility initiates a transfer or discharge of a Medicaid recipient under subsection (2) of this section:

(a) The resident will be ineligible for Medicaid nursing facility payment:

(i) Thirty days after the receipt of written notice of transfer or discharge; or

(ii) If the resident appeals the facility determination, thirty days after the final order is entered upholding the nursing home's decision to transfer or discharge a resident.

(b) The department's home and community services may grant extension of a resident's Medicaid nursing facility payment after the time specified in subsection (3)(a) of this section, when the department's home and community services staff determine:

(i) The nursing facility is making a good faith effort to relocate the resident; and

(ii) A location appropriate to the resident's medical and other needs is not available.

(4) Department designees may review any assessment or determination made by a nursing facility of a resident's need for nursing facility care.

[]

(1) The nursing home must comply with all of the requirements of 42 C.F.R. § 483.10 and § 483.12, and RCW 74.42.450 (1) through (4) and (7), or successor laws, including the following provisions and must not transfer or discharge any resident from the nursing home unless:

(a) At the resident's request;

(b) The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility;

(c) The transfer or discharge is appropriate because the resident's health has improved enough so the resident no longer needs the services provided by the facility;

(d) The safety of individuals in the facility is endangered;

(e) The health of individuals in the facility would otherwise be endangered; or

(f) The resident has failed, after reasonable and appropriate notice, to pay for a stay at the facility.

(2) The following notice requirements apply if a nursing home/facility initiates the transfer or discharge of a resident. The notice must:

(a) Include all information required by 42 C.F.R. § 483.12 when given in a nursing facility;

(b) Be in writing, in language the resident understands;

(c) Be given to the resident, the resident's surrogate decision maker, if any, the resident's family and to the department;

(d) Be provided thirty days in advance of a transfer or discharge initiated by the nursing facility, except that the notice may be given as soon as practicable when the facility cannot meet the resident's urgent medical needs, or under the conditions described in (1)(c), (d), and (e) of this section; and

(e) Be provided fifteen days in advance of a transfer or discharge initiated by the nursing home, unless the transfer is an emergency.

(3) The nursing home must:

(a) Provide sufficient preparation and orientation to the resident to ensure safe and orderly transfer or discharge from the nursing home;

(b) Attempt to avoid the transfer or discharge of a resident from the nursing home through the use of reasonable accommodations unless agreed to by the resident and the requirements of WAC 388-97-032 are met; and

(c) Develop and implement a bed-hold policy. This policy must be consistent with any bed-hold policy that the department develops.

(4) The nursing home must provide the bed-hold policy, in written format, to the resident, and a family member, before the resident is transferred or goes on therapeutic leave. At a minimum the policy must state:

(a) The number of days, if any, the nursing home will hold a resident's bed pending return from hospitalization or social/therapeutic leave;

(b) That a Medicaid eligible resident, whose hospitalization or social/therapeutic leave exceeds the maximum number of bed-hold days will be readmitted to the first available semi-private bed, provided the resident needs nursing facility services. Social/therapeutic leave is defined under WAC 388-97-005. The number of days of social/therapeutic leave allowed for Medicaid residents and the authorization process is found under WAC 388-97-047; and

(c) That a Medicaid eligible resident may be charged if he or she requests that a specific bed be held, but may not be charged a bed-hold fee for the right to return to the first available bed in a semi-private room.

(5) The nursing facility must send a copy of the federally required transfer or discharge notice to:

(a) The department's home and community services when the nursing home has determined under WAC 388-97-037, that the Medicaid resident's health has improved sufficiently so that the resident no longer needs the services provided by the facility; and

(b) The appropriate nursing home quality assurance district manager when the transfer or discharge is for any of the following reasons:

(i) The resident's needs cannot be met in the facility;

(ii) The health or safety of individuals in the facility is endangered; or

(iii) The resident has failed to pay for, or to have paid under Medicare or Medicaid, a stay at the facility.

[]

(1) A skilled nursing facility and a nursing facility that initiates transfer or discharge of any resident, regardless of payment status, must:

(a) Provide the required written notice of transfer or discharge to the resident and, if appropriate, to a family member or the resident's representative;

(b) Attach a department-designated hearing request form to the transfer or discharge notice;

(c) Inform the resident in writing, in a language and manner the resident can understand, that:

(i) An appeal request may be made any time up to ninety days from the date the resident receives the notice of transfer or discharge; and

(ii) Transfer or discharge will be suspended when an appeal request is received by the office of administrative hearings on or before the date the resident actually transfers or discharges; and

(iii) The nursing home will assist the resident in requesting a hearing to appeal the transfer or discharge decision.

(2) A skilled nursing facility or nursing facility must suspend transfer or discharge pending the outcome of the appeal when the resident's appeal is received by the office of administrative hearings on or before the date of the transfer or discharge set forth in the written transfer or discharge notice, or before the resident is actually transferred or discharged.

(3) The resident is entitled to appeal the nursing facility's transfer or discharge decision. The appeals process is set forth in chapter 388-08 WAC and this chapter. In such appeals, the following will apply:

(a) In the event of a conflict between a provision in this chapter and a provision in chapter 388-08 WAC, the provision in this chapter will prevail;

(b) The resident shall be the appellant and the skilled nursing facility or the nursing facility will be the respondent;

(c) The department must be notified of the appeal and may choose whether to participate in the proceedings. If the department chooses to participate, its role is to represent the state's interest in assuring that skilled nursing facility and nursing facility transfer and discharge actions comply substantively and procedurally with the law and with federal requirements necessary for federal funds;

(d) If a Medicare certified or Medicaid certified facility's decision to transfer or discharge a resident is not upheld, and the resident has been relocated, the resident has the right to readmission immediately upon the first available bed in a semi-private room if the resident requires and is eligible for the services provided by the nursing facility or skilled nursing facility.

[]

(1) A nursing facility or hospital must send immediate written notification of the date of discharge or death of a Medicaid resident to the department's local home and community service office.

(2) The nursing facility must:

(a) Notify the department of nursing facility discharge and readmission for all Medicaid recipients admitted as hospital inpatients; and

(b) Document in the resident's clinical record all social/therapeutic leave exceeding twenty-four hours.

(3) The department will pay the nursing facility for a Medicaid resident's social/therapeutic leave not to exceed a total of eighteen days per calendar year per resident.

(4) The department's home and community services may authorize social/therapeutic leave exceeding eighteen days per calendar year per resident when requested by the nursing facility or by the resident. In the absence of prior authorization from the department's home and community services, the department will not make payment to a nursing facility for leave days exceeding eighteen per calendar year per resident.

(5) An individual who is on social/therapeutic leave retains the status of a nursing facility resident.

[]

(1) The nursing home must meet the resident rights requirements of this section and those in the rest of the chapter.

(2) The resident has a right to a dignified existence, self-determination, and communication with, and access to individuals and services inside and outside the nursing home.

(3) A nursing home must promote and protect the rights of each resident, including those with limited cognition or other barriers that limit the exercise of rights.

(4) The resident has the right to:

(a) Exercise his or her rights as a resident of the nursing home and as a citizen or resident of the United States. Refer to WAC 388-97-055;

(b) Be free of interference, coercion, discrimination, and reprisal from the nursing home in exercising his or her rights; and

(c) Not be asked or required to sign any contract or agreement that includes provisions to waive:

(i) Any resident right set forth in this chapter or in the applicable licensing or certification laws; or

(ii) Any potential liability for personal injury or losses of personal property.

(5) The nursing home must take steps to safeguard residents and their personal property from foreseeable risks of injury or loss.

[]

The resident has the right to:

(1) Choose a personal attending physician.

(2) Be fully informed in advance about care and treatment and of any changes in that care or treatment that may affect the resident's well-being.

(3) Participate in planning care and treatment or changes in care and treatment.

[]

WAC 388-97-055, 388-97-060, and 388-97-065 implement the federal Patient Self-Determination Act and clarify requirements under chapters 11.94; 7.70; 70.122; 11.88; and 11.92 RCW.

[]

(1) At the time of admission, or not later than the completion of the initial comprehensive resident assessment, the nursing home ((shall)) must determine if the resident:

(a) ((Whether the resident)) Has appointed another ((person)) individual to make his or her health care, financial, or other decisions ((for the resident));

(b) ((Whether the resident)) Has created any advance directive or other legal documents that will establish a surrogate decision maker in the future; and

(c) ((If a resident)) Is not making ((the resident's)) his or her own decisions, and identify who has the authority for surrogate decision making, and the scope of the surrogate decision maker's authority.

(2) The nursing home must review the requirements of (1) of this section when the resident's condition warrants the review or when there is a significant change in the resident's condition.

(3) In fulfilling its duty to determine who, if anyone, is authorized to make decisions for the resident, the nursing home ((shall)) must:

(a) ((Seek)) Obtain copies of the legal documents that establish the surrogate decision maker's authority to act; and

(b) Document in the resident's clinical record:

(i) The name, address, and telephone number of the ((person)) individual who has legal authority for substitute decision making;

(ii) The type of decision making authority such ((person)) individual has; and

(iii) Where copies of the legal documents are located at the facility.

(((3) In this chapter, the term "resident" includes the resident's surrogate decision maker))

(4) In accordance with state law or at the request of the resident((.)), the resident's surrogate decision maker is, in the case of:

(a) ((In the case of)) A capacitated resident, ((the surrogate decision maker is the person)) the individual authorized by the resident to make decisions on the resident's behalf;

(b) ((In the case of)) A resident adjudicated by a court of law to be incapacitated, ((the surrogate decision maker is)) the court appointed guardian; and

(c) ((In the case of)) A resident who has been determined to be incapacitated, but is not adjudicated incapacitated((, the surrogate decision maker is)) established through:

(i) A legal document, such as a durable power of attorney for health care; or

(ii) Authority for substitute decision making granted by state law, including RCW 7.70.065.

(((4))) (5) Determination of ((a person's incapacity shall be a legal, not medical decision)) an individual's incapacity must be a process according to state law not a medical diagnosis only and be based on:

(a) Demonstrated inability in decision making over time that creates a significant risk of personal harm;

(b) A court order; or

(c) The criteria contained in a legal document, such as durable power of attorney for health care.

(((5) The nursing home shall:

(a) Regularly review any determination of incapacity based on subsections (3)(b) and (c) of this section; and

(b) If an incapacitated resident regains capacity, cease to rely upon the surrogate decision maker to exercise the resident's rights, unless so designated by the resident or by court order.))

(6) The nursing home ((shall)) must promote the resident's right to exercise decision making and self-determination to the fullest extent possible, taking into consideration his or her ability to understand and respond.      Therefore, the nursing home ((shall)) must presume that the resident is the resident's own decision maker unless:

(a) A court has established a full guardianship of the individual;

(b) The capacitated resident has clearly and voluntarily appointed a surrogate decision maker;

(c) A surrogate is established by a legal document such as a durable power of attorney for health care; or

(d) ((A resident has become legally incapacitated)) The facility determines that the resident is an incapacitated individual according to RCW 11.88.010.

(7) The nursing home ((shall)) must honor the exercise of the resident's rights by the surrogate decision maker as long as the surrogate acts in accordance with this section and with state and federal law which govern his or her appointment((, and with this section)).

(8) If a surrogate decision maker exercises a resident's rights, the nursing home ((shall)) must take into consideration the resident's ability to understand and respond and must:

(a) Inform the resident that a surrogate decision maker has been consulted;

(b) Provide the resident with the information and opportunity to participate in all decision making to the maximum extent possible; and

(c) Recognize that involvement of a surrogate decision maker does not lessen the nursing home's duty to:

(i) Protect the resident's rights; and

(ii) Comply with state and federal laws.

(9) The nursing home must:

(a) Regularly review any determination of incapacity based on (4)(b) and (c) of this section;

(b) Except for residents with a guardian, cease to reply upon the surrogate decision maker to exercise the resident's rights, if the resident regains capacity, unless so designated by the resident or by court order; and

(c) In the case of a guardian, notify the court of jurisdiction, in writing, if the resident regains capacity, if the guardian is not respecting or promoting the resident's rights, or if the guardianship should be modified or a different guardian appointed.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-055, filed 9/15/94, effective 10/16/94.]

(1) ((The nursing home as a health care provider as defined in chapter 7.70 RCW, Actions for injuries resulting from health care, shall follow the informed consent process as required in chapter 7.70 RCW in the development of the resident's comprehensive care plan.      Refer to WAC 388-97-090, Comprehensive care planning.

(2))) The nursing home ((shall follow this)) must ensure that the informed consent process is followed with:

(a) The resident to the maximum extent possible, taking into consideration his or her ability to understand and respond; and

(b) ((Any other person the resident has directed be consulted; and

(c))) The surrogate decision maker when the resident is determined to be incapacitated as established through the provision of a legal document such as durable power of attorney for health care, a court proceeding, or as authorized by state law, including RCW 7.70.065.

(2) The informed consent process must include, in words and language that the resident, or if applicable the resident's surrogate decision maker, understands, a description of:

(a) The nature and character of the proposed treatment;

(b) The anticipated results of the proposed treatment;

(c) The recognized possible alternative forms of treatment;

(d) The recognized serious possible risks, complications, and anticipated benefits involved in the treatment and in the recognized possible alternative forms of treatment including nontreatment; and

(e) The right of the resident to choose not to be informed.

(3) To ensure informed consent or refusal by a resident, or if applicable the resident's surrogate decision maker, regarding ((care)) plan or care options, the nursing home ((shall)) must:

(a) Provide the informed consent process to the resident in a neutral manner and in a language, words, and manner the resident can understand;

(b) Inform the resident of the right to consent to or refuse care and service options at the time of resident assessment and ((care)) plan of care development (see WAC 388-97-085 and 388-97-090) and with condition changes, as necessary to ensure that the resident's wishes are known;

(c) Inform the resident at the time of initial ((care)) plan of care decisions and periodically of the right to change his or her mind about an earlier consent or refusal decision;

(d) Ensure that evidence of informed consent or refusal is consistent with WAC 388-97-085((, Resident assessment)) and ((WAC)) 388-97-090((, Comprehensive care planning)); and

(e) Where appropriate, include evidence of resident's choice not to be informed as required in subsections (((1))) (2) and (3) of this section.

(4) The nursing home ((shall)) must take into account that if a resident's rights are being exercised by a surrogate decision maker, the surrogate decision maker ((shall)) must:

(a) First determine if the resident would consent or refuse the proposed or alternative treatment;

(b) Discuss determination of consent or refusal with the resident whenever possible; and

(c) When a determination of the resident's consent or refusal of treatment cannot be made, make the decision in the best interest of the resident.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-060, filed 9/15/94, effective 10/16/94.]

(1) "Advance directive" as used in this chapter means any document indicating a resident's choice with regard to a specific service, treatment, medication or medical procedure option that may be implemented in the future such as power of attorney, health care directive, limited or restricted treatment ((order, code/no code order)) cardiopulmonary resuscitation (CPR), do not resuscitate (DNR), and anatomical gifts.

(2) The nursing home ((shall)) must carry out the provisions of this section in accordance with WAC 388-97-055((, Resident representative and decision making,)) and ((WAC)) 388-97-060((, Informed consent)), and with state law.

(3) The nursing home ((shall)) must:

(a) Document in the clinical record whether or not the resident has an advance directive;

(b) Not request or require the resident to have any advance directives and not condition the provision of care or otherwise discriminate against a resident on the basis of whether or not the resident has executed an advance directive;

(c) In a language and words the resident understands, inform the resident in writing and orally at the time of admission, and thereafter as necessary to ensure the resident's right to make informed choices, about:

(i) The right to make health care decisions, including the right to change his or her mind regarding previous decisions;

(ii) Nursing home policies and procedures concerning implementation of advance directives, including how the nursing home implements emergency responses; and

(d) Review and update as needed the resident advance directive information:

(i) At the resident's request;

(ii) When the resident's condition warrants review; and

(iii) When there is a significant change in the resident's condition.

(((e) If needed, based on the outcome of the review in subsection (3)(d) of this section, update advance directive information.))

(4) When the nursing home becomes aware that a resident's health care directive is in conflict with facility practices and policies which are consistent with state and federal law, the nursing home ((shall)) must:

(a) Inform the resident of the existence of any nursing home practice or policy which would preclude implementing the health care directive;

(b) Provide the resident with written policies and procedures that explain under what circumstances a resident's health care directive will or will not be implemented by the nursing home;

(c) Meet with the resident to discuss the conflict; and

(d) Determine, in light of the conflicting practice or policy, whether the resident chooses to remain at the nursing home((; and

(e) Develop a plan in accordance with subsection (5) of this section; and

(f) Attach the plan to the resident's directive in the clinical record.

(5))):

(i) If the resident chooses to remain in the nursing home, develop with the resident a plan in accordance with chapter 70.122 RCW to implement the resident's wishes.      The nursing home may need to actively participate in ensuring the execution of the plan, including moving the resident at the time of implementation to a care setting that will implement the resident's wishes((.

(6))). Attach the plan to the resident's directive in the resident's clinical record; or

(ii) If, after recognizing the conflict between the resident's wishes and nursing home practice or policy ((as determined in subsection (4)(b) of this section,)) the resident chooses to seek other long-term care services, or another physician who will implement the directive, the nursing home ((shall)) must assist the resident in locating other appropriate services.

(((7))) (5) If a terminally ill resident, in accordance with state law, wishes to die at home, the nursing home ((shall)) must:

(a) Use the informed consent process as described in WAC ((388-97-120, Informed consent)) 388-97-060, and explain to the resident the risks associated with discharge; and

(b) Discharge the resident as soon as reasonably possible.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-065, filed 9/15/94, effective 10/16/94.]

(1) The nursing home must inform the resident, before admission, or at the time of admission in the case of an emergency, and as changes occur during the resident's stay, both orally and in writing and in language and words that the resident understands, of his or her rights as a resident, including:

(a) All rules and regulations governing resident conduct and responsibilities during the stay in the nursing home;

(b) Advanced directives, and of any facility policy or practice that might conflict with the resident's advance directive if made;

(c) Advance notice or transfer requirements, consistent with RCW 70.129.150;

(d) Advance notice of deposits and refunds, consistent with RCW 70.129.150; and

(e) Items, services and activities available in the facility and of charges for those services, including any charges for services not covered under Medicare or Medicaid or by the facility's per diem rate.

(2) The resident has the right:

(a) Upon an oral or written request, to access all records pertaining to the resident including clinical records within twenty-four hours for Medicare certified and Medicaid certified facilities, and according to chapter 70.02 RCW; and

(b) After receipt of his or her records for inspection, to purchase at a cost not to exceed twenty-five cents a page, photocopies of the records or any portions of them upon request and two working days advance notice to the nursing home. For the purposes of this chapter, "working days" means Monday through Friday, except for legal holidays.

(3) The resident has the right to:

(a) Be fully informed in words and language that he or she can understand of his or her total health status, including, but not limited to, his or her medical condition;

(b) Accept or refuse treatment; and

(c) Refuse to participate in experimental research.

(4) The Medicare certified and Medicaid certified facility must inform each resident:

(a) Who is entitled to Medicaid benefits, in writing, prior to the time of admission to the nursing facility or, when the resident becomes eligible for Medicaid of the items, services and activities:

(i) That are included in nursing facility services under the Medicaid state plan and for which the resident may not be charged; and

(ii) That the facility offers and for which the resident may be charged, and the amount of charges for those services;

(b) That deposits and prepayment cannot be solicited or accepted from Medicare or Medicaid eligible residents; and

(c) That minimum stay requirements cannot be imposed on Medicare or Medicaid eligible residents.

(5) The nursing home must, except for emergencies, inform each resident in writing, thirty days in advance before changes are made to the availability or charges for items, services or activities specified in section (4)(a)(i) and (ii), or before changes to the facility rules.

(6) The private pay resident has the right to the following, regarding fee disclosure-deposits:

(a) Prior to admission, a nursing home that requires payment of an admission fee, deposit, or a minimum stay fee, by or on behalf of an individual seeking admission to the facility, must provide the individual:

(i) Full disclosure in writing:

(A) Of the nursing home's schedule of charges for items, services, and activities provided by the facility; and

(B) Prior to admission of what portion of the deposits, admissions fees, or minimum stay fee will be refunded to the resident if the resident leaves the facility.

(ii) The amount of any admission fees, deposits, or minimum stay fees.

(b) If a resident dies or is hospitalized or is transferred and does not return to the facility, the nursing home:

(i) Must refund any deposit or charges already paid, less the facility's per diem rate, for the days the resident actually resided or reserved or retained a bed in the facility, regardless of any minimum stay or discharge notice requirements; except that

(ii) The facility may retain an additional amount to cover its reasonable, actual expenses incurred as a result of a private pay resident's move, not to exceed five days per diem charges, unless the resident has given advance notice in compliance with the admission agreement.

(c) The nursing home must refund any and all refunds due the resident within thirty days from the resident's date of discharge from the facility; and

(d) Where the nursing home requires the execution of an admission contract by or on behalf of an individual seeking admission to the facility, the terms of the contract must be consistent with the requirements of this section.

(7) The nursing home must furnish a written description of legal rights which includes:

(a) A description of the manner of protecting personal funds, under WAC 388-97-07015.

(b) In the case of a nursing facility only, a description of the requirements and procedures for establishing eligibility for Medicaid, including the right to request an assessment which determines the extent of a couple's nonexempt resources at the time of institutionalization and attributes to the community spouse an equitable share of resources which cannot be considered available for payment toward the cost of the institutionalized spouse's medical care in his or her process of spending down to Medicaid eligibility levels;

(c) A posting of names, addresses, and telephone numbers of all relevant state client advocacy groups such as the state survey and certification agency, the state licensure office, the state ombudsman program, the protection and advocacy network, and the Medicaid fraud control unit; and

(d) A statement that the resident may file a complaint with the state survey and certification agency concerning resident abandonment, abuse, neglect, financial exploitation, and misappropriation of resident property in the nursing home.

(8) The nursing home must:

(a) Inform each resident of the name, and specialty of the physician responsible for his or her care; and

(b) Provide a way for each resident to contact his or her physician.

(9) The skilled nursing facility and nursing facility must prominently display in the facility written information, and provide to residents and applicants for admission oral and written information, about how to apply for and use Medicare and Medicaid benefits, and how to receive refunds for previous payments covered by such benefits.

(10) The written information provided by the nursing home pursuant to this section, and the terms of any admission contract executed between the nursing home and an individual seeking admission to the nursing home, must be consistent with the requirements of chapters 74.42 and 18.51 RCW and, in addition, for facilities certified under Medicare or Medicaid, with the applicable federal requirements.

[]

(1) A nursing home must immediately inform the resident, consult with the resident's physician, and if known, notify the resident's surrogate decision maker, and when appropriate, with resident consent, interested family member(s) when there is:

(a) An accident involving the resident which results in injury and has the potential for requiring physician intervention;

(b) A significant change in the resident's physical, mental, or psychosocial status (i.e., a deterioration in health, mental, or psychological status in either life-threatening conditions or clinical complications); refer to WAC 388-97-055;

(c) A need to alter treatment significantly (i.e., a need to discontinue an existing form of treatment due to adverse consequences, or to commence a new form of treatment); or

(d) A decision to transfer or discharge the resident from the facility.

(2) The nursing home must also promptly notify the resident and, if known, the resident's surrogate decision maker, and when appropriate, with the resident's consent, interested family member(s) when there is:

(a) A change in room or roommate assignment, refer to the timing requirements in WAC 388-97-07065; or

(b) A change in resident rights under federal or state law or regulations as specified in WAC 388-97-07005.

(3) The nursing home must record and periodically update the address and phone number of the resident's legal surrogate decision maker and interested family member(s).

[]

(1) The resident has the right to manage his or her financial affairs and the nursing home may not require residents to deposit their personal funds with the nursing home.

(2) Upon written authorization of a resident, the nursing home must hold, safeguard, manage and account for the personal funds of the resident deposited with the nursing home.

(3) The nursing home must establish and maintain a system that assures a full, complete and separate accounting, according to generally accepted accounting principles, of each resident's personal funds entrusted to the nursing home on the resident's behalf and must:

(a) Deposit any resident's personal funds in excess of fifty dollars, one hundred dollars for Medicare residents, in an interest-bearing resident personal fund account or accounts, separate from any nursing home operating accounts, and credit all interest earned to the account;

(b) Keep personal funds under fifty dollars, one hundred dollars for Medicare residents, in a noninterest-bearing account or petty cash fund maintained for residents; and

(c) Make the individual financial record available to the resident or his or her surrogate decision maker through quarterly statements and on request.

(4) The nursing facility must notify each resident that receives Medicaid benefits:

(a) When the amount in the resident's account reaches two hundred dollars less than the SSI resource limit for one individual; and

(b) That if the amount in the account, in addition to the value of the resident's other nonexempt resources, reaches the SSI resource limit for one individual, the resident may lose eligibility for Medicaid or SSI.

(5) The nursing home must convey the resident's funds, and a final accounting of those funds, to the individual or jurisdiction administering the resident's estate, within thirty days of the death of any resident with a personal fund deposited with the nursing home. For a Medicaid resident, the funds must be sent to the state of Washington, department of social and health services, office of financial recovery.

(6) The nursing facility must purchase a surety bond, or an approved alternative, to assure security of personal funds of residents deposited with the facility.

(7) Medicare certified and Medicaid certified facilities may not impose a charge against a resident's personal funds for any item or service for which payment is made under Medicaid or Medicare as described in 42 C.F.R. § 483.10 (c)(8).

(8) Medicare certified and Medicaid certified nursing facilities must:

(a) Not charge a resident (or the resident's representative) for any item or service not requested by the resident;

(b) Not require a resident, or the resident's representative, to request any item or service as a condition of admission or continued stay; and

(c) Inform the resident, or the resident's representative, requesting an item or services for which a charge will be made that there will be a charge for the item or service and what the charge will be.

[]

(1) The resident has the right to personal privacy and confidentiality of his or her personal and clinical records. Personal privacy includes:

(a) Accommodations;

(b) Medical treatment;

(c) Written and telephone communications

(d) Personal care;

(e) Visits; and

(f) Meetings with family and resident groups.

(2) The resident may approve or refuse the release of personal and clinical records to any individual outside the nursing home, unless the resident has been adjudged incapacitated according to state law.

(3) The resident's right to refuse release of personal and clinical records does not apply when:

(a) The resident is transferred to another health care institution; or

(b) Record release is required by law.

[]

The resident has the right to:

(1) Refuse to perform services for the nursing home; and

(2) Perform services for the nursing home, if he or she chooses, when:

(a) The facility has documented the need or desire for work in the plan of care;

(b) The plan specifies the nature of the services performed and whether the services are voluntary or paid;

(c) Compensation for paid services is at or above prevailing rates; and

(d) The resident agrees to the work arrangement described in the plan of care.

[]

A resident may self-administer drugs if the interdisciplinary team has determined that this practice is safe.

[]

A resident has the right to:

(1) Voice grievances without discrimination or reprisal. Grievances include those with respect to treatment which has been furnished as well as that which has not been furnished.

(2) Prompt efforts by the nursing home to resolve voiced grievances, including those with respect to the behavior of other residents.

(3) File a complaint, contact, or provide information to the department, the long-term care ombudsman, the attorney general's office, and law enforcement agencies without interference, discrimination, or reprisal. All forms of retaliatory treatment are prohibited, including those listed in chapter 74.39A RCW.

(4) Receive information from agencies acting as client advocates, and be afforded the opportunity to contact these agencies.

[]

(1) A resident has the right to examine the results of the most recent survey and complaint investigation of the nursing home conducted by federal and state surveyors or inspectors and the plans of correction in effect with respect to the facility.

(2) The nursing home must:

(a) Publicly post a copy of the report and plan of correction of the most recent full survey and complaint investigations;

(b) Make the copy of the survey and complaint investigation results available for examination in a place readily accessible to residents, which does not require staff intervention to access;

(c) Post a notice that the results of the survey and investigation are available and the location of the reports; and

(d) Post reports, with plans of correction, and notices in a place or places in plain view of the nursing home residents, individuals visiting those residents, and individuals who inquire about placement in the facility.

[]

The resident has the right to privacy in written communications, including the right to:

(1) Send and promptly receive mail that is unopened; and

(2) Have access to stationery, postage and writing implements at the resident's own expense.

[]

(1) The resident has the right and the nursing home must provide immediate access to any resident by the following:

(a) Any representative of the secretary;

(b) Any representative of the state;

(c) The resident's personal physician;

(d) Any representative of the state long term care ombudsman (established under section 307 (a)(12) of the Older American's Act of 1965);

(e) The agency responsible for the protection and advocacy system for developmentally disabled individuals (established under part c of the Developmental Disabilities Assistance and Bill of Rights Act);

(f) The agency responsible for the protection and advocacy system for mentally ill individuals (established under the Protection and Advocacy for Mentally Ill Individuals Act);

(g) Subject to the resident's right to deny or withdraw consent at any time, immediate family or other relatives of the resident; and

(h) Subject to reasonable restrictions and the resident's right to deny or withdraw consent at any time, others who are visiting with the consent of the resident.

(2) The nursing home must provide reasonable access to any resident by any entity or individual that provides health, social, legal, or other services to the resident, subject to the resident's right to deny or withdraw consent at any time.

(3) The nursing home must allow representatives of the state ombudsman, described in subsection (1)(d) of this section, to examine a resident's clinical records with the permission of the resident or the resident's surrogate decision maker, and consistent with state law. The ombudsman may also, under federal law, access resident's records when the resident is incapacitated and has no surrogate decision maker, and may access records over the objection of a surrogate decision maker if access is authorized by the state ombudsman pursuant to 42 C.F.R. § 3058g(b).

[]

The resident has the right to have twenty-four hour access to a telephone which:

(1) Provides auditory privacy;

(2) Is accessible to an individual with a disability and accommodates an individual with sensory impairment; and

(3) Does not include the use of telephones in staff offices and at the nurses station(s).

[]

(1) The resident has the right, unless to do so would infringe upon the rights or health and safety of other residents, to:

(a) Retain and use personal possessions, including some furnishings, and appropriate clothing, as space permits; and

(b) Provide his or her own bed and other furniture, if desired and space permits; and

(c) Not be required to keep personal property locked in the facility office, safe, or similar arrangement.

(2) The nursing home must:

(a) Not request or require residents to sign waivers of potential liability for losses of personal property; and

(b) Have a system in place to safeguard personal property within the nursing home that protects the personal property and yet allows the resident to use his or her property.

[]

(1) A resident has the right to:

(a) Share a room with his or her spouse when married residents live in the same facility and both spouses consent to the arrangement; and

(b) Receive three days notice of change in room or roommate except:

(i) For room changes: The move is at the resident's request; and

(ii) For room or roommate changes: A longer or shorter notice is required to protect the health or safety of the resident or another resident; or an admission to the facility is necessary, and the resident is informed in advance. The nursing home must recognize that the change may be traumatic for the resident and take steps to lessen the trauma.

(2) The nursing home must make reasonable efforts to accommodate residents wanting to share the same room.

[]

In dually certified facilities all beds are Medicaid certified. Therefore the beds in a certified distinct part for Medicare are also nursing facility beds for Medicaid.

(1) Each resident has the right to refuse a transfer to another room within the facility, if the purpose of the transfer is to relocate:

(a) A resident from the Medicare distinct part of the facility to a part of the facility that is not a Medicare distinct part; or

(b) A resident from the part of the facility that is not a Medicare distinct part to the Medicare distinct part of the facility.

(2) A resident's exercise of the right to refuse transfer under subsection (1)(a) of this section does not affect the individual's eligibility or entitlement to Medicare or Medicaid benefits.

(3) The skilled nursing facility or nursing facility must inform residents of their rights under subsection (1) and (2) of this section at the time of the proposed transfer or relocation.

[]

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements at 42 C.F.R. §483.13 will be deemed to meet subsections (2)(a) and (7) through (12) of this section.

(2) The resident has the right to be free from any physical or chemical restraints imposed for purposes of:

(a) DISCIPLINE OR CONVENIENCE, AND NOT REQUIRED TO TREAT THE RESIDENT'S MEDICAL SYMPTOMS; OR

(b) Preventing or limiting independent mobility or activity, except that a restraint may be used in a bona fide emergency situation when necessary to prevent a person from inflicting injury upon self or others.      The nursing home shall obtain within seventy-two hours a physician's order for proper treatment resolving the emergency situation and eliminating the cause for the restraint.      Intermediate care facilities for the mentally retarded (ICF/MR) are not required to obtain a physician's order for emergency restraints.

(3) The nursing home shall have written policies and procedures in place governing:

(a) Use of chemical and physical restraints;

(b) The personnel authorized to administer restraints in an emergency; and

(c) Monitoring and controlling the use of restraints.

(4) In certain situations, physical restraints may be necessary for persons with acute or chronic physical impairments.      In these situations, the nursing home shall ensure the use of physical restraints is related to a specific need or problem identified in the comprehensive care plan.

(5) In any situation where chemical or physical restraint is used for a resident, the nursing home shall ensure:

(a) The informed consent process is followed as described under WAC 388-97-060; and

(b) The resident's care plan provides approaches to diminish or eliminate the use of the restraint, where possible.

(6) The nursing home shall ensure that any resident physically restricted is released:

(a) At intervals not to exceed two hours; and

(b) For periods long enough to provide for ambulation, exercise, elimination, food and fluid intake, and socialization as independently as possible.

(7) THE RESIDENT HAS THE RIGHT TO BE FREE FROM VERBAL, SEXUAL, PHYSICAL AND MENTAL ABUSE, CORPORAL PUNISHMENT; AND INVOLUNTARY SECLUSION.

(8) THE NURSING HOME SHALL DEVELOP AND IMPLEMENT WRITTEN POLICIES AND PROCEDURES THAT PROHIBIT MISTREATMENT, NEGLECT AND ABUSE OF RESIDENTS AND MISAPPROPRIATION OF RESIDENT PROPERTY.

(9) THE NURSING HOME SHALL:

(a) NOT USE VERBAL, MENTAL, SEXUAL, OR PHYSICAL ABUSE, CORPORAL PUNISHMENT OR INVOLUNTARY SECLUSION;

(b) NOT EMPLOY PERSONS WHO HAVE BEEN:

(i) FOUND GUILTY OF ABUSING, NEGLECTING OR MISTREATING RESIDENTS; BY A COURT OF LAW; OR

(ii) HAVE HAD A FINDING ENTERED INTO THE STATE NURSE AIDE REGISTRY CONCERNING ABUSE, NEGLECT, MISTREATMENT OF RESIDENTS, AND MISAPPROPRIATION OF THEIR PROPERTY; AND

(c) REPORT ANY KNOWLEDGE IT HAS OF ACTIONS BY A COURT OF LAW AGAINST AN EMPLOYEE, WHICH WOULD INDICATE UNFITNESS FOR SERVICES AS A NURSE AIDE OR OTHER FACILITY STAFF TO THE STATE NURSE AID REGISTRY OR LICENSING AUTHORITIES.

(10) THE NURSING HOME SHALL ENSURE THAT ALL ALLEGED VIOLATIONS INVOLVING MISTREATMENT, NEGLECT OR ABUSE INCLUDING INJURIES OF UNKNOWN SOURCE, AND MISAPPROPRIATION OF RESIDENT PROPERTY ARE REPORTED IMMEDIATELY TO THE ADMINISTRATOR OF THE FACILITY AND TO OTHER OFFICIALS IN ACCORDANCE WITH STATE LAW THROUGH ESTABLISHED PROCEDURES (INCLUDING TO THE STATE SURVEY AND CERTIFICATION AGENCY).

(11) THE NURSING HOME SHALL:

(a) HAVE EVIDENCE THAT ALL ALLEGED VIOLATIONS ARE THOROUGHLY INVESTIGATED, AND

(b) PREVENT FURTHER POTENTIAL ABUSE WHILE THE INVESTIGATION IS IN PROGRESS.

(12) THE RESULTS OF ALL INVESTIGATIONS SHALL BE REPORTED TO THE ADMINISTRATOR OR HIS DESIGNATED REPRESENTATIVE AND TO OTHER OFFICIALS IN ACCORDANCE WITH STATE LAW (INCLUDING TO THE STATE SURVEY AND CERTIFICATION AGENCY) WITHIN FIVE WORKING DAYS OF THE INCIDENT, AND IF THE ALLEGED VIOLATION IS VERIFIED APPROPRIATE CORRECTIVE ACTION MUST BE TAKEN.

(13) Nothing in this section precludes intermediate care facilities for the mentally retarded from using involuntary seclusion in accordance with the requirements of 42 C.F.R., Part 483, Subpart I)) The resident has the right to be free from any physical or chemical restraint imposed for purposes of:

(a) Discipline or convenience, and not required to treat the resident's medical symptoms; or

(b) Preventing or limiting independent mobility or activity.

(2) Chemical or physical restraints may be used in an emergency when it has been assessed as necessary to prevent a resident from inflicting injury to self or to others. "Emergency" means an unexpected, serious occurrence requiring immediate action. The nursing home must obtain a physician's order:

(a) Within twenty-four hours for physical restraints;

(b) Immediately for chemical restraints; and

(c) Including treatments to assist in resolving the emergency situation and eliminating the need for the restraint.

(3) The nursing home must develop and implement written policies and procedures governing:

(a) The emergency use of restraints;

(b) The use of chemical and physical restraints, required for the treatment of the resident's medical symptoms, not for discipline or convenience;

(c) The personnel authorized to administer restraints in an emergency; and

(d) Monitoring and controlling the use of restraints.

(4) In certain situations, chemical or physical restraints may be necessary for residents with acute or chronic mental or physical impairments. When chemical or physical restraints are used the nursing home must ensure that:

(a) The use of the restraint is related to a specific medical need or problem identified through a multi-disciplinary assessment;

(b) The informed consent process is followed as described under WAC 388-97-060; and

(c) The resident's plan of care provides approaches to reduce or eliminate the use of the restraint, where possible.

(5) The nursing home must ensure that any resident physically restrained is released:

(a) At intervals not to exceed two hours; and

(b) For periods long enough to provide for ambulation, exercise, elimination, food and fluid intake, and socialization as independently as possible.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-075, filed 9/15/94, effective 10/16/94.]

(1) Each resident has the right to be free from verbal, sexual, physical and mental abuse, corporal punishment, and involuntary seclusion.

(2) The nursing home must develop and implement written policies and procedures that:

(a) Prohibit abandonment, abuse, and neglect of residents, financial exploitation, and misappropriation of resident property; and

(b) Require staff to report possible abuse, and other related incidents, as required by chapter 74.34 RCW.

(3) The nursing home must not allow staff to:

(a) Engage in verbal, mental, sexual, or physical abuse;

(b) Use corporal punishment;

(c) Involuntarily seclude, abandon, neglect, or financially exploit residents; or

(d) Misappropriate resident property.

(4) The nursing home must not employ individuals in positions that will provide them with the opportunity for unsupervised access with vulnerable residents, if the individuals have:

(a) Been found to have abused, neglected, exploited or abandoned a minor or vulnerable adult, by a court of law or by a licensing authority;

(b) A finding of abuse, neglect, exploitation or abandonment on any state registry, including the nursing assistant registry; or

(c) Been found to have abused, neglected, or misappropriated resident property by the department's resident protection program.

(5) The nursing home must report any information it has about an action taken by a court of law against an employee to the department's complaint resolution unit and the appropriate department of health licensing authority, if that action would disqualify the individual from employment as described in RCW 43.43.842.

(6) The nursing home must ensure that all allegations involving abandonment, abuse, neglect, financial exploitation, or misappropriation of resident property, including injuries of unknown origin, are reported immediately to the administrator of the facility and to other officials, including the department. The nursing home must:

(a) Ensure that the reports are made through established procedures in accordance with state law, including chapter 74.34 RCW; and

(b) Not have any policy or procedure that interferes with the requirement of chapter 74.34 RCW that employees and other mandatory reporters file reports directly with the department, and with law enforcement, if they suspect sexual or physical assault has occurred.

(7) The nursing home must:

(a) Have evidence that all alleged violations are thoroughly investigated;

(b) Prevent further potential abandonment, abuse, neglect, financial exploitation, or misappropriation of resident property while the investigation is in progress; and

(c) Report the results of all investigations to the administrator or his designated representative and to other officials in accordance with state law (including the state survey and certification agency) within five working days of the incident, and if the alleged violation is verified appropriate action must be taken.

[]

(1) As used in this section, the term "individual," means any individual, including a volunteer, used by the facility to provide services to residents.

(2) The department will review all allegations of resident abandonment, abuse, neglect, financial exploitation, or misappropriation of resident property, as defined in this chapter and RCW 74.34.020.

(3) If, after the review of an allegation, the department concludes that there is reason to believe that an individual has abused or neglected a resident, or has misappropriated a resident's property, then the department will initiate an investigation.

(4) The department's investigation may include, but is not limited to:

(a) The review of facility and state agency records;

(b) Interviews with any individuals who may have relevant information about the allegation; and

(c) The collection of any evidence deemed necessary by the investigator.

(5) If, after review of the results of the investigation, the department makes a preliminary determination that the resident abuse, neglect, or misappropriation of resident funds has occurred, the department will make a preliminary finding to that effect; except that a preliminary finding of neglect will not be made if the individual is able to demonstrate, that the neglect was caused by factors beyond the control of the individual.

(6) Within ten days of making its preliminary determination, the department must send notice of a preliminary finding:

(a) To the individual by first class and certified mail, return receipt requested. The department may choose to substitute personal service for certified mail;

(b) To the current administrator of the facility where the incident occurred; and

(c) To the appropriate licensing agency.

(7) The notice will include the following information:

(a) A description of the allegation;

(b) The date and time of the incident, if known;

(c) That the individual may appeal the preliminary finding; and

(d) That the preliminary finding will become final unless the individual makes a written request for a hearing within thirty days of the date of the notice.

(8) The individual may appeal the department's preliminary finding of abuse, neglect or misappropriation of resident property by notifying the office of administrative hearings in writing within thirty days of the date of the notice.

(9) If, within one hundred eighty days of the date of the notice of the preliminary finding, an individual requests a hearing and can demonstrate good cause for failing to request a hearing within thirty days, the office of administrative hearing may grant the request. The individual's name will remain on the nursing assistant registry pending the outcome of the hearing.

(10) Upon receipt of a written request for a hearing from an individual, the office of administrative hearings will schedule a hearing, taking into account the following requirements:

(a) The hearing decision must be issued within one hundred twenty days of the date the office of administrative hearings receives a hearing request;

(b) The hearing will be conducted at a reasonable time and at a place that is convenient for the individual;

(c) The hearing, and any subsequent appeals, shall be governed by this chapter, chapter 34.05 RCW, and chapter 388-08 WAC, or its successor regulations;

(d) A continuance may be granted upon the request of any party for good cause, as long as the hearing decision can still be issued within one hundred twenty days of the date of the receipt of the appeal. Neither the department nor the individual can waive the one hundred twenty-day requirement. If, however, the administrative law judge finds that extenuating circumstances exist that will make it impossible to complete the record within one hundred twenty days, the administrative law judge may extend the one hundred twenty-day requirement a maximum of sixty days; and

(e) If the administrative law judge upholds the department's preliminary finding, it becomes final.

(11) The department will report a final finding of abuse, neglect and misappropriation of resident property within ten working days to the following:

(a) The individual;

(b) The current administrator of the facility in which the incident occurred;

(c) The administrator of the facility that currently employs the individual;

(d) The department's nursing assistant registry; and

(e) The appropriate licensing authority.

(13) The individual against whom a finding is made is entitled to submit a statement disputing the allegations. Information about the finding, including the individual's statement, must be made available to all requesters.

(14) The findings will remain on the department's nursing assistant registry permanently unless:

(a) The finding is set aside by further administrative or judicial review as provided for in chapter 34.05 RCW;

(b) The department determines that the finding was made in error;

(c) The department removed a single finding of neglect from the nursing assistant registry based upon a petition by the individual as provided in 42 U.S.C. 1396r (g)(1)(C); or

(d) The department is notified of the individual's death.

(15) Information obtained during the investigation into allegations of abuse, neglect and misappropriation of property, and any documents generated by the department will be maintained and disseminated with regard for the privacy of the resident and any reporting individuals and in accordance with laws and regulations regarding confidentiality and privacy.

[]

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 388-97-08010
Resident dignity and accommodation of needs.

(1) Dignity. The nursing home must ensure that:

(a) Resident care is provided in a manner to enhance each resident's dignity, and to respect and recognize his or her individuality; and

(b) Each resident's personal care needs are provided in a private area free from exposure to individuals not involved in providing the care.

(2) Accommodation of needs. Each resident has the right to reasonable accommodation of personal needs and preferences, except when the health or safety of the individual or other residents would be endangered.

[]

The nursing home must provide and maintain:

(1) A safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible;

(2) Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior;

(3) Comfortable and safe temperature levels:

(a) Facilities licensed after October 1, 1990 must maintain a temperature range of seventy-one to eighty-one degrees Fahrenheit; and

(b) Regardless of external weather conditions, all nursing homes must develop and implement procedures and processes to maintain a temperature level that is comfortable and safe for residents;

(4) Comfortable sound levels, to include:

(a) Minimizing the use of the public address system to ensure each use is in the best interest of the residents; and

(b) Taking reasonable precautions with noisy services so as not to disturb residents, particularly during their sleeping time; and

(5) Lighting suitable for any task the resident chooses to do, and any task the staff must do.

[]

The resident has the right to:

(1) Choose activities, schedules, and health care consistent with his or her interests, assessments, and plan of care;

(2) Interact with members of the community both inside and outside the nursing home;

(3) Make choices about aspects of his or her life in the facility that are significant to the resident; and

(4) Participate in social, religious, and community activities that do not interfere with the rights of other residents in the nursing home.

[]

(1) A resident has the right to organize and participate in resident groups in the nursing home.

(2) The nursing home must provide a resident or family group, if one exists, with private space.

(3) Staff or visitors may attend meetings only at the group's invitation.

(4) The nursing home must provide a designated staff individual responsible for providing assistance and responding to written requests that result from group meetings.

(5) When a resident or family group exists, the nursing home must listen to the views and act upon the grievances and recommendations of residents and families concerning proposed policy and operational decisions affecting resident care and life in the nursing home.

(6) A resident's family has the right to meet in the nursing home with the families of other residents in the facility.

[]

The nursing home must:

(1) Provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental, and psychosocial well-being of each resident;

(2) Provide activities meaningful to the residents at various times throughout every day and evening based on each resident's need and preference; and

(3) Ensure that the activities program is directed by a qualified professional who:

(a) Is a qualified therapeutic recreation specialist or an activities professional who is eligible for certification as a therapeutic recreation specialist or as an activities professional by a recognized accrediting body on or after October 1, 1990; or

(b) Has two years of experience in a social or recreational program within the last five years, one of which was full-time in a patient activities program in a health care setting; or

(c) Is a qualified occupational therapist or occupational therapy assistant.

[]

The nursing home must:

(1) Provide medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident; and

(2) Employ a qualified social worker on a full-time basis if the nursing home has more than one hundred twenty beds. A qualified social worker is an individual with:

(a) A bachelor's degree in social work or a bachelor's degree in a human services field including but not limited to sociology, special education, rehabilitation counseling, and psychology; and

(b) One year of supervised social work experience in a health care setting working directly with patients or residents.

[]

(1) Each resident must have a reasonable opportunity to have regular contact with animals, if desired.

(2) The nursing home must:

(a) Consider the recommendations of nursing home residents, resident councils, and staff;

(b) Determine how to provide residents access to animals;

(c) Determine the type and number of animals available in the facility, which the facility can safely manage. Such animals should include only those customarily considered domestic pets.

(d) Ensure that any resident's rights, preferences, and medical needs are not compromised by the presence of an animal; and

(e) Ensure any animal visiting or living on the premises has a suitable temperament, is healthy, and otherwise poses no significant health or safety risks to residents, staff, or visitors.

(3) Animals living on the nursing home premises must:

(a) Have regular examinations and immunizations, appropriate for the species, by a veterinarian licensed in Washington state; and

(b) Be veterinarian certified to be free of diseases transmittable to humans.

(4) Pets must be restricted from:

(a) Central food preparation areas; and

(b) Residents who object to the presence of pets.

[]

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements at C.F.R. §483.20 will be deemed to meet this section.

(2))) The nursing home ((shall)) must:

(a) Provide resident care based on a systematic, comprehensive, interdisciplinary assessment, and care planning process in which the resident ((actively)) participates, to the fullest extent possible.

(((3) The nursing home shall:

(a))) (b) Conduct initially and periodically a comprehensive, accurate, standardized, reproducible assessment of each resident's functional capacity((.

(b)));

(c) At the time each resident is admitted((, have physician orders for the resident's immediate care; and

(c))):

(i) Have physician's orders for the resident's immediate care; and

(ii) Ensure that the resident's immediate care needs are identified in an admission assessment; and

(d) Ensure that the comprehensive assessment of a resident's needs describes the resident's capability to perform daily life functions and significant impairments in functional capacity.

(((4))) (2) The comprehensive assessment ((shall)) must include at least the following information:

(a) ((Medically defined conditions and prior medical history;

(b) Medical status measurement;

(c) Physical and mental functional status;

(d) Sensory and physical impairments;

(e) Nutritional status and requirements;

(f) Special treatments or procedures;

(g) Mental and psychosocial status;

(h) Discharge potential;

(i) Dental condition;

(j) Activities potential;

(k) Rehabilitation potential;

(l) Cognitive status; and

(m) Drug therapy.

(5))) Identification and demographic information;

(b) Customary routine;

(c) Cognitive patterns;

(d) Communication;

(e) Vision;

(f) Mood and behavior patterns;

(g) Psychosocial well-being;

(h) Physical functioning and structural problems;

(i) Continence;

(j) Disease diagnosis and health conditions;

(k) Dental and nutritional status;

(l) Skin conditions;

(m) Activity pursuit;

(n) Medications;

(o) Special treatments and procedures;

(p) Discharge potential;

(q) Documentation of summary information regarding the assessment performed; and

(r) Documentation of participation in assessment.

(3) The nursing home ((shall)) must conduct comprehensive assessments:

(a) No later than fourteen days after the date of admission;

(b) Promptly after a significant change in the resident's physical or mental condition; and

(c) In no case less often than once every twelve months.

(((6))) (4) The nursing home ((shall)) must ensure that:

(a) Each resident is ((examined)) assessed no less than once every three months((, and as appropriate, the resident's assessment is revised to assure the continued accuracy of the assessment)); and

(b) The results of the assessment are used to develop, review and revise the resident's comprehensive plan of care under WAC ((388-97-150)) 388-97-090((, comprehensive planning)).

(5) The skilled nursing facility and nursing facility must:

(a) For the required assessment, complete the state approved resident assessment instrument (RAI) for each resident in accordance with federal requirements;

(b) Place copies of the completed state approved RAI in each resident's clinical record, unless all charting is computerized;

(c) Maintain all copies of resident assessments completed within the resident's active clinical record for fifteen months;

(d) Assess each resident not less than every three months, using the state approved assessment instrument; and

(e) Transmit all state and federally required RAI information for each resident to the department:

(i) In a manner approved by the department;

(ii) Within ten days of completion of any RAI required under this subsection; and

(iii) Within ten days of discharging or readmitting a resident.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-085, filed 9/15/94, effective 10/16/94.]

(1) ((Medicaid-certified nursing facilities in compliance with federal regulations at 42 C.F.R. §483.20 will be deemed to meet subsections (2) and (3) of this section.

(2))) The nursing home ((shall)) must develop a comprehensive ((care)) plan of care for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing and mental and psychosocial needs that are identified in the comprehensive assessment.

(((3))) (2) The comprehensive plan or care ((plan shall)) must:

(a) Describe the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being as required under WAC 388-97-110((, Quality of care));

(b) Describe any services that would otherwise be required, but are not provided due to the resident's exercise of rights, including the right to refuse treatment (refer to WAC ((388-97-070, resident rights, and WAC)) 388-97-07005 and 388-97-060((, Informed consent)));

(c) Be developed within seven days after completion of the comprehensive assessment;

(d) Be prepared by an interdisciplinary team that includes the attending physician, a registered nurse with responsibility for the resident, and other appropriate staff in disciplines as determined by the residents needs; ((and))

(e) Consist of an ongoing process which includes a meeting if desired by the resident or the resident's representative; and

(f) Include the ongoing participation of the resident to the fullest extent possible, the resident's family or the resident's ((legal representative)) surrogate decision maker.

(3) The nursing home must implement a plan of care to meet the immediate needs of newly admitted residents, prior to the completion of the comprehensive assessment and plan of care.

(4) The nursing home ((shall)) must:

(a) Follow the informed consent process with the resident as specified in WAC 388-97-060((, Informed consent)), regarding the interdisciplinary team's plan of care ((plan)) recommendations;

(b) Respect the resident's right to decide plan of care ((plan)) goals and treatment choices, including acceptance or refusal of plan of care ((plan)) recommendations;

(c) Include in the interdisciplinary plan of care ((planning)) process:

(i) Staff members requested by the resident; and

(ii) Direct care staff who work most closely with the resident;

(d) Respect the resident's wishes regarding which ((persons)) individuals, if any, the resident wants to take part in resident plan of care ((planning)) functions;

(e) Provide reasonable advance notice to and reasonably accommodate the resident((, the resident's surrogate decision maker,)) family members or other ((persons)) individuals the resident wishes to have attend, when scheduling plan of care ((planning)) meeting times; and

(f) Where for practical reasons any ((persons)) individuals significant to the plan of care ((planning)) process, including the resident, are unable to attend plan of care ((planning)) meetings, provide a method for such ((persons)) individuals to give timely input and recommendations.

(5) The nursing home ((shall)) must ensure that ((resident care plans include)) each comprehensive plan of care:

(a) ((Designation of persons)) Designates the discipline of the individuals responsible for carrying out the program; and

(b) ((Review of the comprehensive care plan)) Is reviewed at least quarterly by qualified staff, as part of the ongoing process of monitoring the resident's needs and preferences.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-090, filed 9/15/94, effective 10/16/94.]

(1) A nursing home must ensure that it provides residents with dementia with an environment designed to attain or maintain the highest level of functioning and well-being possible, taking into consideration the resident's medical condition and functional status. Therefore, the nursing home must:

(a) Have a program designed to meet the identified needs of the residents;

(b) Develop and implement program policies and procedures.

(c) Train all staff, who have resident contact, in the special needs and care approaches applicable to residents with dementia. This training must be ongoing and consistent with requirements under WAC 388-97-170 (2)(b).

(2) A nursing home that has a locked or secured dementia unit must:

(a) Always have staff present in the unit, available to meet the needs of the residents and to protect them in the event of an emergency;

(b) Have staff available to assist residents, as needed, in accessing outdoor areas;

(c) Have admission, transfer, and discharge criteria which ensures that:

(i) The process of informed consent is followed before admission to or transfer/discharge from the unit;

(ii) The resident is provided with unit specific admission or transfer/discharge criteria, prior to admission to the unit;

(iii) The resident's need for admission to the unit from another part of the nursing home, or transfer/discharge from the unit, is based on the comprehensive assessment and plan of care;

(iv) Through an evaluation prior to admission, a resident admitted directly from outside the nursing home meets the cognitive and functional criteria of the unit;

(v) In the case of an individual admitted directly to the unit from outside the nursing home, as specified in subsection (2)(b)(iv) above, the nursing home may complete the comprehensive assessment after the individual's admission to the unit, provided that the nursing home complies with required time frames for completion of the resident assessment under WAC 388-97-085.

(d) Provide private pay residents, or their surrogate decision maker written notification:

(i) If admitted from outside the nursing home, of additional charges, if any, for services, items, and activities in the unit, prior to admission; and

(ii) If admitted from another part of the nursing home, thirty days in advance of changes to those charges.

(e) Comply with physical plant requirements in WAC 388-97-350 through 388-97-35060, for existing facilities and for new construction.

[]

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements at 42 C.F.R. §483.25 will be deemed to meet subsections (2) through (4) of this section, except for (4)(m) and (4)(n).

(2) Each resident shall receive and the nursing home shall)) Consistent with resident rights, the nursing home must provide each resident with the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being, self-care and independence in accordance with his or her comprehensive assessment and plan of care.

(((3))) (2) Based on the comprehensive assessment of a resident, the nursing home ((shall)) must ensure that:

(a) A resident's abilities in activities of daily living do not ((diminish)) decline unless circumstances of the resident's clinical condition demonstrate that ((diminution)) the decline was unavoidable.      This includes the resident's ability to:

(i) Bathe, dress, and groom;

(ii) Transfer and ambulate;

(iii) Toilet;

(iv) Eat; and

(v) Use speech, language, or other functional communication systems.

(((vi) A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene.))

(b) A resident is given the appropriate treatment and services to maintain or improve the resident's abilities in activities of daily living specified in subsection (((3)))(2)(a) of this section; and

(c) A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene.

(((4))) (3) The nursing home ((shall)) must ensure that the appropriate care and services are provided to the resident in the following areas, as applicable in accordance with the resident's individualized assessments and plan of care ((plan)):

(a) Vision and hearing;

(b) Skin;

(c) Continence;

(d) Range of motion;

(e) Mental and psychosocial functioning and adjustment;

(f) Nasogastric and gastrostomy tubes;

(((h))) (g) Accident prevention;

(((i))) (h) Nutrition;

(((j))) (i) Hydration;

(((k))) (j) Special needs, including:

(i) Injections;

(ii) Parenteral and enteral fluids;

(iii) Colostomy, ureterostomy, or ileostomy care;

(iv) Tracheostomy care;

(v) Tracheal suction;

(vi) Respiratory care;

(vii) Dental care;

(viii) Foot care; and

(((viii))) (ix) Prostheses.

(((l))) (k) Medications, including freedom from:

(i) Unnecessary drugs;

(ii) Nursing home error rate of five percent or greater; and

(iii) Significant medication errors.

(((m))) (l) Self-administration of medication; and

(((n))) (m) Independent living skills.

(((5))) (4) The nursing home ((shall)) must ensure that each resident is monitored for desired responses and undesirable side effects of prescribed drugs.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-110, filed 9/15/94, effective 10/16/94.]

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements at 42 C.F.R. §483.30 will be deemed to meet subsections (2) and (3) of this section.

(2))) The nursing home ((shall)) must ensure that a sufficient number of qualified nursing personnel are available on a twenty-four hour basis seven days per week to provide nursing and related services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident as determined by resident assessments and individual plans of care.

(((3))) (2) The nursing home ((shall)) must:

(a) Designate a registered nurse or licensed practical nurse to serve as charge nurse, who is accountable for nursing services on each tour of duty; and

(b) Have a full time director of nursing service who ((shall be)) is a registered nurse.

(((4))) (3) The nursing home ((shall)) must have:

(a) A registered nurse on duty directly supervising resident care a minimum of sixteen hours per day, seven days per week; and

(b) A registered nurse or licensed practical nurse on duty directly supervising resident care the remaining eight hours per day, seven days per week((.

(c) In intermediate care facilities for the mentally retarded (ICF/MR), there shall be at least one registered nurse or licensed practical nurse on duty eight hours per day, and additional licensed staff on any shifts if indicated.      Subsections (3)(a) and (4)(a) and (b) of this section do not apply to intermediate care facilities for the mentally retarded.

(5))). "Directly supervising" means the supervising individual is on the premises and is quickly and easily available to provide necessary assessments and other direct care of residents; and oversight of supervised staff.

(4) The nursing home ((shall)) must ensure that staff respond to each resident's requests for assistance in a manner which promptly meets the quality of life and quality of care needs of all the residents.

(((6))) (5) The director of nursing services ((shall be)) is responsible for:

(a) Coordinating the plan of care for each resident;

(b) Ensuring that registered nurses and licensed practical nurses comply with chapter ((18.88 RCW, and licensed practical nurses comply with chapter 18.78)) 18.79 RCW; and

(c) Ensuring that the nursing care provided is based on the nursing process in accordance with nationally recognized and accepted standards of professional nursing practice.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-115, filed 9/15/94, effective 10/16/94.]

The nursing home must:

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements at 42 C.F.R. §483.35 will be deemed to meet subsections (2), (3), (8), (9), (10), (12)(a) and (13) of this section.

(2) THE NURSING HOME SHALL PROVIDE EACH RESIDENT WITH A NOURISHING, PALATABLE, WELL-BALANCED DIET THAT MEETS THE DAILY NUTRITIONAL AND SPECIAL DIETARY NEEDS OF EACH RESIDENT.      THE FOOD SHALL BE SERVED IN SUCH A MANNER TO BE ATTRACTIVE AND AT TEMPERATURES SAFE AND ACCEPTABLE TO THE RESIDENT.

(3) THE NURSING HOME SHALL PROVIDE A MINIMUM OF THREE MEALS IN EACH TWENTY-FOUR HOUR PERIOD, AT REGULAR TIMES COMPARABLE TO NORMAL MEAL TIMES IN THE COMMUNITY.

(4) The nursing home shall make available to residents on a daily basis fresh fruits and vegetables in season.

(5) The nursing home shall make reasonable efforts to:

(a) Accommodate individual mealtime preferences and portion sizes, as well as preferences for between meal and evening snacks when not medically contraindicated;

(b) Offer breakfast served later or an alternative to the regular breakfast for late risers; and

(c) Provide food consistent with the cultural and religious needs of the residents.

(6) The nursing home shall obtain input from residents and/or resident councils in meal planning, scheduling, and the menu selection process.

(7) The nursing home shall:

(a) Encourage residents to continue eating independently;

(b) Provide effective adaptive utensils as needed to promote independence;

(c) Allow sufficient time for eating in a relaxed manner;

(d) Provide individualized assistance as needed; and

(e) Provide table service, in a dining area/room, located outside of the resident's room, to all residents capable of eating at a table.

(8) THE NURSING HOME SHALL HAVE SUFFICIENT SUPPORT PERSONNEL COMPETENT TO CARRY OUT THE FUNCTIONS OF DIETARY SERVICE.

(9) THE FACILITY SHALL EMPLOY A REGISTERED AND CERTIFIED OR LICENSED DIETITIAN EITHER FULL-TIME, PART-TIME OR ON A CONSULTANT BASIS.

(10) IF A QUALIFIED DIETITIAN IS NOT EMPLOYED FULL-TIME, THE FACILITY SHALL EMPLOY A FOOD SERVICE MANAGER TO SERVE AS THE DIRECTOR OF FOOD SERVICE.

(11) The food service manager means a person who:

(a) Has completed a dietetic technician or dietetic assistant training program, correspondence or classroom, approved by the American Dietetic Association/Dietary Manager Association; or

(b) Has completed a state-approved training program providing ninety or more hours of classroom instruction in food service supervision, and has experience in a health care institution; and

(c) Receives regularly scheduled consultation from a qualified dietitian.      Consultation services include:

(i) Nutrition assessment;

(ii) Liaison with medical and nursing staff and administrator;

(iii) Inservice training;

(iv) Guidance to the director of food service and food service staff; and

(v) Approval of regular and therapeutic menus.

(12) THE DIETITIAN SHALL:

(a) APPROVE MENUS WHICH MEET THE DIETARY ALLOWANCES OF THE FOOD AND NUTRITION BOARD OF THE NATIONAL RESEARCH COUNCIL, NATIONAL ACADEMY OF SCIENCES; AND

(b) Prepare dated menus for general and modified diets at least three weeks in advance; and

(c) Retain dated menus, dated records of foods received, a record of the number of meals served, and standardized recipes for at least three months for department review as necessary.

(13) WHEN A RESIDENT REFUSES FOOD SERVED, THE FACILITY SHALL OFFER A SUBSTITUTE OF A SIMILAR NUTRITIVE VALUE.

(14) The nursing home shall:

(a) Ensure menus are followed;

(b) Post the current dated general menu, including substitutions, in the food service area and in a place accessible and conspicuous to residents and visitors; and

(c) Note any variations, to the regular menu on the menu.

(15) The nursing home shall:

(a) Ensure residents' diets are provided as prescribed by the physician.      Diet modifications for texture only may be used as an interim measure when ordered by a registered nurse; and

(b) Provide supplementary fluids and nourishments in accordance with the resident's individual needs as determined by the assessment process.

(16) The nursing home shall review a resident's modified diet to ensure the food form and texture are consistent with the resident's current needs and functional level:

(a) At the request of the resident;

(b) When the resident's condition warrants; and

(c) At the time of the care plan review.

(17) The nursing home shall ensure:

(a) A resident's tube feedings are of uniform consistency and quality; and

(b) Tube feedings are prepared, stored, distributed, and served in such a manner so as to maintain uniformity and to prevent contamination.

(18) The nursing home shall ensure food service is in compliance with chapter 246-215 WAC, rules and regulations of the state board of health governing food services sanitation)) Provide each resident with a nourishing, palatable, well-balanced diet that meets their daily nutritional and special dietary needs.

(2) Serve food in an attractive manner and at temperatures safe and acceptable to each resident.

(3) Ensure that food service is in compliance with chapter 246-215 WAC.

(4) Retain dated menus, dated records of foods received, a record of the number of meals served, and standardized recipes for at least three months for department review as necessary.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-120, filed 9/15/94, effective 10/16/94.]

The nursing home must:

(1) Provide a minimum of three meals in each twenty-four period, at regular times similar to normal meal times in the community;

(2) Make fresh fruits and vegetables, in season, available to residents on a daily basis;

(3) Make reasonable efforts to:

(a) Accommodate individual mealtime preferences and portion sizes, as well as preferences for between meal and evening snacks when not medically contraindicated;

(b) Offer a late breakfast or an alternative to the regular breakfast for late risers; and

(c) Provide food consistent with the cultural and religious needs of the residents.

(4) Use input from residents and the resident council, if the nursing home has one, in meal planning, scheduling, and the meal selection process.

[]

The nursing home must:

(1) Encourage residents to continue eating independently;

(2) Provide effective adaptive utensils as needed to promote independence;

(3) Allow sufficient time for eating in a relaxed manner;

(4) Provide individualized assistance as needed;

(5) Provide table service, for all residents capable of eating at a table, in a dining area/room, located outside of the resident's room; and

(6) Offer a substitute of similar nutritive value when a resident refuses food served.

[]

The nursing home must have sufficient support personnel capable of carrying out the functions of dietary services and must:

(1) Employ a qualified dietitian either full-time, part-time or on a consultant basis who must:

(a) Approve regular and therapeutic menus which meet the dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences;

(b) Prepare dated menus for general and modified diets at least three weeks in advance;

(c) Provide services which include:

(i) Nutrition assessment;

(ii) Liaison with medical and nursing staff, and administrator;

(iii) Inservice training; and

(iv) Guidance to the director of food service, and food service staff.

(2) If a qualified dietitian is not employed full-time as the food service manager the nursing home must employ a food service manager to serve as the director of food service.

(3) The food service manager means:

(a) An individual who is a qualified dietitian; or

(b) An individual:

(i) Who has completed a dietetic technician or dietetic assistant training program, correspondence or classroom, approved by the American Dietetic Association/Dietary Manager Association; and

(ii) Receives regularly scheduled consultation from a qualified dietitian.

[]

The nursing home must:

(1) Ensure that menus are followed;

(2) Post the current dated general menu, including substitutes, in the food service area and in a place accessible and conspicuous to residents and visitors, in print the residents can read; and

(3) Note any changes to the regular menu on the menu.

[]

The nursing home must:

(1) Ensure that residents' diets are provided as prescribed by the physician. Diet modifications, for texture only, may be used as an interim measure when ordered by a registered nurse; and

(2) Provide supplementary fluid and nourishment in accordance with each resident's needs as determined by the assessment process.

[]

The nursing home must review a resident's modified diet to ensure that the food form and texture are consistent with the resident's current needs and functional level:

(1) At the request of the resident.

(2) When the resident's condition warrants.

(3) At the time of the plan of care review.

[]

If the nursing prepares tube feeding formula, or mixes additives to the prepared formula it must ensure that:

(1) Each resident's tube feedings are of uniform consistency and quality; and

(2) Tube feeding formulas are prepared, stored, distributed, and served in such a manner so as to maintain uniformity and to prevent contamination

[]

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements at 42 C.F.R. §483.40 will be deemed to meet subsections (2) through (9) of this section.

(2))) Except as specified in RCW 74.42.200, a physician ((shall)) must personally approve in writing a recommendation that ((a person)) an individual be admitted to a nursing home.

(((3))) (2) The nursing home ((shall)) must ensure that:

(a) Except as specified in RCW 74.42.200, the medical care of each resident is supervised by a physician; ((and))

(b) Another physician supervises the medical care of residents when their attending physician is unavailable((.

(4) The nursing home shall provide, or arrange for the provision, of physician services)); and

(c) Physician services are provided twenty-four hours per day, in case of emergency.

(((5))) (3) The physician ((shall)) must:

(a) Review the resident's total program of care, including medications and treatments, at each federally required visit;

(b) Write, sign and date progress notes at each visit; and

(c) Sign and date all orders.

(((6))) (4) Except as specified in subsections (((7) and (8))) (5) and (6) of this section, a physician may delegate tasks to a physician's assistant or advanced registered nurse practitioner who is:

(a) Licensed by the state;

(b) Acting within the scope of practice as defined by state law; and

(c) Under the supervision of the physician.

(((7))) (5) The physician may not delegate a task when the delegation is prohibited under state law or by the facility's own policies.

(((8))) (6) In the Medicare-certified portion of the facility, the physician may:

(a) Alternate federally required physician visits between personal visits by:

(i) The physician; and

(ii) An advanced registered nurse practitioner or physician's assistant; and

(b) Not delegate responsibility for the initial required physician visit.

(((9))) (7) In Medicaid-certified nursing facilities the physician may delegate any federally required physician task, including tasks which the regulations specify must be performed personally by the physician, to a physician's assistant or advanced registered nurse practitioner who is not an employee of the facility but who is working in collaboration with a physician.

(((10))) (8) The attending physician, or the physician-designated advanced registered nurse practitioner or physician's assistant ((shall)) must:

(a) Participate in the interdisciplinary plan of care ((planning)) process as described in WAC 388-97-090;

(b) Provide to the resident, or where applicable the resident's surrogate decision maker, information so that the resident can make an informed consent to care or refusal of care (see WAC 388-97-060((, Informed consent))); and

(c) Order resident self-medication when appropriate.

(((11))) (9) The nursing home ((shall have)) must obtain from the physician the following medical information before or at the time of the resident's admission:

(a) A summary or summaries of the resident's current health status, including history and physical findings reflecting a review of systems;

(b) Orders, as necessary for medications, treatments, diagnostic studies, specialized rehabilitative services, diet, and any restrictions related to physical mobility; and

(c) Plans for continuing care and discharge.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-125, filed 9/15/94, effective 10/16/94.]

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements at 42 C.F.R. §483.45 will be deemed to meet subsection (2) of this section.

(2))) If specialized habilitative and rehabilitative services such as, but not limited to, physical therapy, speech-language pathology, occupational therapy, and mental health rehabilitative services for mental illness and mental retardation, are required in the resident's comprehensive plan of care, the facility ((shall)) must:

(a) Provide the required services; or

(b) Obtain the required services from an outside provider of specialized rehabilitative services.

(((3))) (2) As determined by the resident's individualized comprehensive plan of care ((plan)), qualified therapists, as defined in ((WAC 388-96-010, shall)) RCW 74.46.020(40), will provide specialized habilitative or rehabilitative services under the written order of the physician.      According to state law and at the qualified therapist's discretion, certain services may be delegated to and provided by support personnel under appropriate supervision.

(((4))) (3) The nursing facility must:

(a) Ensure that residents who display mental or psychosocial adjustment difficulties receive appropriate treatment and services to correct the assessed problem; and

(b) Provide or arrange for the mental health or mental retardation services needed by residents that are of a lesser intensity than the specialized services defined at WAC 388-97-251.

(4) The nursing home may provide specialized rehabilitative and habilitative services to outpatients on the facility premises, only if the nursing home continues to also meet the needs of current residents.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-130, filed 9/15/94, effective 10/16/94.]

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements at 42 C.F.R. §483.60 will be deemed to meet subsections (2) and (3) of this section.

(2))) The nursing home ((shall)) must:

(a) Obtain routine and emergency drugs and biologicals for its residents under an agreement with a licensed pharmacy;

(b) Ensure that pharmaceutical services:

(i) Meet the needs of each resident;

(ii) Establish and monitor systems for the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals; and

(c) Employ or obtain the services of a licensed pharmacist who ((shall)) must:

(i) Provide consultation on all aspects of the provision of pharmacy services in the nursing home;

(ii) Determine that nursing home drug records are in order;

(iii) Perform regular reviews at least once each month of each resident's drug therapy; and

(iv) Document and report drug irregularities to the attending physician and the director of nursing.

(((3))) (2) Drugs and biologicals used in the nursing home ((shall)) must be labeled and stored in accordance with applicable state and federal laws.

(((4))) (3) The nursing home ((shall)) must provide pharmaceutical services that:

(a) Meet recognized and accepted standards of pharmacy practice; and

(b) Comply with chapter 246-865 WAC((, Pharmaceutical services-extended care facility)), except nursing home staff administering drugs to residents may document administration at the time of pouring the drug or immediately after administration.

(((5))) (4) The nursing home ((shall)) must ensure:

(a) Education and training for nursing home staff by the licensed pharmacist on drug-related subjects including, but not limited to:

(i) Recognized and accepted standards of pharmacy practice and applicable pharmacy laws and rules;

(ii) Appropriate monitoring of residents ((by staff)) to determine desired effect and undesirable side effects of drug regimens; and

(iii) Use of psychotropic drugs.

(b) Reference materials regarding medication administration, adverse reactions, toxicology, and poison center information are readily available;

(c) Pharmacist monthly drug review reports are acted on in a timely and effective manner;

(((c))) (d) Accurate detection, documentation, reporting and resolution of drug errors and adverse drug reactions;

(((d))) and

(e) Only ((persons)) individuals authorized by state law to do so ((shall)) will receive drug orders and administer drugs;

(((6))) (5) The resident ((shall have)) has the right to a choice of pharmacies when purchasing prescription and nonprescription drugs as long as the following conditions are met to ensure the resident is protected from medication errors:

(a) The medications are delivered in a unit of use compatible with the established system of the facility for dispensing drugs; and

(b) The medications are delivered in a timely manner to prevent interruption of dose schedule.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-135, filed 9/15/94, effective 10/16/94.]

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements at 42 C.F.R. §483.65 will be deemed to meet the requirements of subsections (2), (3), and (4).

(2))) The nursing home ((shall)) must:

(a) Establish and maintain an effective infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection;

(b) Prohibit any employee with a communicable disease or infected skin lesion from direct contact with residents or their food, if direct contact could transmit the disease; and

(c) Require staff to wash their hands after each direct resident contact for which handwashing is indicated by accepted professional practice.

(((3))) (2) Under the infection control program, the nursing home ((shall)) must:

(a) Investigate, control and prevent infections in the facility;

(b) Decide what procedures should be applied in individual circumstances; and

(c) Maintain a record of incidence of infection and corrective action taken.

(((4))) (3) Nursing home personnel must handle, store, process, and transport linens so as to prevent the spread of infection.

(((5) The nursing home shall report any case or suspected case of a reportable disease to the appropriate department of health officer.

(6))) (4) The nursing home ((shall)) must develop and implement effective methods for the safe storage, transport and disposal of garbage, refuse and infectious waste, consistent with all applicable local, state, and federal requirements for such disposal.

(((7))) (5) The nursing home ((shall)) must provide areas, equipment, and supplies to implement an effective infection control program((.      The nursing home shall)) and ensure:

(a) Ready availability of hand cleaning supplies and appropriate drying equipment or material at each sink;

(b) Safe use of disposable and single service supplies and equipment;

(c) Effective procedures for cleaning, disinfecting or sterilizing according to equipment use;

(d) Chemicals and equipment used for cleaning, disinfecting, and sterilizing, including chemicals used to launder personal clothing, are used in accordance with manufacturer's directions and recommendations; and

(e) Safe and effective procedures for disinfecting:

(i) All bathing and therapy tubs between each resident use; and

(ii) Swimming pools, spas and hot tubs.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-140, filed 9/15/94, effective 10/16/94.]

(1) The nursing home must develop and implement policies and procedures that comply with nationally recognized tuberculosis standards set by the Centers for Disease Control (CDC), and applicable state law. Such policies and procedures include, but are not limited to, the following;

(a) Evaluation of any resident or employee with symptoms suggestive of tuberculosis whether tuberculin skin test results were positive or negative;

(b) Identifying and following up residents and personnel with suspected or actual tuberculosis, in a timely manner; and

(c) Identifying and following up visitors and volunteers with symptoms suggestive of tuberculosis.

(2) The nursing home must comply with chapter 49.17 RCW, Washington Industrial Safety and Health Act (WISHA) requirements to protect the health and safety of employees.

(3) The nursing home must ensure that tuberculosis screening is carried out as follows:

(a) Skin testing, whether documented historically or performed currently, must be by intradermal (Mantoux) administration of purified protein derivative (PPD) and read in forty-eight to seventy-two hours of administration, by trained personnel, and with results recorded in millimeters of induration;

(b) The nursing home must conduct tuberculin skin testing of residents and personnel, within three days of admission or hire, to establish tuberculosis status.

(c) The skin test must consist of a baseline two step test, given no more than one to three weeks apart, unless the individual meets the requirements in (d) or (e) of this subsection.

(d) An individual does not need to be skin tested for tuberculosis if he/she has:

(i) A documented history of a previous positive skin test results;

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

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

(e) An individual needs to have only a one-step skin test upon admission or employment if:

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

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

(f) Annual one step skin testing for personnel, thereafter.

(4) If the skin test results in a positive reaction the nursing home must:

(a) Ensure that the individual has a chest X-ray within seven days; and

(b) Evaluate each resident or employee, with a positive test result, for signs and symptoms of tuberculosis.

(5) Where tuberculosis is suspected, by presenting symptoms, or diagnosed, for a resident or an employee, the nursing home must:

(a) Notify the local public health officer so that appropriate contact investigation can be performed;

(b) Institute appropriate measures for the control of the transmission of droplet nuclei;

(c) Apply living or work restrictions where residents or personnel are, or may be, infectious and pose a risk to other residents and personnel; and

(d) Ensure that personnel caring for a resident with suspected tuberculosis comply with the WISHA standard for respiratory protection found in WAC 296-62-071.

(6) The nursing home must:

(a) Retain records of the tuberculin test results, reports of X-ray findings, physician or public health official orders, and declination in the nursing home; and

(b) Retain employee tuberculin testing results for the duration of employment; and

(c) Provide the employee a copy of his/her testing results.

(7) The local health department may require additional tuberculin testing of residents or personnel as necessary for contact investigation.

(8) A resident or employee who has reason to decline skin testing may submit a signed statement to the nursing home giving the reason for declining and evidence to support the reason.

[]

(1) ((Where)) When the nursing home accepts the care of a resident with suspected or confirmed tuberculosis, the nursing home ((shall)) must:

(a) Coordinate the resident's admission, nursing home care, discharge planning, and discharge with the local health officer or officer designee; ((and))

(b) Provide necessary education about tuberculosis for staff, visitors, and residents; and

(c) Ensure that personnel caring for a resident with active tuberculosis comply with the WISHA standards for respiratory protection, WAC 246-62-071.

(2) For a resident who requires respiratory isolation for tuberculosis, the nursing home ((shall)) must:

(a) Provide a private or semiprivate isolation room:

(i) In accordance with WAC ((388-97-330(2), Resident rooms)) 388-97-33040;

(ii) In which, construction review of the department of health determines that room air is maintained under negative pressure; and appropriately exhausted, either directly to the outside away from intake vents or through properly designed, installed, and maintained high efficiency particulate air (HEPA) filters((;)), or other measures deemed appropriate to protect others in the facility;

(iii) However, when a semiprivate isolation room is used, only residents requiring respiratory isolation for confirmed or suspected tuberculosis are placed together.

(b) Provide supplemental environment approaches, such as ultraviolet lights, where deemed to be necessary;

(c) Provide appropriate protective equipment for staff and visitors; and

(d) Have measures in place for the decontamination of equipment and other items used by the resident.

(((3) When a semiprivate isolation room is utilized, the nursing home shall ensure that only residents requiring respiratory isolation for confirmed or suspected tuberculosis are placed together.))

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-155, filed 9/15/94, effective 10/16/94.]

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements at 42 C.F.R. §483.75 will be deemed to meet subsections (2) through (6) of this section.

(2))) The nursing home ((shall)) must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well being of each resident.

(((3))) (2) The nursing home must:

(a) Be licensed under chapter 18.51 RCW;

(b) Operate and provide services in compliance with:

(i) All applicable federal, state and local laws, regulations, and codes;

(ii) Accepted professional standards and principles that apply to professionals providing services in nursing homes; and

(c) Have a governing body or designated ((persons)) individuals functioning as a governing body, that is legally responsible for establishing and implementing policies regarding the management and operation of the nursing home.

(((4))) (3) The governing body of the nursing home ((shall)) must appoint the administrator who ((is)):

(a) Is licensed by the state; ((and))

(b) Is responsible for management of the facility;

(c) Keeps the licensee informed of all surveys and notices of noncompliance;

(d) Complies with all requirements of chapter 18.52 RCW, and all regulations put into effect under the chapter;

(e) Is an onsite, full-time individual in active administrative charge at the premises of only one nursing home, a minimum of four days and an average of forty hours per week. Exception: Onsite, full-time administrator with small resident populations or in rural areas will be defined as an individual in active administrative charge at the premises of only one nursing home:

(i) A minimum of four days and an average of twenty hours per week at facilities with one to thirty beds; or

(ii) A minimum of four days and an average of thirty hours per week at facilities with thirty-one to forty-nine beds; and

(f) Nursing homes temporarily without an administrator may operate up to four continuous weeks under a responsible individual authorized to act as administrator designee. The designee must be qualified by experience to assume designated duties and the nursing home must have a written agreement with a Washington State licensed nursing home administrator who must be available to consult with the designee.

(((5))) (4) The nursing home ((shall)) must employ on a full time, part time or consultant basis those professionals necessary to carry out the requirements of this chapter.

(((6))) (5) If the nursing home does not employ a qualified professional ((person)) individual to furnish a specific service to be provided by the nursing home, the nursing home ((shall)) must:

(a) Have that service furnished to residents by ((a person)) an individual or agency outside the nursing home under a written arrangement or agreement; and

(b) Ensure the arrangement or agreement referred to in subsection (((6))) (5)(a) of this section specifies in writing that the nursing home assumes responsibility for:

(i) Obtaining services that meet professional standards and principles that apply to professionals providing services in nursing homes; and

(ii) The timeliness of services.

(((7) The nursing home administrator shall comply with all requirements of chapter 18.52 RCW and all regulations promulgated thereunder.

(8))) (6) The nursing home ((shall report to the local law enforcement agency any person threatening bodily harm or causing a disturbance of such magnitude as to threaten any person's welfare and safety)) must:

(a) Report to the local law enforcement agency and the department any individual threatening bodily harm or causing a disturbance which threatens any individual's welfare and safety;

(b) Identify, investigate, and report incidents involving residents, according to established nursing home guidelines; and

(c) Comply with "whistle blower" rules as defined in chapter 74.34 RCW. "Whistle blower" means a resident or employee of a nursing home, or any individual licensed under Title 18 RCW, who in good faith reports alleged abandonment, abuse, neglect, financial exploitation, or misappropriation of resident property to the department.

(7) The department will:

(a) Discourage "whistle blower" complaints made in bad faith;

(b) Take action against a nursing home that is found to have used retaliatory treatment toward a resident or employee who has voiced grievances; and

(c) Investigate complaints, made to the department's toll free number, according to established protocols.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-160, filed 9/15/94, effective 10/16/94.]

(1) The nursing home and mandatory reporters under chapter 74.34 RCW are responsible for the reporting and notification requirements found in this section and elsewhere in this chapter.

(2) The nursing home must immediately notify the department's aging and adult services administration (AASA) of:

(a) Any allegations of resident abandonment, abuse, or neglect, including substantial injuries of an unknown source, financial exploitation and misappropriation of a resident's property;

(b) Any unusual event, having an actual or potential negative impact on residents, requiring the actual or potential implementation of the nursing home's disaster plan. These unusual events include but are not limited to those listed under WAC 388-97-185 (1)(a) through (k), and could include the evacuation of all or part of the residents to another area of the nursing home or to another address; and

(c) Circumstances which threaten the nursing home's ability to ensure continuation of services to residents.

(2) The nursing home must notify the department's AASA of:

(a) Physical plant changes, including but not limited to:

(i) New construction;

(ii) Proposed resident area or room use change;

(iii) Resident room number changes; and

(iv) Proposed bed banking;

(b) Mechanical failure of equipment important to the everyday functioning of the facility, which cannot be repaired within a reasonable time frame, such as an elevator; and

(c) An actual or proposed change of ownership (CHOW).

(3) The nursing home must notify, in writing, the department's AASA and each resident, of a loss of, or change in, the nursing home's administrator or director of nursing services at the time the loss or change occurs.

(4) The nursing home licensee must notify the department in writing of any change in the name of the licensee, or of the nursing home, at the time the change occurs.

(5) If a licensee operates in a building it does not own, the licensee must immediately notify the department of the occurrence of any event of default under the terms of the lease, or if it receives verbal or written notice that the lease agreement will be terminated, or that the lease agreement will not be renewed.

(6) The nursing home must report any case or suspected case of a reportable disease to the appropriate department of health officer and must also notify the appropriate department(s) of other health and safety issues, according to state and local laws.

[]

Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
AMENDATORY SECTION(Amending Order 3782, filed 9/15/94, effective 10/16/94)

WAC 388-97-165
Staff and equipment.

(1) The nursing home ((shall)) must ensure that:

(a) Sufficient numbers of appropriately qualified and trained staff are available to provide necessary care and services safely under routine conditions, as well as fire, emergency, and disaster situations;

(b) Adequate equipment, supplies and space are available to carry out all functions and responsibilities of the nursing home; ((and))

(c) All staff, including management, provide care and services consistent with:

(i) Empowering each resident to attain or maintain the highest practicable physical, mental, and psychosocial well-being, self-care and independence;

(ii) Respecting resident rights; and

(iii) Enhancing each resident's quality of life.

(2) The nursing home ((shall)) must ensure that any employee giving direct resident care, excluding professionally licensed nursing staff:

(a) Has successfully completed or is a student in a DSHS-approved nursing assistant training program; and

(b) Meets other requirements applicable to ((persons)) individuals performing nursing related duties in a nursing home, including those which apply to minors.

(3) The nursing home ((shall)) must ensure:

(a) Students in an DSHS-approved nursing assistant training program:

(i) Complete training and competency evaluation within four months of beginning work as a nursing assistant;

(ii) Complete at least sixteen hours of training in communication and interpersonal skills, infection control, safety/emergency procedures including the Heimlich maneuver, promoting residents' independence, and respecting residents' rights before any direct contact with a resident; and

(iii) Wear name tags which clearly identify student or trainee status at all times in all interactions with residents and visitors in all nursing homes, including the nursing homes in which the student completes clinical training requirements and in which the student is employed;

(b) Residents and visitors have sufficient information to distinguish between the varying qualifications of nursing assistants; and

(c) Each employee hired as a nursing assistant applies for registration with the department of health within three days of employment in accordance with chapter 18.88A RCW.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-165, filed 9/15/94, effective 10/16/94.]

(1) The nursing home ((shall)) must have a staff development program that is under the direction of a designated registered nurse or licensed practical nurse.

(2) The nursing home ((shall)) must:

(a) Ensure each employee receives initial orientation to the facility and its policies and is initially assigned only to duties for which the employee has demonstrated competence;

(b) Ensure all employees receive appropriate inservice education to maintain a level of knowledge appropriate to, and demonstrated competence in, the performance of ongoing job duties consistent with the principle of assisting the resident to attain or maintain the highest practicable physical, mental, and psychosocial well-being.      To this end, the nursing home ((shall)) must:

(i) Assess the specific training needs of each employee and address those needs; and

(ii) Determine the special needs of the nursing home's resident population which may require training emphasis.

(c) Comply with other applicable training requirements, such as, but not limited to, the bloodborne pathogen standard.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-170, filed 9/15/94, effective 10/16/94.]

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements at 42 C.F.R. §483.75(i) will be deemed to meet this section.

(2) Except for intermediate care facilities for the mentally retarded (ICF/MR),)) The nursing home ((shall)) must designate a physician to serve as medical director.

(((3))) (2) The medical director is responsible for:

(a) Implementation of resident care policies; and

(b) The coordination of medical care in the facility.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-175, filed 9/15/94, effective 10/16/94.]

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements at 42 C.F.R. §483.75(l) will be deemed to meet subsection (2) of this section.

(2))) The nursing home ((shall)) must:

(a) Maintain clinical records on each resident in accordance with accepted professional standards and practices that are:

(i) Complete;

(ii) Accurately documented;

(iii) Readily accessible; and

(iv) Systematically organized.

(b) Safeguard clinical record information against alteration, loss, destruction, and unauthorized use; and

(c) Keep confidential all information contained in the resident's records, regardless of the form or storage method of the records, except when release is required by:

(i) Transfer to another health care institution;

(ii) Law;

(iii) Third party payment contract; or

(iv) The resident.

(((3))) (2) The nursing home ((shall)) must ensure the clinical record of each resident includes at least the following:

(a) Resident identification and sociological data, including the name and address of the ((person or persons)) individual or individuals the resident designates as significant;

(b) Medical information required under WAC 388-97-125((, Physician services,));

(c) Physician's orders;

(d) Assessments;

(e) Plans of care;

(f) Services provided;

(g) In the case of the Medicaid-certified nursing facility, records related to preadmission screening and ((annual)) resident review;

(h) Progress notes;

(i) Medications administered;

(j) Consents, authorizations, releases;

(k) Allergic responses;

(l) Laboratory, X-ray, and other findings; and

(m) Other records as appropriate.

(((4))) (3) The nursing home ((shall)) must:

(a) Designate ((a person)) an individual responsible for the record system who:

(i) Has appropriate training and experience in clinical record management; or

(ii) Receives consultation from a qualified clinical record practitioner, such as an registered record administrator or accredited record technician.

(b) Make all records available to authorized representatives of the department for review and duplication as necessary; and

(c) Maintain the following:

(i) A master resident index having a reference for each resident including the health record number, if applicable; full name; date of birth; admission dates; and discharge dates; and

(ii) A chronological census register, including all admissions, discharge, deaths and transfers, and noting the receiving facility.      The nursing home ((shall)) must ensure the register includes discharges for social leave and transfers to other treatment facilities in excess of twenty-four hours.

(((5))) (4) The nursing home ((shall)) must ensure the clinical record of each resident:

(a) Is documented and authenticated accurately, promptly and legibly by ((persons)) individuals giving the order, making the observation, performing the examination, assessment, treatment or providing the care and services((, and)). "Authenticated" means the authorization of a written entry in a record by signature, including the first initial and last name and title, or a unique identifier allowing identification of the responsible individual; and:

(i) Documents from other health care facilities that are clearly identified as being authenticated at that facility ((shall)) will be considered authenticated at the receiving facility; and

(ii) The original or a durable, legible, direct copy of each document ((shall)) will be accepted.

(b) Contains appropriate information for a deceased resident including:

(i) The time and date of death;

(ii) Apparent cause of death;

(iii) Notification of the physician and appropriate resident representative; and

(iv) The disposition of the body and personal effects.

(((6))) (5) In cases where the nursing home maintains records by computer rather than hard copy, the nursing home ((shall)) must:

(a) Have in place safeguards to prevent unauthorized access; and

(b) Provide for reconstruction of information.

(((7))) (6) The nursing home ((shall)) must:

(a) Retain health records for the time period required in RCW 18.51.300((;)):

(i) For a period of no less than eight years following the most recent discharge of the resident; except

(ii) That the records of minors must be retained for no less than three years following the attainment of age eighteen years, or ten years following their most recent discharge, whichever is longer.

(b) In the event of a change of ownership, provide for the orderly transfer of ((health)) clinical records to the new licensee; and

(c) In the event a nursing home ceases operation, make arrangements prior to cessation, as approved by the department, for preservation of the ((health)) clinical records.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-180, filed 9/15/94, effective 10/16/94.]

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements at 42 C.F.R. §483.75(m) will be deemed to meet subsection (2) of this section.

(2) The nursing home shall train all employees in emergency procedures when they begin to work in the nursing home, periodically review emergency procedures with existing staff, and carry out unannounced staff drills using those procedures.

(3))) The nursing home ((shall have)) must develop and implement detailed written plans and procedures to meet potential emergencies and disasters. At a minimum the nursing home ((shall)) must ensure these plans provide for:

(a) Fire or smoke;

(b) Severe weather;

(c) Loss of power;

(d) Earthquake;

(e) Explosion;

(f) Missing resident, elopement;

(g) Loss of normal water supply;

(h) Bomb threats; ((and))

(i) Armed ((persons)) individuals;

(j) Gas leak, or loss of service; and

(k) Loss of heat supply.

(((4))) (2) The nursing home must train all employees in emergency procedures when they begin work in the nursing home, periodically review emergency procedures with existing staff, and carry out unannounced staff drills using those procedures.

(3) The nursing home ((shall)) must ensure emergency plans:

(a) Are developed and maintained with the assistance of qualified fire, safety, and other appropriate experts as necessary;

(b) Are reviewed annually; and

(c) Include evacuation routes prominently posted on each unit.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-185, filed 9/15/94, effective 10/16/94.]

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements at 42 C.F.R. §483.75(o) will be deemed to meet subsection (2) of this section.

(2))) The nursing home shall must maintain a process for quality assessment and assurance.      The department may not require disclosure of the records of the quality assessment and assurance committee except in so far as such disclosure is related to ensuring compliance with the requirements of this section.

(((3))) (2) The nursing home ((shall)) must ensure the ((nursing home's)) quality assessment and assurance process:

(a) Seeks out and incorporates input from the resident and family councils, if any, or individual residents and support groups; and

(b) Reviews expressed concerns and grievances.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-190, filed 9/15/94, effective 10/16/94.]

(1) The nursing home ((shall)) must develop and implement written policies and procedures ((in accordance with RCW 74.42.430, and other state and federal laws applicable to resident rights and nursing home operations)), including those specified in RCW 74.42.430, for all services provided in the facility.

(2) The nursing home ((shall)) must ensure the written policies and procedures ((referred to in subsection (1) of this section)):

(a) Promote and protect each resident's:

(i) Rights, including health care decision making;

(ii) Personal interests; and

(iii) Financial and property interests((.));

(b) Are ((made)) readily available to staff, residents, members of residents' families, the public, and representatives of the department;

(c) ((In the case of policies and procedures related to health care decision making and resident representation, are provided to the resident in accordance with federal requirements, where applicable; and

(d))) Are current, and continued without interruption in the event of staff changes; and

(d) Are consistent with other state and federal laws applicable to nursing home operations.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-195, filed 9/15/94, effective 10/16/94.]

(1) Except as provided in this section, a nursing home must not employ any individual, directly or by contract, or accept as a volunteer or student, any individual who may have regularly scheduled unsupervised access to residents if the individual:

(a) Has been convicted of a "crime against children and other persons" as defined in RCW 43.43.830, unless the individual has been convicted of one of the five crimes listed below and the required number of years has passed between the most recent conviction and the date of the application for employment:

(i) Simple assault, assault in the fourth degree, or the same offense as it may hereafter be renamed, and three or more years have passed;

(ii) Prostitution, or the same offense as it may hereafter be renamed, and three or more years have passed;

(iii) Theft in the second degree, or the same offense as it may hereafter be renamed, and five or more years have passed;

(iv) Theft in the third degree, or the same offense as it may hereafter be renamed, and three or more years have passed; or

(v) Forgery, or the same offense as forgery may hereafter be renamed, and five or more years have passed.

(b) Has been convicted of crimes relating to financial exploitation as defined under RCW 43.43.830;

(c) Has been found, by a court of law, to have abused, neglected, exploited, or abandoned a minor or vulnerable adult in criminal, dependency or domestic relations proceeding. A "vulnerable adult" is defined in chapter 74.34 RCW;

(d) Was subject to an order of protection under chapter 74.34 RCW for abandonment, abuse, neglect, or financial exploitation of a vulnerable adult, or misappropriation of resident property; or

(e) Has been found to have neglected, exploited, or abandoned a minor or vulnerable adult by a disciplining authority, including the state department of health, or by the department's resident protection program.

(2) A nursing home may conditionally employ an individual pending a background inquiry provided the nursing home requests the inquiry within seventy-two hours of the conditional employment.

(3) A nursing home licensed under chapter 18.51 RCW must make a background inquiry request to one of the following:

(a) The Washington state patrol;

(b) The department;

(c) The most recent employer licensed under chapters 18.51, 18.20, and 70.128 RCW provided termination of that employment was within twelve months of the current employment application and provided the inquiry was completed by the department or the Washington state patrol within the two years of the current date of application; or

(d) A nurse pool agency licensed under chapter 18.52C RCW, or hereafter renamed, provided the background inquiry was completed by the Washington state patrol within two years before the current date of employment in the nursing home; and

(e) A nursing home may not rely on a criminal background inquiry from a former employer, including a nursing pool, if the nursing home knows or has reason to know that the applicant has, or may have, a disqualifying conviction or finding.

(4) Nursing homes must:

(a) Request a background inquiry of any individual employed, directly or by contract, or accepted as a volunteer or student; and

(b) Notify appropriate licensing or certification agency of any individual resigning or terminated as a result of having a conviction record.

(5) Before a nursing home employs any individual, directly or by contract, or accepts any individual as a volunteer or student, a nursing home must:

(a) Inform the individual that the facility must make a background inquiry and require the individual to sign a disclosure statement, authorizing the inquiry; or

(b) Inform the individual that he or she may make a request for a copy of a completed background inquiry of this section; and (c) Require the individual to sign a statement authorizing the nursing home, the department, and the Washington state patrol to make a background inquiry; and

(d) Verbally inform the individual of the background inquiry results within seventy-two hours of receipt.

(6) The nursing home must establish procedures ensuring that:

(a) The individual is verbally informed of the background inquiry results within seventy-two hours of receipt;

(b) All disclosure statements and background inquiry responses and all copies are maintained in a confidential and secure manner;

(c) Disclosure statements and background inquiry responses are used for employment purposes only;

(d) Disclosure statements and background inquiry responses are not disclosed to any individual except:

(i) The individual about whom the nursing home made the disclosure or background inquiry;

(ii) Authorized state employees including the department's licensure and certification staff, resident protection program staff and background inquiry unit staff;

(iii) Authorized federal employees including those from the Department of Health and Human Services, Health Care Financing Administration;

(iv) The Washington state patrol auditor; and

(v) Potential employers licensed under chapters 18.51, 18.20, and 70.128 RCW who are making a request as provided for under subsection (3) of this section; and

(e) A record of findings be retained by the facility for twelve months beyond the date of employment termination.

[]

(1) The nursing home ((shall ensure sufficient washing and drying facilities to meet the residents' care and comfort needs without delay.      To that end the nursing home shall)) must meet the requirements of WAC 388-97-347, and:

(a) Launder facility linens on the premises; or

(b) Contract with a laundry capable of meeting quality standards, infection control, and turn-around time requirements; and

(c) Make provision for laundering of residents' personal clothing.

(2) ((The nursing home shall ensure the temperature and time of the hot water cycle to disinfect nursing home linen is:

(a) One hundred sixty degrees Fahrenheit during a five minute minimum wash cycle or one hundred forty degrees Fahrenheit during a fifteen minute minimum wash cycle; or

(b) Equivalent disinfection method which conforms to generally accepted standards of infection control for health care facility linen.

(3))) For residents' personal clothing, the nursing home ((shall)):

(a) Must have a system in place to ensure that personal clothing is not damaged or lost during handling and laundering; and

(b) May use department approved chemical disinfection in lieu of the hot water disinfection.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-205, filed 9/15/94, effective 10/16/94.]

(1) The nursing home may provide short-term care to individuals which include:

(a) Respite services to provide relief care for families or other caregivers of individuals with disabilities which must:

(i) Provide short-term care and supervision in substitution for the caregiver;

(ii) Be for short-term stays up to a maximum of thirty-one days; and

(iii) Not be used as a short-term placement pending the individual's admission to the nursing home; and

(b) Adult day or night care to provide short-term nursing home care:

(i) Not to exceed sixteen hours each day; and

(ii) May be on a regular or intermittent basis.

(2) The nursing home providing respite services, and adult day or night care must:

(a) Develop and implement policies and procedures consistent with this section;

(b) Ensure that individuals receiving short-term services under respite or adult day or night care are treated and cared for in accordance with the rights and choices of long-term residents, except for transfer and discharge rights which are provided under the program for short-term services which covers the individual in the nursing home;

(c) Have appropriate and adequate staff, space, and equipment to meet the individual's needs without jeopardy to the care of regular residents;

(d) Before or at the time of admission, obtain sufficient information to meet the individual's anticipated needs. At a minimum, such information must include:

(i) The name, address, and telephone number of the individual's attending physician, and alternate physician if any;

(ii) Medical and social history, which may be obtained from a respite care assessment and service plan performed by a case manager designated by an area agency on aging under contract with the department, and mental and physical assessment data; and

(iii) Physician's orders for diet, medication and routine care consistent with the individual's status on admission.

(e) Ensure the individuals have assessments performed, where needed, and where the assessment of the individual reveals symptoms of tuberculosis, follow tuberculosis testing requirements under WAC 388-97-147;

(f) With the participation of the individual and, where appropriate, their representative, develop a plan of care to maintain or improve their health and functional status during their stay or care in the nursing home;

(g) Provide for the individual to:

(i) Bring medications from home in accordance with nursing home policy; and

(ii) Self-medicate where determined safe.

(h) Promptly report injury, illness, or other adverse change in health condition to the attending physician; and

(i) Inquire as to the need for and comply with any request of the individual, or where appropriate, the individual's representative, to secure cash and other valuables brought to the nursing home during the stay/care.

(3) The nursing home may, in lieu of opening a new record, reopen the individual's clinical record with each period of stay or care up to one year from the previous stay or care, provided the nursing home reviews and updates the recorded information.

(4) Medicaid certified nursing facilities must complete the state-approved resident assessment instrument, within fourteen days, for any individual whose respite stay exceeds fourteen days.

[]

(1) (("Dialysis" means the process of separating crystalloids and colloids in solution by means of the crystalloids and colloids unequal diffusion through a natural or artificial, semipermeable membrane.

(2) "Dialysis helper" means a person who has:

(a) Completed an inservice class approved by the kidney center; and

(b) Been hired by the resident to provide to the resident care related only to dialysis treatment.

(3) "Kidney center" means those facilities as defined and certified by the federal government to provide end stage renal disease (ESRD) services and which provide services specified in WAC 246-520-020)) The nursing home must ensure that appropriate care, treatment, and services are provided to each nursing home resident receiving dialysis. "Dialysis" means the process of separating crystalloids and colloids in solution by means of the crystalloids and colloids unequal diffusion through a natural or artificial semipermeable membrane.

(((4))) (2) Dialysis for acute renal failure ((shall)) must not be administered in a nursing home.

(((5))) (3) A nursing home may only administer maintenance dialysis in the nursing home after the:

(a) Analysis of other options and elimination of these options based on the resident's best interest; and

(b) The decision is made jointly by a team of ((persons)) individuals representing the kidney center, the resident, the resident's nephrologist, and the nursing home. A "kidney center" means those facilities as defined and certified by the federal government to provide end stage renal (ESRD) services.

(((6))) (4) The nursing home ((shall)) must ensure that:

(a) A current written agreement is in effect with each kidney center responsible for the management and care of each ((patient)) nursing home resident undergoing dialysis ((in the nursing home)); and

(b) Such agreement delineates the functions, responsibilities, and services of both the kidney center and the nursing home.

(((6) The nursing home shall ensure appropriate care, treatment, and services to each resident receiving dialysis in the nursing home.

(7))) (5) The kidney center ((shall)) must assist the nursing home in ensuring appropriate care, treatment, and services related to dialysis ((in the nursing home)).      Responsibilities of the kidney center ((shall)) must include, but not be limited to the:

(a) Provision of clinical and chemical laboratory services;

(b) Services of a qualified dietitian;

(c) Social services;

(d) Preventative maintenance and emergency servicing of dialysis and water purification equipment;

(e) Certification and continuing education of dialysis helpers and periodic review and updating of dialysis helpers' competencies. A "dialysis helper" means an individual who has completed an inservice class approved by the kidney center and has been hired by the resident to provide to the resident care related only to the dialysis treatment;

(f) An in-hospital dialysis program for the care and treatment of a dialysis resident with a complication or acute condition necessitating hospital care;

(g) A continuing in-service education program for nursing home staff working with a dialysis resident;

(h) A program for periodic, on-site review of the nursing home's dialysis rooms;

(i) Selection, procurement, and installation of dialysis equipment;

(j) Selection and procurement of dialysis supplies;

(k) Proper storage of dialysis supplies; and

(l) Specification, procurement, and installation of the purification process for treatment of water used as a diluent in the dialyzing fluid.

(((8))) (6) Only a registered nurse from the kidney center or a dialysis helper may administer dialysis in the nursing home.

(a) A dialysis helper may be a registered nurse; and

(b) When a dialysis helper is not a registered nurse, the nursing home ((shall)) must have a registered nurse who has completed an in-service class approved by the kidney center, on the premises during dialysis.

(((9))) (7) A physician, designated or approved by the kidney center, ((shall)) must be on call at all times dialysis is being administered in the nursing home.

(((10))) (8) The resident's attending physician and the kidney center ((shall)) must provide, or direct and supervise, the continuing medical management and surveillance of the care of each nursing home resident receiving dialysis ((resident in a nursing home)).

(((11))) (9) The nursing home ((shall)) must:

(a) Ensure the kidney center develops a dialysis treatment plan; and

(b) Incorporate this treatment plan into the resident's comprehensive plan of care and include specific medical orders for medications, treatment, and diet.

(((12))) (10) The dialysis room in the nursing home ((shall)) must be in compliance with federal standards established ((under 42 C.F.R. §405.2140,)) for ESRD facilities.      This includes:

(a) Storage space available for equipment and supplies;

(b) A telephone at the bedside of each dialysis resident; and

(c) A mechanical means of summoning additional staff to the dialysis area in the event of a dialysis emergency.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-220, filed 9/15/94, effective 10/16/94.]

(1) Pre-admission screening (PAS) is a process by which individuals are evaluated:

(a) For the presence of a serious mental illness or a developmental disability, before admission to the nursing facility;

(b) For nursing facility level of care; and

(c) If the individual does have either a serious mental illness or a developmental disability, to determine whether there is a need for specialized services, or services of a lesser intensity.

(2) The referring hospital, physician, or other referral source must:

(a) Perform the identification screen using a standardized department-specified Level I screening form for all individuals seeking admission to a nursing facility unless they:

(i) Are being readmitted to the nursing facility from the hospital;

(ii) Are being transferred from one nursing facility to another, with or without an intervening hospital stay; or

(iii) Require only thirty days of convalescent care following treatment in an acute care hospital or thirty days respite care as defined in WAC 388-97-212. NOTE: The nursing facility must refer the individual to the department's home and community services office if the individual stays beyond thirty days.

(b) Identify whether the individual may have a serious mental illness or a developmental disability as defined under 42 C.F.R. § 483.102, or successor laws; and

(c) Refer all individuals identified as likely to have a serious mental illness or a developmental disability to the department for a Level II screening. Exception: Individuals identified as meeting any of the advanced categorical determinations in WAC 388-97-249, do not need to be referred to the department.

[]

Individuals identified as having symptoms of mental illness or a developmental disability and meeting any of the advanced categorical determinations do not need to be referred for a Level II screening. The determinations include that the individual:

(1) Is admitted to the nursing facility for respite care as defined under WAC 388-97-212;

(2) Cannot accurately be diagnosed because of delirium. NOTE: The individual would be subject to a Level II screening when the delirium cleared;

(3) Has been certified by a physician to be terminally ill as defined under section 1861 (dd)(3)(A) of the Social Security Act;

(4) Has been diagnosed with a severe physical illness such as coma, ventilator dependence, and is functioning at a brain stem level;

(5) Has a severe level of impairment from diagnoses such as:

(a) Chronic obstructive pulmonary disease;

(b) Parkinson's disease;

(c) Huntington's chorea;

(d) Amyotrophic lateral sclerosis;

(e) Congestive heart failure; or

(6) Has a primary diagnosis of dementia, including Alzheimer's disease or a related disorder. NOTE: There must be evidence to support this determination.

[]

(1) For individuals likely to have a serious mental illness or developmental disability, and who do not fit any of the categorical determinations, the department must determine their need for nursing facility level of care. If they do meet the nursing facility level of care, the department refers them to the department's designee, either the mental health PASRR contractor or the division of developmental disabilities, for a Level II screening.

(2) The department's designee will verify the diagnosis and determine whether the referred individuals need specialized services, or services of a lesser intensity:

(a) "Specialized services" for an individual with mental retardation or related conditions is defined under 42 C.F.R. § 483.120 (a)(2), and § 483.440 (a)(1), or successor laws. These specialized services do not include services to maintain a generally independent individual able to function with little supervision or in the absence of a treatment program; and

(b) "Specialized services" for an individual with a serious mental illness is defined under 42 C.F.R. § 483.120 (a)(1), or successor laws. These services are generally considered acute psychiatric inpatient care, emergency respite care, or stabilization and crisis services.

(3) The need for specialized services, for a nursing facility applicant, will be determined as follows:

(a) If the individual is identified as likely to have a serious mental illness, a qualified mental health professional will verify whether the individual has a serious mental illness and, if so, will recommend whether the individual needs specialized services; and

(b) If the individual is identified as likely to have a developmental disability, a licensed psychologist will verify whether the individual has a developmental disability and, if so, staff of the division of developmental disabilities will assess and determine whether the individual requires specialized services.

[]

After a resident's admission the nursing facility must:

(1) Review the Level I screening form for accuracy and make changes as needed if the resident develops a qualifying diagnosis or if the resident's symptoms were undetected or misdiagnosed; and

(2) Refer residents who have qualifying diagnoses and who require further PASRR assessment to the department;

(3) Record the identification screen information or subsequent changes on the resident assessment instrument according to the schedule required under 42 C.F.R. § 483.20;

(4) Maintain the identification screen form and PASRR assessment information, including recommendations, in the resident's active clinical record; and

(5) Promptly notify the department after a significant change in the physical or mental condition of any resident that is mentally ill or mentally retarded.

[]

(1) ((A nursing facility)) The resident has the right to choose to remain in the nursing facility and receive specialized services if:

(a) He or she has continuously resided in a nursing facility since October 1, 1987; and

(b) The department determined, in 1990, that the resident required specialized services for a serious mental illness or developmental disability but did not require nursing facility services.

(2) In the event that residents chose to remain in the nursing facility as outlined in subsection (1) above, the department, or designee, will clarify the effect on eligibility for Medicaid services under the state plan if the resident chooses to leave the facility, including its effect on readmission to the facility.

(3) A nursing facility applicant or resident who has been adversely impacted by a ((PASARR)) PASRR determination may appeal the department's determination of:

(a) Not in need of nursing facility care as defined under WAC ((388-97-235, Medical eligibility for nursing facility care, and 42 C.F.R. §483.130 (m)(2), (5), or (6))) 388-97-022;

(b) Not in need of specialized services as defined under WAC ((388-97-255, Preadmission screening and annual resident review (PASARR), and 42 C.F.R. §483.130 (m)(1), (2), (3), or (6))) 388-97-251; or

(c) Need for specialized services as defined under WAC ((388-97-255, Preadmission screening and annual resident review (PASARR), 42 C.F.R. §483.130 (4) and (5), and 42 C.F.R. §483.132 (a)(4))) 388-97-251.

(((2))) (4) The nursing facility ((shall)) must assist the ((nursing facility)) applicant or resident, as needed, in requesting a hearing to appeal the department's ((PASARR)) PASRR determination.

(((3))) (5) If the department's ((PASARR)) PASRR determination requires that a resident be transferred or discharged, the department ((shall)) will:

(a) Provide the required notice of transfer or discharge to the resident, the resident's surrogate decision maker, and if appropriate, a family member or the resident's representative thirty days or more before the date of transfer or discharge;

(b) Attach a hearing request form to the transfer or discharge notice;

(c) Inform the resident, in writing in a language and manner the resident can understand, that:

(i) An appeal request may be made any time up to ninety days from the date the resident receives the notice of transfer or discharge;

(ii) Transfer or discharge will be suspended when an appeal request is received by the office of ((appeals)) administrative hearings on or before the date of transfer or discharge set forth in the written transfer or discharge notice; and

(iii) The resident ((shall)) will be ineligible for Medicaid nursing facility payment:

(A) Thirty days after the receipt of written notice of transfer or discharge; or

(B) If the resident appeals under subsection (1)(a) of this section, thirty days after the final order is entered upholding the department's decision to transfer or discharge a resident.

(((4) Aging and adult)) (6) The department's home and community services may ((grant extension of a)) pay for the resident's ((Medicaid)) nursing facility ((payment)) services after the time specified in subsection (3)(c)(iii) of this section, ((when)) if the department determines that a location appropriate to the resident's medical and other needs is not available.

(((5))) (7) The department ((shall)) will:

(a) Send a copy of the transfer/discharge notice to the resident's attending physician, the nursing facility and, where appropriate, a family member or the resident's representative;

(b) Suspend transfer or discharge ((pending the outcome of the appeal when the resident's appeal request is received by the office of appeals on or before the date of transfer or discharge set forth in the written transfer or discharge notice,)):

(i) If the office of administrative hearings receives an appeal on or before the date set for transfer or discharge or before the resident is actually transferred or discharged; and

(ii) Until the office of appeals makes a determination; and

(c) Provide assistance to the resident for relocation necessitated by the department's ((PASARR)) PASRR determination.

(((6))) (8) Resident appeals of ((PASARR)) PASRR determinations ((shall)) will be in accordance with 42 C.F.R. §431 Subpart E, chapter 388-08 WAC, and the procedures defined in this section.      In the event of a conflict between a provision in this chapter and a provision in chapter 388-08 WAC, the provision in this chapter ((shall)) will prevail.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-260, filed 9/15/94, effective 10/16/94.]

(1) An ICF/MR nursing facility that meets the requirements of 42 C.F.R. § 483. Subpart I will be deemed to meet the requirements of this subchapter except that in an ICF/MR nursing facility:

(a) There must be at least one registered nurse or licensed practical nurse on duty eight hours per day, and additional licensed staff on any shift if indicated. WAC 388-97-115 (2)(a) and (3)(a) and (b) do not apply to ICF/MR nursing facilities; and

(b) A medical director is not required.

(2) Staff from the division of developmental disabilities will approve of social/therapeutic leave for individuals who reside in ICF/MR nursing facilities.

[]

PHYSICAL ENVIRONMENT

((ALL FACILITIES))GENERAL
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-295
((General)) Design.

The design of a nursing home ((shall be designed, equipped, and maintained to:

(1) Protect the health and safety of residents, personnel, and the public; and

(2) Provide)) must facilitate resident-centered care and services in a safe, clean, comfortable and homelike environment ((allowing)) that allows the resident to use his or her personal belongings to the greatest extent possible.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-295, filed 9/15/94, effective 10/16/94.]

The nursing home must ensure that: (1) New construction complies with all the requirements of subchapter II;

(2) New construction approved by the department of health, certificate of need and construction review, before the effective date of this chapter complies with the rules in effect at the time of the plan approval;

(3) The department of health, certificate of need and construction review, is contacted for all new construction; and

(4) The department has done a pre-occupancy survey and has determined that the new construction is in compliance with these regulations before the area is placed in use.

[]

The nursing home must: (1) Conform to at least the minimum standards for the prevention of fire, and for the protection of life and property against fire, according to the Uniform Fire Code, RCW 19.27.031, the federal Life Safety Code, and additional state guidelines in chapter 212-12 WAC; and

(2) Comply with all other applicable requirements of state and federal law.

[]

All nursing homes must: (1) Maintain electrical, mechanical, and patient care equipment in safe and operating condition; and

(2) Ensure floors, walls, ceilings, and equipment surfaces are maintained in clean condition and in good repair.

[]

(1) All nursing homes must maintain comfortable sound levels, to include minimizing the use of the public address system and taking reasonable precautions with noisy services so residents are not disturbed, particularly during their sleeping time; and

(2) In new construction, the nursing home must:

(a) Have walls, floor/ceiling and roof/ceiling assemblies constructed with materials that provide comfortable sound levels in all resident areas, rated at an STC 50 or greater; and

(b) Utilize an alternative to the public address system for nonemergency communication that best serves the residents' needs.

[]

The nursing home must be readily accessible to a person with disability and comply with WAC 388-97-410.

[]

New construction includes, but is not limited to: (1) New structures.

(a) A new building to be licensed as a nursing home; or

(b) An addition to a building currently licensed as a nursing home.

(2) Existing buildings.

(a) Conversion of another building to a nursing home;

(b) Change in the use of space for access by residents within an existing nursing home; and

(c) Alterations including physical, mechanical, or electrical changes made to an existing nursing home, except for normal routine maintenance and repair.

(3) See WAC 388-97-400(3) for less extensive alterations.

[]

The following regulations do not apply to nursing homes certified exclusively under 42 C.F.R. §483, Subpart I, ((Conditions of participation for intermediate care facilities for the mentally retarded as now or hereafter amended)) or successor laws.

(1) WAC ((388-97-330 (1)(d), Resident rooms.)) 388-97-33520, regarding the required number of square feet per bed((.)); and

(2) WAC ((388-97-335(9), Resident room equipment.)) 388-97-33570, regarding cubicle curtains.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-310, filed 9/15/94, effective 10/16/94.]

(1) The nursing home ((shall)) must have an alternate source of power and automatic transfer equipment to connect the alternate source within ten seconds of the failure of the normal source.

(((a))) (2) The nursing home ((shall)) must ensure the alternate source is ((a)):

(a) Generator driven by a prime mover with on-site fuel supply((, unit equipment));

(b) Permanently fixed in place((, and));

(c) Approved for emergency service((.

(b) When life support systems are used, the nursing home shall provide emergency electrical power with an)); and

(d) An on premises emergency generator, as defined in NFPA 99, Health care facilities, ((that is located on the premises)) when life support systems are used.

(((2))) (3) The nursing home ((shall)) must ensure the emergency power supply provides a minimum of four hours of effective power for lighting for night lights, exit signs, exit corridors, stairways, dining and recreation areas, work stations, medication preparation areas, boiler rooms, electrical service room and emergency generator locations.

(((3))) (4) A nursing home first licensed on or after October 1, 1981, ((shall)) must have emergency power supplied to:

(a) ((Uninterrupted function of)) Communication systems, all alarm systems, an elevator that reaches every resident floor including the ground floor, equipment to provide heating for resident rooms or a room to which all residents can be moved ((when the outside design temperature is plus twenty degrees Fahrenheit or lower based on the median extremes as shown in the ASHRAE HANDBOOK OF FUNDAMENTALS)); and

(b) ((Uninterrupted function of selected specially marked receptacles)) Electrical outlets located in medication preparation areas, pharmacy dispensing areas, staff work stations, ((and)) dining areas, resident corridors, and resident bed locations designated for use with life support systems.

(5) In new construction, the emergency power equipment must meet the earthquake standards for the facility's geographic locale.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-315, filed 9/15/94, effective 10/16/94.]

(((1) LOCATION.))      The nursing home ((shall locate)) must ensure that:

(((a))) (1) Each resident care unit is located to minimize through traffic to any general service, diagnostic, treatment, or administrative area; and

(((b) All rooms or areas within the unit on the same floor level.))

(2) ((REQUIRED SERVICES.

(a) The nursing home shall ensure each resident care unit has at least the following basic services:

(i) A staff work station;

(ii) A medicine storage and preparation area;

(iii Utility rooms which maintain separated clean and soiled functions;

(iv) Storage space for linen, other supplies, and equipment;

(v) Housekeeping services; and

(vi) Janitor's closet.

(b) Resident care units may share basic services if the units are in close proximity to each other and the combined units serve a total of not more than sixty residents; except the nursing home shall have a separate staff work station on a secured dementia care unit.

(3) STAFF WORK STATION.      On each unit, the nursing home shall have a staff work station appropriate to the needs of staff using the space.      At a minimum, the nursing home shall equip the area with:

(a) A charting surface;

(b) A rack or other storage for current health records;

(c) Storage for record and clerical supplies;

(d) A telephone;

(e) A resident call system; and

(f) A clock.

(4) CALL SYSTEMS.      The nursing home shall provide the following or an equivalent system which meets these standards:

(a) An electrical communication system which registers a call by distinctive light at the room door and by distinctive light and audible tone at the staff work station.      The system shall be equipped to receive resident calls from:

(i) The bedside of each resident;

(ii) Each day room or other area used by residents;

(iii) Resident toilet, bath and shower rooms.

(b) An emergency signal device activated by a nonconductive pull cord, or adapted to meet the needs of the resident.      The nursing home shall locate the signal device for easy reach by the resident.

(5) TELEPHONES.      A nursing home resident shall have twenty-four hour access to a telephone which:

(a) Provides auditory privacy; and

(b) Is accessible to a person with a disability and accommodates a person with sensory impairment.

(6) UTILITY SERVICE ROOMS.      The nursing home shall provide a utility room designed, equipped, and maintained to ensure separation of clean and sterile supplies and equipment from those which are contaminated.      The nursing home shall ensure:

(a) Each clean utility area has a work counter, a sink, and closed storage units for supplies and small equipment.

(b) Each soiled utility area has:

(i) A work counter and a sink large enough to totally submerge the items being cleaned and disinfected;

(ii) Storage for cleaning supplies and other items;

(iii) Locked storage for cleaning agents, disinfectants and other caustic or toxic agents;

(iv) Adequate space for waste containers, linen hampers, and other large equipment; and

(v) Adequate ventilation to remove odors and moisture.

(7) DRUG FACILITIES.      The nursing home shall ensure an area is designed and equipped for drug preparation and locked storage near each work station.      The nursing home shall ensure:

(a) The drug facilities are well illuminated, ventilated, and equipped with a work counter, sink with hot and cold running water, and drug storage units.

(b) The drug storage units provide:

(i) Locked storage for all drugs;

(ii) Separately keyed storage for Schedule II and III controlled substances; and

(iii) Segregated storage of different resident's drugs.

(c) There is a refrigerator for storage of thermolabile drugs in the drug facility; and

(d) Locks and keys for drug facilities are different from other locks and keys within the nursing home.

(8) LINEN STORAGE.      The nursing home shall provide:

(a) A clean area for storage of clean linen and other bedding.      This may be an area within the clean utility room.

(b) A soiled linen space for collection and temporary storage of soiled linen.      This may be in an area of the soiled utility room.

(9) EQUIPMENT STORAGE.      The nursing home shall provide adequate storage space for wheelchairs and other ambulation equipment.      The nursing home shall ensure equipment does not impinge upon the required corridor space.

(10) JANITORS' CLOSET.      The nursing home shall have a janitors' closet with a service sink and adequate storage space for housekeeping equipment and supplies near each resident care unit)) In new construction, the resident care unit, and the services to support resident care and nursing needs, are designed to serve a maximum of sixty beds on the same floor.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-325, filed 9/15/94, effective 10/16/94.]

(1) The nursing home must ensure each resident care unit has at least the following required service areas:

(a) A staff work station;

(b) A medicine storage and preparation area;

(c) A utility room that maintains separated clean and soiled functions;

(d) Storage space for linen, other supplies, and equipment; and

(e) Housekeeping services and janitor's closet.

(2) Resident care units may share required services if the units are in close proximity to each other and the combined units serve a total of not more than sixty residents; except the nursing home must have a separate staff work station on a secured dementia care unit.

[]

(1) On each unit, the nursing home must have a staff work station appropriate to the needs of staff using the space. At a minimum, the nursing home must equip the area with:

(a) A charting surface;

(b) A rack or other storage for current health records;

(c) Storage for record and clerical supplies;

(d) A telephone;

(e) A resident call system; and

(f) A clock.

(2) In new construction the work station space must be open to the corridor.

[]

The nursing home must provide the following, or an equivalent system that meets these standards:

(1) A wired or wireless communication system which registers a call by distinctive light at the room door and by distinctive light and audible tone at the staff work station. The system must be equipped to receive resident calls from:

(a) The bedside of each resident;

(b) Every common area, dining and activity areas, common use toilet rooms, and other areas used by residents; and

(c) Resident toilet, bath and shower rooms.

(2) An emergency signal device activated by a nonconductive pull cord, or adapted to meet the needs of the resident. The nursing home must locate the signal device for easy reach by the resident. A signal device must be adapted to meet resident needs and, in the dementia unit, may be adapted for staff and family use, see WAC 388-97-35050.

[]

The nursing home must provide twenty-four hour access to a telephone for resident use which:

(1) Provides auditory privacy;

(2) Is accessible to a person with a disability and accommodates a person with sensory impairment;

(3) Is not located in a staff office or at a nurse's station; and

(4) Does not require payment for local calls.

[]

(1) All nursing homes must:

(a) Provide utility rooms designed, equipped, and maintained to ensure separation of clean and sterile supplies and equipment from those that are contaminated;

(b) Ensure that each clean utility room has a work counter, a sink equipped with single use hand drying towels and soap for handwashing, and closed storage units for supplies and small equipment; and

(c) Ensure that each soiled utility room has:

(i) A work counter and a sink large enough to totally submerge the items being cleaned and disinfected;

(ii) Storage for cleaning supplies and other items, including equipment, to meet nursing home needs;

(iii) Locked storage for cleaning agents, disinfectants and other caustic or toxic agents;

(iv) Adequate space for waste containers, linen hampers, and other large equipment; and

(v) Adequate ventilation to remove odors and moisture.

(2) In new construction.

(a) A resident room must not be more than ninety feet from a clean utility room and a soiled utility room;

(b) Each soiled utility room must contain:

(i) A double-compartment sink with inside dimensions of each compartment deep enough to totally submerge items being cleaned and disinfected;

(ii) Sufficient, available work surface on each side of the sink to adequately process and dry equipment with a minimum of three feet of work surface on the clean side;

(iii) Drying/draining racks for wet equipment;

(iv) Work counters, sinks, and other fixed equipment arranged to prevent intermingling of clean and contaminated items during the cleaning process; and

(v) A siphon jet type clinic service sink or equivalent installed on the soiled side of the utility room away from the door.

(c) The nursing home's space for waste containers, linen hampers, and other large equipment, must not block work areas; and

(d) The utility rooms must meet the ventilation requirements of Table 5, WAC 388-97-47020.

[]

The nursing home must provide an area designed and equipped for drug preparation and locked storage convenient to each work station. The nursing home must ensure:

(1) The drug facilities are well illuminated, ventilated, and equipped with a work counter, sink with hot and cold running water, and drug storage units;

(2) The drug storage units are one or more of the following:

(a) Locked cabinetry constructed in accordance with board of pharmacy regulations for drug storage which has:

(i) Separately keyed storage for Schedule II and III controlled substances; and

(ii) Segregated storage of different residents' drugs, or

(b) An automated medication distribution device or storage.

(3) There is a refrigerator for storage of thermolabile drugs in the drug facility;

(4) Locks and keys for drug facilities are different from other locks and keys within the nursing home; and

(5) In new construction, the drug facility must be a separate room.

[]

The nursing home must provide:

(1) A clean area for storage of clean linen and other bedding. This may be an area within the clean utility room;

(2) A soiled linen area for the collection and temporary storage of soiled linen. This may be within the soiled utility room; and

(3) In new construction, storage for linen barrels and clean linen carts.

[]

The nursing home must have a janitors closet with a service sink and adequate storage space for housekeeping equipment and supplies convenient to each resident unit.

[]

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements of C.F.R. §483.70(d) will be deemed to meet subsections (2)(a), (b), (d), (e), and (4), except (2)(c) and (3).

(2) EACH RESIDENT ROOM SHALL MEET THE FOLLOWING REQUIREMENTS:

(a) EACH RESIDENT ROOM SHALL HAVE DIRECT ACCESS TO AN EXIT CORRIDOR AND SHALL BE LOCATED TO PREVENT THROUGH TRAFFIC;

(b) THE MAXIMUM CAPACITY OF ANY RESIDENT BEDROOM SHALL BE FOUR BEDS;

(c) There shall be no more than two beds between any resident bed and exterior window wall;

(d) MINIMUM ROOM AREAS FOR EXISTING FACILITIES EXCLUSIVE OF TOILET ROOMS, CLOSETS, LOCKERS OR WARDROBES SHALL BE AT LEAST EIGHTY SQUARE FEET PER BED IN EACH MULTI-BED ROOM AND AT LEAST ONE HUNDRED SQUARE FEET FOR EACH SINGLE BED ROOM;

(e) EACH RESIDENT ROOM SHALL BE DESIGNED OR EQUIPPED TO ENSURE FULL VISUAL PRIVACY FOR EACH RESIDENT.

(3) If a nursing home provides an isolation room, the nursing home shall ensure the room is uncarpeted and contains:

(a) A lavatory with water supplied through a mixing valve; and

(b) It's own adjoining toilet room containing a bathing facility.

(4) EXCEPTIONS.      THE DIRECTOR OF NURSING HOME SERVICES, AGING AND ADULT SERVICES ADMINISTRATION, MAY PERMIT EXCEPTIONS TO (2)(c) AND (d) FOR NURSING HOMES WHEN THE NURSING HOME DEMONSTRATES IN WRITING THAT THE EXCEPTION:

(a) IS IN ACCORDANCE WITH THE SPECIAL NEEDS OF THE RESIDENT; AND

(b) WILL NOT ADVERSELY AFFECT ANY RESIDENTS' HEALTH OR SAFETY.)) The nursing home must ensure that each resident bedroom:

(a) Has direct access to an exit corridor;

(b) Is located on an exterior wall with a transparent glass window; and

(c) Is located to prevent through traffic.

(2) In a new building or addition, each resident bedroom must:

(a) Have an exterior transparent glass window:

(i) With an area equal to at least one-tenth of the bedroom usage floor area;

(ii) Located twenty-four or more from another building or the opposite wall of a court, or ten feet or more away from a property line, except on street sides;

(iii) Located eight feet or more from any exterior walkway, paved surface, or driveway; and

(iv) With a sill three feet or less above the floor.

(b) Be floor level above grade level except for earth berms. "Grade" means the level of ground adjacent to the building floor level measured at the required exterior window. The ground must be level or slope downward for a distance of at least ten feet from the wall of the building. From there the ground may slope upward to the maximum sill height of the required window at a rate of one foot vertical for two feet horizontal.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-330, filed 9/15/94, effective 10/16/94.]

(1) The nursing home must ensure that any resident bedroom has:

(a) No more than two beds between any resident bed and exterior window wall; and

(b) A maximum capacity of four beds.

(2) In a new building, addition, or change of use to a resident bedroom the maximum capacity is two beds per room, for plans submitted after September 1, 1995.

[]

The nursing home must ensure that minimum usable room space exclusive of toilet rooms, closets, lockers, wardrobes, must:

(1) In existing facilities, be at least eighty square feet per bed in each multi-bed room and at least one hundred square feet for each single bed room;

(2) In a new building or addition, be one-hundred and ten square feet per bed in multi-bed rooms, and one-hundred square feet in single bed rooms;

(3) In new construction, ensure that the minimum usable room space is also exclusive of vestibules; and

(4) For exceptions to room size requirements refer to WAC 388-97-310.

[]

The nursing home must ensure that each resident bedroom is designed or equipped to ensure full visual privacy for each resident.

[]

If a nursing home provides an isolation room, the nursing home must ensure the room is uncarpeted and contains:

(1) A handwashing sink with water supplied through a mixing valve;

(2) It's own adjoining toilet room containing a bathing facility; and

(3) In new construction, the handwashing sink located between the corridor door and the bed.

[]

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 388-97-33050
Resident room size variance.

The director of residential care services, aging and adult services administration, or their designee, may permit exceptions to WAC 388-97-33010 (1)(a) and 388-97-33020(1) when the nursing home demonstrates in writing that the exception:

(1) Is in accordance with the special needs of the resident; and

(2) Will not adversely affect any resident's health or safety.

[]

The nursing home ((shall)) must determine a resident's furniture and equipment needs at the time of admission and routinely thereafter to ensure resident comfort.      Except as specified in WAC 388-97-07060, the nursing home ((shall)) must provide each resident with the following((, except as specified in WAC 388-97-070(15), Personal property:

(1) A comfortable bed of size and height to maximize a resident's independent functioning.      Beds may be arranged to satisfy the needs and desires of the individual resident provided the arrangement does not negatively impact the health or safety of other residents;

(2) Appropriate bedding;

(3) A bedside cabinet that allows for storage of small personal articles and a separate drawer or enclosed compartment for storage of resident care utensils/equipment;

(4) A lockable storage space accessible to each resident for storage of small personal items, upon request;

(5) A separated, enclosed wardrobe or closet for resident's clothing and belongings accessible to the resident;

(6) Comfortable seating to provide for proper body alignment and support;

(7) A wall-mounted or equivalent reading light, to accommodate the needs of the resident;

(8) A resident call signal device for each bed adapted to accommodate the needs of the resident, except as required in the dementia care unit; and

(9) Flame-retardant cubicle curtains in multi-bed rooms which provide full visual privacy for each resident)) items required in WAC 388-97-33510 through 388-97-33580.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-335, filed 9/15/94, effective 10/16/94.]

The nursing home must provide:

(1) A comfortable bed of size and height to maximize a resident's independent functioning. Beds may be arranged to satisfy the needs and desires of the individual resident provided the arrangement does not negatively impact the health or safety of other residents;

(2) Appropriate bedding; and

(3) A bedside cabinet that allows for storage of small personal articles and a separate drawer or enclosed compartment for storage of resident care utensils/equipment.

[]

The nursing home must provide:

(1) A lockable storage space accessible to each resident for storage of small personal items, upon request; and

(2) In a new building or addition, a lockable cabinet space or drawer for storage of personal belongings for each resident bed, in addition to the bedside cabinet.

[]

The nursing home must provide:

(1) A separated, enclosed wardrobe or closet for each resident's clothing and belongings accessible to the resident; and

(2) In a new building or addition, each bed in each room must have a separate, enclosed wardrobe or closet accessible to the resident with:

(a) Minimum inside dimensions of twenty-two inches deep by a minimum of twenty-six inches wide by sixty inches high; and

(b) Inside space including a rod, at least fifteen inches long, and allowing for fifty-four inches of clear hanging length adjustable to meet the needs of the resident.

[]

The nursing home must provide comfortable seating for residents and visitors, not including resident care equipment, that provides proper body alignment and support.

[]

The nursing home must provide a permanently mounted or equivalent light suitable for any task the resident chooses to do or any task the staff must do.

[]

The nursing home must provide a resident call signal device that complies with WAC 388-97-32530.

[]

The nursing home must provide:

(1) Flame-retardant cubicle curtains in multi-bed rooms that provide full visual privacy for each resident;

(2) In a new building or addition, the cubicle curtain or enclosed space must provide full visual privacy for each bed in a multi-bed room with enclosed space containing at least sixty-four square feet of floor area with a minimum dimension of seven feet. "Full visual privacy" in a multi-bed room prevents staff, visitors and other residents from seeing a resident in bed, while allowing staff, visitors, and other residents access to the toilet room, handwashing sink, exterior window, and the entrance door;

(3) For exceptions to cubicle curtain requirements refer to WAC 388-97-310.

[]

The nursing home must provide:

(1) A phone jack for each bed in each room;

(2) A handwashing sink in each multi-bed room and a handwashing sink in each single room that does not have an adjoining toilet room containing a handwashing sink. A handwashing sink located in a resident bedroom must be located between the corridor entry door and the nearest resident bed; and

(3) Storage that meets the requirements of WAC 388-97-357, 388-97-35710, and 388-97-35720.

[]

(((1) Each resident room shall be equipped with or located near toilet and bathing facilities.

(2))) The nursing home ((shall)) must ensure that:

(((a))) (1) Each resident room is equipped with or located convenient to toilet facilities.

(2) For new construction, a toilet room ((is)) must:

(a) Be directly accessible from each resident room and from each bathing facility without going through or entering a general corridor while maintaining resident dignity;

(b) ((One toilet room)) Serve((s)) two bedrooms or less((.

(3) The nursing home shall ensure:

(a) All lockable toilets and bathrooms have readily available a means of unlocking from the outside; and

(b) Locks are operable from the inside with a single effort.

(4) The nursing home shall ensure there is at least one bathing unit for every twenty residents or fraction thereof which is not in a room served by an adjoining bathroom.

(5) The nursing home shall ensure for each resident care unit there is at least one bathing device designed for bathing by immersion.

(6) The nursing home shall ensure there is at least one roll-in shower or equivalent on each resident care unit:

(a) Designed and equipped for unobstructed ease of shower chair entry and use; and

(b) With a spray attachment equipped with a backflow prevention device.

(7) The nursing home shall ensure resident bathing equipment is smooth, cleanable, and able to be disinfected after each use));

(c) Be designed to accommodate a person in a wheelchair;

(d) Contain at least one handwashing sink; and

(e) Provide a properly located and securely mounted grab bar at each side and the back of each toilet fixture in each toilet room and staff. Grab bars must measure twelve to eighteen inches from center on the open side. Side grab bars must be able to swing up.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-340, filed 9/15/94, effective 10/16/94.]

The nursing home must ensure:

(1) Each resident room is equipped with or located near bathing facilities;

(2) At least one bathing unit for no more than thirty residents that is not located in a room served by an adjoining bathroom;

(3) At least one bathing device for immersion per floor;

(4) At least one roll in shower or equivalent on each resident care unit:

(a) Designed and equipped for unobstructed ease of shower chair entry and use; and

(b) With a spray attachment equipped with a backflow prevention device.

(5) Resident bathing equipment is smooth, cleanable, and able to be disinfected after each use.

(6) For new construction, in each bathing unit containing more than one bathing facility:

(a) Each bathtub, shower, or equivalent, is located in a separate room or compartment with three solid walls;

(b) The entry wall may be a "shower" type curtain or equivalent;

(c) The area for each bathtub and shower is sufficient to accommodate a shower chair, an attendant, and provide visual privacy for bathing, drying, and dressing;

(d) Shower and tub surfaces are slip-resistant;

(e) Bathing areas are constructed of materials that are impervious to water and cleanable; and

(f) Grab bars are installed on all three sides of a shower with the shower head grab bar being "L" shaped.

[]

The nursing home must ensure:

(1) All lockable toilet facilities and bathrooms have readily available a means of unlocking from the outside; and

(2) Locks are operable from the inside with a single motion.

[]

(1) ((Medicaid-certified nursing facilities in compliance with federal requirements at C.F.R. §483.70(g) will be deemed to meet this section.

(2))) The nursing home ((shall)) must provide one or more rooms designated for resident dining and activities((.      These rooms shall)) that are:

(a) ((Be)) Well lighted;

(b) ((Be)) Well ventilated;

(c) ((Be)) Adequately furnished; and

(d) ((Have sufficient space)) Large enough to accommodate all activities.

(2) In a new building or addition, the nursing home must design space for dining rooms, dayrooms, and activity areas for resident convenience and comfort and to provide a homelike environment. The nursing home must:

(a) Ensure these rooms or areas are exterior rooms with windows that have a maximum sill height of thirty-six inches;

(b) Provide space for dining, day use, and activities with a minimum combined total of thirty square feet for each licensed bed;

(c) Design any multi-purpose rooms to prevent program interference with each other;

(d) Locate a day room on each resident care unit;

(e) Provide storage spaces for all activity and recreational equipment and supplies, adjoining or adjacent to the facilities provided; and

(f) Locate a common use toilet facility, with handwashing sink and accessories, providing direct access from the hallway and within a maximum of forty feet from these spaces.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-345, filed 9/15/94, effective 10/16/94.]

The nursing home must comply with WAC 388-97-205 and ensure:

(1) Sufficient laundry washing and drying facilities to meet the residents' care and comfort needs without delay.

(2) The temperature and time of the hot water cycle to disinfect nursing home linen is in accordance with the following table:

Water temperature	Cycle length
160 degrees F	At least 5 minutes
140 degrees F	At least 15 minutes

(3) In new construction, soiled linens and soiled clothing are stored and sorted in a room ventilated according to Table 5, WAC 388-97-47020. The room must:

(a) Have self-closing doors;

(b) Be separated from the washing and drying facilities;

(c) Contain a handwashing sink;

(d) Have a floor drain; and

(e) Contain a clinic service sink.

(4) In new construction, clean linen is stored in a room ventilated according to Table 5, WAC 388-97-47020. The room must:

(a) Be separated from the washing and drying facilities; and

(b) Have self closing doors.

[]

(((1) DEMENTIA CARE UNIT.))      A nursing home that began operating a dementia care unit at any time after November 13, 1989, must meet all requirements of this section((.      A new building or addition to an existing nursing home shall also meet the requirements of WAC 388-97-460(1).      Refer to WAC 388-97-095 for program requirements.      The dementia care unit shall:

(a) Provide dining areas which may also serve as day areas for the unit;

(b) Provide secured outdoor space and walkways including:

(i) Ambulation area.      Walking surfaces shall be firm, stable, and free from abrupt changes.      Walking surfaces subject to wet conditions shall have slip-resistant surfaces;

(ii) Outdoor furniture; and

(iii) Nontoxic plants.

(c) Staff toilet room with lavatory;

(d) Provide indoor ambulation areas meeting the needs of the residents, and maintained free of equipment;

(e) Ensure floors, walls, and ceiling surfaces display contrasting color for identification.      Surfaces may have a disguise design to obscure or conceal areas that residents should not enter.      Exterior exit doors shall be marked so that they are readily distinguishable from adjacent construction and the way of exit travel is obvious and direct;

(f) Ensure door thresholds are one-half inch high or less;

(g) Provide an electrical signaling system at each bedside, designed primarily for staff and visitor use in emergent situations, which registers by a distinctive light at the resident room door and light and tone at the staff work station.      The facility shall accommodate the needs of residents able to utilize a call system;

(h) Not use a public address system except for emergencies;

(i) Ensure required approvals are obtained from the state fire marshal, department of social and health services and the local official enforcing the uniform building code and uniform fire code when automatic door locks are used.

(j) Always have staff present in the unit to protect all residents in the event of fire and for residents' evacuation to areas of refuge and from the building when necessary.

(2) SPECIALIZED REHABILITATION.      Nursing homes initially licensed after October 1, 1981, shall ensure inpatient services:

(a) Are located for easy access in general service areas;

(b) Include exercise, treatment, and supportive equipment as required by the narrative program in the construction documents;

(c) Have adequate space for exercise equipment and treatment tables with sufficient work space on each side;

(d) Provide privacy cubicle curtains on tracks or the equivalent around treatment areas;

(e) Provide a lavatory in the treatment area and a toilet nearby;

(f) Provide space and a desk or equivalent for administrative, clerical, interviewing, and consultive functions;

(g) Provide adequate enclosed storage cabinets for clean linen and supplies and locked storage for cleaning chemicals in the rehabilitation room or nearby janitor's closet;

(h) Provide adequate storage space for large equipment;

(i) Provide a janitor's closet close to the area;

(j) Provide for soiled linen storage; and

(k) Provide a separate room or area for hydrotherapy tanks, or the equivalent, if tanks are used.

(3) OUTPATIENT REHABILITATION.      The nursing home shall ensure facilities with outpatient programs provide:

(a) A designated reception and waiting room or area and space for interviewing or counseling individual outpatients and their families;

(b) Adequate space for the program to minimize disruption to designated resident care units;

(c) Accessible toilet and shower facilities nearby;

(d) Lockers or a safe place to store outpatient personal belongings; and

(e) A separate room or area for hydrotherapy tanks, or the equivalent)), WAC 388-97-35010 through 388-97-35060, and the resident care unit requirements of WAC 388-97-325 through 388-97-32580. Refer to WAC 388-97-097, for program requirements.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-350, filed 9/15/94, effective 10/16/94.]

(1) The nursing home must provide dining areas in the dementia care unit which may also serve as day areas for the unit.

(2) In a new building or addition, the dining, dayroom, and activity area or areas on the unit must provide a minimum of thirty square feet per resident.

[]

The nursing home must provide the dementia care unit with:

(1) Secured outdoor space and walkways;

(2) An ambulation area with accessible walking surfaces that:

(a) Are firm, stable, and free from cracks and abrupt changes with a maximum of one inch between sidewalk and adjoining landscape areas;

(b) Have slip-resistant surfaces if subject to wet conditions; and

(c) Sufficient space and outdoor furniture with flexibility in arrangement of the furniture to accommodate residents who use wheelchairs and mobility aids; and

(3) Nontoxic outdoor plants in areas accessible to residents.

(4) In new construction the outdoor areas must also meet the requirements of WAC 388-97-45510.

[]

The nursing home must provide the dementia care unit with:

(1) Indoor areas that meet the needs of the residents and are maintained free of equipment; and

(2) Nontoxic indoor plants in areas accessible to residents.

[]

The nursing home must ensure that the dementia care un it has a continuous ambulation route which may include outdoor ambulation areas and allows the resident to return to the resident's starting point without reversing direction.

[]

The nursing home must:

(1) Provide a staff toilet room with a handwashing sink;

(2) Ensure that floors, walls, and ceiling surfaces display contrasting color for identification:

(a) Surfaces may have a disguise design to obscure or conceal areas that residents should not enter; and

(b) Exterior exit doors must be marked so that they are readily distinguishable from adjacent construction and the way of exit travel is obvious and direct;

(3) Ensure that door thresholds are one-half inch high or less;

(4) Provide a signal device adapted:

(a) To meet residents' needs; and

(b) For staff and family use, if necessary;

(5) Ensure that the public address system is used only for emergency use; and

(6) Refer to WAC 388-97-470(2) for dementia care unit exceptions to individual temperature controls.

[]

In dementia care units the nursing home must:

(1) Have proof that required approvals for any automatic door locks were obtained from the state fire marshal, department of social and health services, and the local official who enforces the uniform building code and uniform fire code; and

(2) In a new building or addition, for egress door control devices to be used on doors and gates which are a part of the exit system, the building must:

(a) Have an approved automatic fire alarm system;

(b) Have an approved supervised automatic fire sprinkler system which is electrically interconnected with the fire alarm system; and

(c) Have a system which must:

(i) Automatically release if power to the system is lost;

(ii) Automatically release with activation of the building's fire alarm system;

(iii) Release with an override switch installed at each staff work station or at a constantly staff attended location within the building; and

(iv) Have directions for releasing the device at each egress controlled door and gate; and

(d) Prohibit the use of keyed locks at all doors and gates in all egress pathways.

[]

(1) If nursing homes initially licensed after October 1, 1981 provide inpatient specialized rehabilitation, they must ensure that those services provide:

(a) Easy access in general service areas;

(b) Exercise, treatment, and supportive equipment as required by the narrative program in the construction documents;

(c) Adequate space for exercise equipment and treatment tables with sufficient work space on each side;

(d) Privacy cubicle curtains on tracks or the equivalent around treatment areas;

(e) A sink in the treatment area and a toilet and handwashing sink in a toilet room nearby;

(f) Space and a desk or equivalent for administrative, clerical, interviewing, and consultative functions;

(g) Adequate enclosed storage cabinets for clean linen and supplies and locked storage for cleaning chemicals in the rehabilitation room or nearby janitor's closet;

(h) Adequate storage space for large equipment;

(i) A janitor's closet close to the area;

(j) Soiled linen storage; and

(k) A separate room or area for hydrotherapy tanks, or the equivalent, if provided.

(2) For any new construction under WAC 388-97-29560, nursing homes licensed before October 1, 1981, must comply with the requirements in subsection (1) of this section.

[]

The nursing home must ensure that facilities with outpatient programs provide:

(1) A designated reception and waiting room or area and space for interviewing or counseling individual outpatients and their families;

(2) Adequate space for the program so that disruption to designated resident care units is minimized;

(3) Accessible toilet and shower facilities nearby;

(4) Lockers or a safe place to store outpatient personal belongings;

(5) A separate room or area for hydrotherapy tanks, or the equivalent, if provided; and

(6) In new construction, required access must come from the exterior without passing through the interior of the facility.

[]

The nursing home ((shall)) must ensure food service areas are in compliance with chapter 246-215 WAC, state board of health rules governing food service sanitation.      The nursing home ((shall)) must:

(1) Ensure food service areas are provided for the purpose of preparing, serving, and storing food and drink unless food service is provided from another licensed food service facility;

(2) Ensure food service areas are located to facilitate receiving of food ((stores)) supplies, disposal of kitchen waste, and transportation of food to dining and resident care areas;

(3) Locate and arrange the kitchen to avoid contamination of food, to prevent heat and noise entering resident care areas, and to prevent through traffic;

(4) Locate the receiving area for ready access to storage and refrigeration areas;

(5) Conveniently locate a handwashing ((facilities to)) sink near the food preparation and dishwashing area, and include ((a lavatory)), a waste receptacle((,)) and dispensers stocked with soap and paper towels;

(6) Adequately ventilate, light, and equip the dishwashing room or area for sanitary processing of dishes;

(7) Locate the garbage storage area in a well-ventilated room or an outside area;

(8) ((When a can-wash area is provided, have)) Provide hot and cold water and a floor drain connected to the sanitary sewage system in a can wash area, unless located in outside covered area;

(9) Provide space for an office or a desk and files for food service management located central to deliveries and kitchen operations; and

(10) Include housekeeping facilities or a janitor's closet for the exclusive use of food service with a service sink and storage of housekeeping equipment and supplies.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-355, filed 9/15/94, effective 10/16/94.]

The nursing home must:

(1) Provide adequate storage space for wheelchairs and other ambulation equipment;

(2) Ensure stored equipment does not impinge upon the required corridor space; and

(3) In new construction, provide adequate storage of four square feet or more of storage space per bed which does not impinge upon required corridor space.

[]

The nursing home must provide separate storage for extra pillows and blankets for each bed. This may be in a location convenient to the resident room or combined with the wardrobe or closet if it does not impinge upon the required space for clothing.

[]

A nursing home must have general storage space of not less than five square feet per bed in addition to the closets and storage required in WAC 388-97-33520.

[]

The nursing home ((shall)) must ensure that lighting and lighting levels:

(1) ((Lighting is)) Are adequate and comfortable for the functions being conducted in each area of the nursing home;

(2) ((Lighting levels are appropriate to the task,)) Are suitable for any task the resident chooses or any task the staff must do;

(3) Support the independent functioning of the resident((,));

(4) Provide a homelike environment((,)) ; and

(5) Minimize glare((;

(3) Adequate natural or artificial light for inside illumination is provided in every useable room area, including storerooms, attic and basement rooms, hallways, stairways, inclines, and ramps;

(4) Lighting levels in parking lots and approaches to buildings are appropriate for resident and visitor convenience and safety;

(5) All outside areas where nursing home equipment and machinery are stored have proper lighting; and

(6) Light shields are provided in kitchens and related food serving areas, utility rooms, medication rooms, exam rooms, pool enclosures, and resident rooms when ceiling-mounted florescent lights are used)).

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-360, filed 9/15/94, effective 10/16/94.]

(1) The nursing home must ensure that adequate natural or artificial light for inside illumination is provided in every useable room area, including but not limited to storerooms, attic and basement rooms, hallways, stairways, inclines, and ramps.

(2) In new buildings and additions, the nursing home must utilize:

(a) Windows and skylights to minimize the need for artificial light and to allow a resident to experience the natural daylight cycle; and

(b) Windows and skylights near entrances/exits in order to avoid difficulty in adjusting to light levels when entering or leaving the facility.

[]

The nursing home must ensure:

(1) Lighting levels in parking lots and approaches to buildings are appropriate for resident and visitor convenience and safety; and

(2) All outside areas where nursing home equipment and machinery are stored have proper lighting.

[]

The nursing home must ensure that light shields are provided in food preparation and serving areas, utility rooms, medication rooms, exam rooms, pool enclosures, laundry areas, and on ceiling mounted fluorescent lights in resident rooms.

[]

The nursing home must ensure:

(1) Lighting fixtures and circuitry provide at least the illumination levels shown within Table B;

(2) Design takes into consideration that lighting systems normally decrease in output with age and dirt accumulation; and

(3) Light fixture locations and switching arrangements are appropriate for the needs of the occupants of the spaces and follow Illuminating Engineering Society (IES) recommendations for health care facilities.

TABLE B

Average Maintained

Footcandles

Area	Ambient Light1	Task Light2
Adm and lobby, day	30	NA
Adm and lobby, night	20	NA
Barber, beautician	50	NA
Chapel, quiet area	30	NA
Corridors, interior ramps	30	NA
Corridors, at night		20
Dining areas	50	NA
Doorways, exterior	20	NA
Exam, treatment table	NA	100
Exam, treatment room	30	50
Exit stairways and landings	30	NA
Food preparation areas	50	75
Janitor's closet	30	NA
Laundry	30	50
Medicine prep area	30	100
Nurses' desk	30	70
Nurses' station, day	30	50
Nurses' station, night	20	50
Physical therapy	30	50
Resident room	30	50
Resident reading light	NA	75
Recreation area	30	50
Toilet, hand washing sinks, and mirrors	30	50
Toilet and bathing facilities, general	30	NA
Utility room, general	30
Utility room, work counter	NA	50
Worktable, course work	30	70
Worktable, fine work	50	100

1/	Ambient light measurements are taken two and one-half feet from the floor (plus or minus six inches).      Minimum footcandles are based upon average measurement.      A minimum of three measurements should be taken, including a measurement at the center of each area, near the outer perimeter, and at a point equidistant from the center and the perimeter measurement.
2/	Task light measurements are taken at the work surface.      Minimum footcandles for task light are based upon average measurement.      A minimum of three measurements should be taken, including a measurement at the center of each work surface, near the outer perimeter of the work surface, and at a point equidistant from the center and the perimeter measurement.

[]

The nursing home must install in each resident room a night light that is:

(1) Flush mounted on the wall;

(2) Designed to prevent viewing the light source from thirty inches or more above the floor;

(3) Designed to provide a maximum illumination level of 10 footcandles;

(4) Located to provide safe pathway lighting for the staff and residents; and

(3) Controlled by a switch at each resident room entrance door or by a master switch.

[]

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 388-97-36060
Switches in new construction.

The nursing home must install quiet operating switches for general illumination adjacent to doors in all areas and accessible to residents in resident rooms.

[]

(1) The nursing home must provide enough electrical outlets to meet the care and personal appliance needs of each resident. An approved power tap may be used only for portable appliances with specific overcurrent protection needs, such as a computer. A "power tap" is a device for indoor use consisting of an attachment plug on the end of a flexible cord and two or more receptacles on the opposite end, with overcurrent protection. A power tap must be:

(a) Polarized or grounded;

(b) UL listed; and

(c) Directly connected to a permanently installed electrical outlet.

(2) In new construction, the nursing home must ensure:

(a) There are a minimum of seven outlets:

(i) Four hospital grade electrical outlets located convenient to each residents' bed and centered at forty to forty-four inches above the floor, with a minimum of:

(ii) Two additional electrical outlets at separate, convenient locations in each resident room; and

(iii) One duplex electrical outlet located adjacent to each handwashing sink intended for resident use.

(b) All electrical outlets located within five feet of any sink, toilet, bath, or shower are protected by a ground fault circuit interrupter.

[]

The nursing home ((shall)) must provide ((the following)):

(1) A safe, functional, sanitary, and comfortable environment for the residents, staff, and the public; and

(2) Signs to designate areas of hazard((;

(3) Reference material regarding medication administration, adverse reactions, toxicology, and poison control center information readily available to nursing home staff at all times;

(4) Poisons and other nonmedicinal chemical agents in containers identified with a warning label stored:

(a) In a separate locked storage when not in use by staff; and

(b) Separate from drugs used for medicinal purposes.

(5) Equipment and supplies stored in a manner to not jeopardize the safety of residents, staff, or the public;

(6) Handrails on each side of all corridors and stairwells accessible to residents;

(7) Electrical outlets available for the number of electrical appliances in use)).

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-365, filed 9/15/94, effective 10/16/94.]

The nursing home must ensure that poisons and nonmedicinal chemicals are stored in containers identified with warning labels. The containers must be stored:

(1) In a separate locked storage when not in use by staff; and

(2) Separate from drugs used for medicinal purposes.

[]

The nursing home must ensure that the manner in which equipment and supplies are stored does not jeopardize the safety of residents, staff, or the public.

[]

The nursing home must:

(1) Provide handrails on each side of all corridors and stairwells accessible to residents; and

(2) In new construction ensure that:

(a) Ends of handrails are returned to the walls;

(b) Handrails are mounted thirty to thirty-four inches above the floor and project not more than three and three-quarters inches from the wall; and

(c) Handrails terminate not more than six inches from a door.

[]

(1) The nursing home ((shall)) must comply with the requirements of the Public Water Supply, chapter 246-290 WAC.

(((2) The nursing home shall establish procedures to ensure that water is available to essential areas when there is a loss in normal water supply.

(3) The nursing home shall ensure the hot water system maintains water temperatures at one hundred ten degrees Fahrenheit, plus or minus ten degrees Fahrenheit, at fixtures used by residents and staff.

(4) The nursing home shall prohibit all cross connections between potable and nonpotable water.))

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-370, filed 9/15/94, effective 10/16/94.]

The nursing home must ensure:

(1) The hot water system maintains water temperatures at one hundred ten degrees Fahrenheit, plus or minus ten degrees Fahrenheit, at fixtures used by residents and staff.

(2) For laundry temperatures, refer to WAC 388-97-347.

(3) For dishwashing temperatures, refer to chapter 246-215 WAC.

[]

The nursing home must:

(1) Prohibit all cross connections between potable and nonpotable water;

(2) Use backflow prevention devices on plumbing fixtures, equipment, facilities, buildings, premises or areas which are actual or potential cross-connections to prevent the backflow of water or other liquids, gases, mixtures or substances into a water distribution system or other fixtures, equipment, facilities, buildings or areas; and

(3) Follow guidelines, practices, procedures, interpretations and enforcement as outlined in the manual titled "Accepted Procedure and Practice in Cross-Connection Control; Pacific NW Edition; American Waterworks Association," or any successor manual, referenced in chapter 246-290 WAC for public water supply.

[]

(((1) Medicaid-certified nursing facilities in compliance with federal requirements at C.F.R. §483.70 (h)(4) will be deemed to meet this section.

(2))) The nursing home ((shall)) must:

(1) Maintain an effective pest control program so that the facility is free of pests such as rodents and insects;

(2) Construct and maintain buildings to prevent the entrance of pests such as rodents and insects; and

(3) Provide mesh screens or equivalent with a minimum mesh of one-sixteenth inch on all windows and other openings that can be left open.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-375, filed 9/15/94, effective 10/16/94.]

The nursing home ((shall)) must ensure:

(1) All sewage and liquid wastes are discharged into an approved public sewage system where such system is available; or

(2) Sewage and liquid wastes are collected, treated, and disposed of in an on-site sewage system in accordance with chapter 246-272 WAC and meets with the approval of the local health department and/or the state department of health.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-385, filed 9/15/94, effective 10/16/94.]

(1) ((PRELIMINARY PLANS.

(a) Narrative program.      The sponsor for each construction project shall provide a narrative as part of the preliminary plans to the department of health with a copy to aging and adult services administration which identifies:

(i) How the design promotes a homelike environment and facilitates resident-centered care and services;

(ii) Functional space requirements;

(iii) Staffing patterns;

(iv) Traffic patterns;

(v) Each function to be performed;

(vi) Types of equipment required; and

(vii) Services which will not be provided directly, but will instead be provided through contract.

(b) The plans and specifications for new construction shall be prepared by or under the direction of a Washington licensed architect or engineer, and be submitted in duplicate to the department of health.      The plans shall be reviewed and approved as preliminaries by the department of health in coordination with aging and adult services administration prior to preparation of final plans.      Refer to WAC 388-97-390(4), General, if the proposed project is not extensive enough to require professional architectural or engineering services.

(c) Preliminary plans shall be drawn to scale and shall include:

(i) Plot plan showing streets, entrance ways, driveways, parking, design statements for adequate water supply, sewage and disposal systems, space for the storage of recycled materials, and the arrangement of buildings on the site noting handicapped accessible parking and entrances;

(ii) Floor plans showing existing and proposed arrangements within the building, including the fixed and major movable equipment; and

(iii) Each room, space, and corridor identified by function and number.

(d) Preliminary specifications shall include a general description of construction and materials, including interior finishes.

(2) FINAL CONSTRUCTION DOCUMENTS.

(a) Construction shall not commence until three sets of final plans drawn to scale with complete specifications have been submitted to and approved by the department of health in coordination with aging and adult services administration.

(b) Final construction documents shall be prepared, stamped, signed and dated by a licensed architect or engineer.

(c) These plans and specifications shall show complete details to be furnished to contractors for construction of the buildings, including:

(i) Plot plan;

(ii) Plans of each floor of the building, including fixed equipment;

(iii) Elevations, sections, and construction details;

(iv) Schedule of floor, wall, and ceiling finishes, door and window sizes and types;

(v) Mechanical and electrical systems; and

(vi) Provision for noise, dust and draft control, fire protection, safety and comfort of the residents if construction work takes place in or near occupied areas.

(d) For buildings over four thousand square feet, a copy of the lead agency declaration of nonsignificance of environmental impact shall be submitted to the department of health as specified in chapter 248-06 WAC.

(3) PREINSTALLATION SUBMISSIONS shall be submitted to the department of health and approved prior to installation.      Submissions shall include:

(a) Stamped shop drawings for fire sprinkler system;

(b) Shop drawings for fire detection and alarm systems; and

(c) If carpets are to be installed:

(i) A floor plan or finish schedule denoting areas to be carpeted;

(ii) Function of areas to be carpeted;

(iii) Coding with a key for carpet types;

(iv) A copy of a testing laboratory report of the floor radiant panel and smoke density tests; and

(v) A copy of the manufacturer's carpet specifications

(4) CONSTRUCTION TIMELINES.      All construction shall take place in accordance with the approved final plans and specifications.      Changes to plans must be reviewed and approved by the department of health in coordination with aging and adult services administration prior to incorporation into the construction project.

(a) If construction has not begun within one year from the date of approval, the plans must be resubmitted for review in accordance with current requirements.

(b) If construction is not completed within two years from the date of approval, the plans shall be resubmitted for approval of the remaining construction consistent with current requirements.

(c) To obtain an extension beyond two years, a written request shall be submitted and approved thirty days prior to the end of the two-year period)) The project sponsor must submit plans for all new construction to the department of health, construction review, for review and approval. Documents must be approved before the work begins. The project sponsor must also submit documents to department of health, certificate of need for review and applicable determination.

(2) The nursing home may request exemptions to new construction requirements as described in WAC 388-97-405.

(3) If the proposed project if not extensive enough to require professional architectural or engineering services, the project sponsor must submit a written description to the department of health, construction review, to determine if WAC 388-97-401 applies.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-400, filed 9/15/94, effective 10/16/94.]

If preliminary documents and specifications are submitted, they must:

(1) Include a narrative program with drawings. Copies of these documents must be sent to the department of health, certificate of need and construction review, and to aging and adult services administration. The narrative program must identify:

(a) How the design promotes a homelike environment and facilitates resident-centered care and services;

(b) Functional space requirements;

(c) Staffing patterns;

(d) Each function to be performed;

(e) Types of equipment required; and

(f) Services that will not be provided directly, but will instead be provided through contract.

(2) Refer to WAC 388-97-400(3), if the proposed project is not extensive enough to require professional architectural or engineering services.

(3) Be drawn to scale and include:

(a) A site plan showing streets, entrance ways, driveways, parking, design statements for adequate water supply, sewage and disposal systems, space for the storage of recycled materials, and the arrangement of buildings on the site noting handicapped accessible parking and entrances;

(b) Floor plans showing existing and proposed arrangements within the building, including the fixed and major movable equipment; and

(c) Each room, space, and corridor identified by function and number.

(4) Include a general description of construction and materials, including interior finishes.

[]

(1) Construction must not start until at least two sets of final construction documents drawn to scale with complete specifications have been submitted to and approved by the department of health, construction review, in coordination with aging and adult services administration and the department of health, certificate of need.

(2) A licensed architect or engineer must prepare, stamp, sign, and date the final construction documents.

(3) Construction documents that are changed after approval by the department of health, construction review, require resubmission before any construction on the proposed change is started.

(4) The construction of the facility must follow the final approved construction documents.

(5) These drawings and specifications must show complete details to be furnished to contractors for construction of the buildings, including:

(a) Site plan;

(b) Drawings of each floor of the building, including fixed equipment;

(c) Elevations, sections, and construction details;

(d) Schedule of floor, wall, and ceiling finishes, door and window sizes and types, and door finish hardware;

(e) Mechanical and electrical systems;

(f) Provision for noise, dust, smoke, and draft control, fire protection, safety and comfort of the residents if construction work takes place in or near occupied areas; and

(g) Landscape plans and vegetation planting schedules for dementia care units.

(6) Submit a reduced set of the final construction floor plans on eight and one half by eleven inch or eleven by seventeen inch sheets showing each room function and number.

[]

The department of health, construction review, must receive and approve pre-installation submissions prior to installation. Pre-installation submissions may include any or all of the following:

(1) Stamped shop drawings, hydraulic calculations, and equipment information sheets for fire sprinkler system(s);

(2) Shop drawings, battery calculations, and equipment information sheets for fire detection and alarm systems;

(3) Shop drawings and equipment information sheets for a kitchen hood and duct automatic fire extinguishing system;

(4) Drawings and equipment information sheets for special egress control devices; and

(5) Drawings and/or a finish schedule denoting areas to be carpeted with:

(a) A coding system identifying type of carpet in each area;

(b) A copy the manufacturer's specifications for each type of carpet; and

(c) A copy of a testing laboratory report of the radiant panel and smoke density tests for each type of carpet.

[]

(1) Construction documents must be resubmitted for review as a new project according to current requirements if construction:

(a) Has not started within one year from the date of approval; or

(b) Is not completed within two years from the date of approval.

(2) To obtain an extension beyond two years, a written request must be submitted and approved thirty days prior to the end of the two-year period.

[]

(1) The director of ((nursing home)) residential care services, aging and adult services administration, may grant exemptions to new construction requirements for:

(a) ((For)) Alterations when the applicant demonstrates the proposed alterations will serve to correct deficiencies or will upgrade the nursing home in order to better serve residents; and

(b) ((For)) Substitution of procedures, materials, or equipment for requirements specified in this chapter when such procedures, materials, or equipment have been demonstrated to the director's satisfaction to better serve residents.

(2) The nursing home ((shall)) must ensure requests for exemptions are in writing and include any necessary approvals from the local code enforcement authority and the state fire marshal.

(3) The nursing home ((shall)) must ensure all exemptions granted under the foregoing provisions are kept on file at the nursing home.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-405, filed 9/15/94, effective 10/16/94.]

The nursing home ((shall)) must through its design, construction and necessary permits demonstrate compliance with the following codes and local jurisdiction standards:

(1) The Uniform Building Code, and Uniform Building Code Standards, as published by the International Conference of Building Officials as amended and adopted by the Washington state building code council and published as ((chapters 51-20 and 51-21 WAC, or as hereafter amended)) chapter 51-40 WAC, or successor laws;

(2) The Uniform Mechanical Code, including chapter 22, Fuel Gas Piping, Appendix B, as published by the International Conference of Building Officials and the International Association of Plumbing and Mechanical Officials as amended and adopted by the Washington state building code council and published as chapter ((51-22 WAC, or as hereafter amended)) 51-42 WAC, or successor laws;

(3) The Uniform Fire Code, and Uniform Fire Code Standards, as published by the International Conference of Building Officials and the Western Fire Chiefs Association as amended and adopted by the Washington state building code council and published as chapters ((51-24 and 51-25 WAC, or as hereafter amended)) 51-44 and 51-45 WAC, or successor laws;

(4) The Uniform Plumbing Code, and Uniform Plumbing Code Standards, as published by the International Association of Plumbing and Mechanical Officials, as amended and adopted by the Washington state building code council and published as chapters ((51-26 and 51-27 WAC, or as hereafter amended)) 51-46 and 51-47 WAC, or successor laws;

(5) The Washington state ventilation and indoor air quality code, as adopted by the Washington state building code council and filed as chapter 51-13 WAC, or ((as hereafter amended)) successor laws; and

(6) The Washington state energy code, as amended and adopted by the Washington state building code council and filed as chapter 51-11 WAC, or ((as hereafter amended)) successor laws.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-410, filed 9/15/94, effective 10/16/94.]

The nursing home ((shall)) must ensure((:)) that all electrical wiring complies with state and local electrical codes including chapter 296-46 WAC, (("Rules and regulations for installing electrical wires and equipment and administrative rules,")) and the National Electric Code of the National Fire Protection Association (NFPA-70) as adopted by the Washington state department of labor and industry.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-415, filed 9/15/94, effective 10/16/94.]

The nursing home ((shall)) must ensure that elevators are installed in accordance with chapter 296-81 WAC.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-420, filed 9/15/94, effective 10/16/94.]

The nursing home ((shall)) must:

(1) Follow all local ordinances relating to zoning, building, and environmental standards; and

(2) Obtain all local permits before construction and keep permits on file at the nursing home.

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-425, filed 9/15/94, effective 10/16/94.]

(((1) ENTRANCES AND EXITS.))      The nursing home ((shall)) must have the main entrances and exits sheltered from the weather and barrier free accessible in accordance with chapter ((51-20)) 51-40 WAC.

(((2) LOBBY.      The nursing home shall have a lobby or area in close proximity to the main entrance which is accessible and which includes:

(a) Waiting space with seating accommodations;

(b) Reception and information area;

(c) Space to accommodate persons in wheelchairs;

(d) Public restroom;

(e) Drinking fountain; and

(f) Public telephone.

(3) INTERVIEW SPACE.      The nursing home shall have interview spaces for private interviews relating to social service and admission.

(4) OFFICES.      The nursing home shall provide:

(a) Office space convenient to the work area for the administrator, the director of nursing services, medical records staff, social services staff, activities director, and other personnel as appropriate;

(b) Work space for physicians and outside consultants;

(c) Space for locked storage of health records which provides for fire and water protection; and

(d) Space for the safe storage and handling of financial and business records.

(5) INSERVICE EDUCATION.      The nursing home shall provide space for employee inservice education that will not infringe upon resident space.

(6) STAFF.      The nursing home shall ensure a lounge, lockers, and toilets are provided convenient to the work areas for employees and volunteers.))

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-430, filed 9/15/94, effective 10/16/94.]

The nursing home must have a lobby or area in close proximity to the main entrance that is barrier free accessible and includes:

(1) Waiting space with seating accommodations;

(2) Reception and information area;

(3) Space to accommodate persons in wheelchairs;

(4) Public restroom;

(5) Drinking fountain; and

(6) Public telephone.

[]

The nursing home must have interview spaces for private interviews relating to social service and admission.

[]

The nursing home must provide:

(1) Office space convenient to the work area for the administrator, the director of nursing services, medical records staff, social services staff, activities director, and other personnel as appropriate;

(2) Work space for physicians and outside consultants;

(3) Space for locked storage of health records which provides for fire and water protection; and

(4) Space for the safe storage and handling of financial and business records.

[]

The nursing home must provide space for employee inservice education that will not infringe upon resident space.

[]

The nursing home must ensure a lounge, lockers, and toilets are provided convenient to the work areas for employees and volunteers.

[]

(((1) DINING ROOMS, DAYROOMS, ACTIVITY AREAS.      In a new building or addition, the nursing home shall design dining rooms, dayrooms, and activity areas for resident convenience and comfort and provide a homelike environment.      The nursing home shall:

(a) Ensure these rooms or areas are exterior rooms with windows;

(b) Provide space for dining, day, and activity areas at a minimum of thirty square feet per bed for the first one hundred beds and twenty-seven square feet per bed in excess of one hundred;

(c) Locate a day room adjacent to each resident care unit;

(d) Provide designated dining and activity spaces separate from each other and designed to prevent program interference with each other;

(e) Provide storage spaces for all activity and recreational equipment and supplies, adjoining or adjacent to the facilities provided; and

(f) Conveniently locate a common use toilet facility with lavatory near each dining, day, and activity room.

(2) VISITING AND PRIVATE SPACE.      In a new building or addition,)) The nursing home ((shall)) must design a separate room or areas for residents to have family and friends visit and for residents to spend time alone.      The nursing home ((shall)) must ensure these areas provide:

(((a))) (1) Space which facilitates conversation and privacy; and

(((b))) (2) Access to a common-use toilet facility.

(((3) OUTDOOR RECREATION SPACE AND WALKWAYS.      In a new building or addition, a nursing home shall provide a safe, protected outdoor area for resident use.      The nursing home shall ensure the outdoor area has:

(a) Sufficient shaded and sheltered areas to meet the resident's needs;

(b) Accessible walking surfaces which are firm, stable, and free from cracks and abrupt changes;

(c) Sufficient space and outdoor furniture provided with flexibility in arrangement of the furniture to accommodate residents who use wheelchairs and mobility aids; and

(d) Plants.

(4) LAUNDRY STORAGE.      The nursing home shall ensure:

(a) Soiled linens and soiled clothing are stored and sorted in a separate well-ventilated, lighted enclosed room apart from washing and drying facilities that has self-closing doors.      There shall be a handwashing facility and a floor drain in the room; and

(b) Clean linen is stored in a separate well-ventilated enclosed room apart from washing and drying facilities.

(5) GENERAL STORAGE AREA.      A nursing home shall have general storage space of not less than five square feet per bed in addition to the closets and storage required in WAC 388-97-445, Resident room.))

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-455, filed 9/15/94, effective 10/16/94.]

A nursing home must provide a safe, protected outdoor area for resident use. The nursing home must ensure the outdoor area has:

(1) Shaded and sheltered areas to meet residents needs;

(2) Accessible walking surfaces which are firm, stable, and free from cracks and abrupt changes with a maximum of one inch between sidewalk and adjoining landscape areas;

(3) Sufficient space and outdoor furniture provided with flexibility in arrangement of the furniture to accommodate residents who use wheelchairs and mobility aids;

(4) Shrubs, natural foliage, and trees; and

(5) If used as a resident courtyard, the outdoor area must not be used for public or service deliveries.

[]

(((1) DEMENTIA CARE UNIT.      See WAC 388-97-350(1) and 388-97-095.      In a new building or addition, the nursing home shall ensure a dementia care unit has:

(a) Dining areas which provides a minimum of twenty square feet per resident;

(b) A continuous ambulation route allowing the resident to return to the resident's starting point without reversing direction;

(c) Egress door control devices only when the security locking is approved by the state fire marshal and conform to the following requirements:

(i) A security locking system which meets the fire and life safety requirements of the Uniform Building Code and the state building code such as, but not limited to, an approved automatic fire alarm system and an approved supervised automatic sprinkler system which is electrically interconnected with the fire alarm system;

(ii) Exits from the dementia care unit and building shall release automatically with activation of the building fire alarm system.      Exits shall include secured outdoor space and walkways, walls, or fences and/or ambulation areas;

(iii) Keyed locks are prohibited in any egress path;

(iv) Releasing devices of security locking systems shall be labeled with directions at the egress path doors;

(v) An override switch shall be installed at each staff work station or at a constantly attended location within the building to override all other mechanisms and unlock exit doors in the event of an emergency;

(vi) If primary power to the building is lost, all security locking systems shall automatically release;

(vii) A copy of the written approval of the security locking system from the local officials enforcing the Uniform building Code, Uniform Fire Code, and the state building code shall be on file at the nursing home.

(2) POOLS.))      The nursing home ((shall)) must ensure swimming pools, spas, and tubs which remain filled between uses meet the requirements in chapter 246-260 WAC((.

(3) PHARMACY.      The nursing home shall ensure an on-site pharmacy meets the requirements of the Washington state board of pharmacy per chapter 246-857 WAC)).

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-460, filed 9/15/94, effective 10/16/94.]

The nursing home must ensure that an on-site pharmacy meets the requirements of the Washington State board of pharmacy per chapters 18.64 RCW and 246-865 WAC.

[]

(((1) ACCESSIBLE.      The nursing home shall be readily accessible to a person with disability.

(2) VECTOR CONTROL.      The nursing home shall:

(a) Construct and maintain buildings to prevent the entrance of pests such as rodents and insects; and

(b) Provide mesh screens or equivalent with a minimum mesh of one-sixteenth inch on all windows and other openings which can be left open.

(3) ELEVATORS.))      The nursing home ((shall)) must:

(((a))) (1) Ensure that all buildings having residential use areas or service areas that are not located on ((other than)) the main entrance floor ((with)), have an elevator((.

(b) Locate)); and

(2) Have at least one elevator sized to accommodate a resident bed and attendant for each sixty beds on floors other than the main entrance floor.

(((4) STAIRWAYS, RAMPS, AND CORRIDORS.      The nursing home shall ensure stairways, ramps and corridors conform with the Uniform Building Code.

(5) HANDRAILS.      The nursing home shall provide handrails along both sides of all resident use corridors.      The nursing home shall ensure:

(a) Ends of handrails are returned to the walls;

(b) Handrails are mounted thirty-four to thirty-eight inches above the floor and project not more than three and one-half inches from the wall; and

(c) Handrails terminate not more than six inches from a door.

(6) DOORS.      The nursing home shall ensure:

(a) Doors to resident rooms provide a minimum of forty-four inches clear width;

(b) Doors to resident bathrooms and toilet rooms are a minimum of thirty-two inches clear width for wheelchair access;

(c) All doors to resident toilet rooms and bathing facilities open outward except if doors open directly into a resident occupied corridor;

(d) Doors to toilet rooms and bathrooms have locks, and a means of unlocking doors from the outside;

(e) Doors to occupied areas not swing into corridors; and

(f) All passage doors are arranged so that doors do not open onto or obstruct other doors.

(7) FLOOR FINISHES.      The nursing home shall ensure:

(a) Floors at all entrances have slip resistant finishes even when wet;

(b) All uncarpeted floors are smooth, nonabsorbent and easily cleanable;

(c) Coving.      The nursing home shall ensure:

(i) Kitchens, restrooms, laundry, utility rooms, and bathing areas have integral coves of continuous commercial grade sheet vinyl, bullnose ceramic tile or sealed bullnose quarry tile at least four inches in height; and

(ii) All other wall junctions have either integral coving or top set base with toe.

(d) Carpets may be used in all areas except: toilet rooms, bathrooms, kitchen, laundry, utility rooms, medication rooms, maintenance, isolation rooms if provided, and areas subject to high moisture or flooding;

(e) Specifications for acceptable carpeting are:

(i) Pile yarn fibers are easily cleanable and meet the standards of NFPA 101, Life Safety Code;

(ii) Pile is looped texture in all resident use areas.      Cut pile may be used in nonresident use areas;

(iii) Average pile density of five thousand ounces per cubic yard in resident use areas and four thousand ounces per cubic yard in nonresident areas;

(iv) A maximum pile height of .255 inches in resident use areas and .312 inches in nonresident use areas;

(v) Cemented to the floor; and

(vi) Edges covered and top set base with toe at all wall junctures.

(f) When recarpeting, the safety of residents shall be assured during and after recarpeting installation within room or area.      The nursing home shall ensure the room or area is:

(i) Well ventilated;

(ii) Unoccupied; and

(iii) Unavailable for use until room is free of volatile fumes and odors.

(8) WALLS.      The nursing home shall ensure:

(a) Wall finishes are easily cleanable; and

(b) A water-resistant finish extending above the splash line in all rooms or areas subject to splash or spray, such as, bathing facilities, toilet rooms, janitors' closets, and can-wash areas.

(9) ACCESSORIES.      The nursing home shall provide the following accessories with the necessary backing for mounting:

(a) Suitable shelf or equivalent and mirror at each lavatory in toilet rooms, resident rooms and locker rooms;

(b) Towel bars and/or hooks at each lavatory in resident rooms and at each bathing facility.      Towel bars shall meet grab bar standards;

(c) A robe hook at each bathing facility, toilet room and in examination room or therapy area;

(d) A securely mounted toilet paper holder properly located within easy reach of the user at each toilet fixture;

(e) Sanitary seat covers, except where toilet seats are open front type;

(f) Dispensers for single use towels mounted to avoid contamination from splash and spray and located within reach of a person in a wheelchair;

(g) Suitable provision for dispensed handwashing soap at each lavatory, sink, and bathing facility;

(h) Sanitary napkin dispensers and disposers in public and employee women's toilet rooms; and

(i) Grab bars easily cleanable and resistant to corrosion.

(10) MISCELLANEOUS.      The nursing home shall ensure:

(a) Rooms and service areas are identified by visible and tactile signs; and

(b) Equipment and casework is designed, manufactured and installed for ease of proper cleaning and maintenance, and suitable for the functions of each area.))

[Statutory Authority: RCW 18.51.070 and 74.42.620.      94-19-041 (Order 3782), § 388-97-465, filed 9/15/94, effective 10/16/94.]

The nursing home must ensure stairways, ramps and corridors conform with the Uniform Building Code.

[]

The nursing must ensure that:

(1) An abrupt change in the walking surface level including at door thresholds which are greater that one quarter inch are beveled to a one vertical in two horizontal; and

(2) Changes in the walking surface level greater than one half inch are accomplished by means of a ramp with a maximum slope of one vertical in twelve horizontal.

[]

The nursing home must ensure doors to:

(1) Resident rooms provide a minimum of forty-four inches clear width;

(2) Resident bathrooms and toilet rooms are a minimum of thirty-two inches clear width for wheelchair access;

(3) All resident toilet rooms and bathing facilities open outward except if doors open directly into a resident occupied corridor;

(4) Toilet rooms and bathrooms have single action locks, and a means of unlocking doors from the outside;

(5) Occupied areas do not swing into corridors; and

(6) All passages are arranged so that doors do not open onto or obstruct other doors while maintaining resident dignity.

[]

The nursing home must ensure:

(1) Floors at all outside entrances have slip resistant finishes both inside and outside the entrance even when wet; and

(2) All uncarpeted floors are smooth, nonabsorbent and easily cleanable.

[]

The nursing home must ensure that department of health, construction review approves of all carpet installation.

(1) Carpets may be used in all areas except: toilet rooms, bathrooms, kitchen, laundry, utility rooms, medication rooms, maintenance, isolation rooms if provided, and areas subject to high moisture or flooding. Specifications for acceptable carpeting are:

(a) Pile yarn fibers are easily cleanable and meet the standards of NFPA 101, Life Safety Code;

(b) Pile is looped texture in all resident use areas. Cut pile may be used in nonresident use areas;

(c) Average pile density of five thousand ounces per cubic yard in resident use areas and four thousand ounces per cubic yard in nonresident areas. The formula for calculating the density of the carpet is:Yarn weight in ounces x 36 = Ounces of cubic yards of density.

Pile height in inches(d) A maximum pile height of .255 inches in resident use areas and .312 inches in nonresident use areas;

(e) Cemented to the floor; and

(f) Edges covered and top set base with toe at all wall junctures.

(2) When recarpeting, the safety of residents must be assured during and after recarpeting installation within the room or area. The nursing home must ensure the room or area is:

(a) Well ventilated;

(b) Unoccupied; and

(c) Unavailable for use until room is free of volatile fumes and odors.

[]

The nursing home must ensure:

(1) Kitchens, restrooms, laundry, utility rooms, and bathing areas have integral coves of continuous commercial grade sheet vinyl, bullnose ceramic tile or sealed bullnose quarry tile at least six inches in height; and

(2) All other wall junctions have either integral coving or top set base with toe.

[]

The nursing home must ensure:

(1) Wall finishes are easily cleanable;

(2) A water-resistant finish extends above the splash line in all rooms or areas subject to splash or spray, such as bathing facilities with tubs only, toilet rooms, janitors' closets, and can-wash areas; and

(3) Bathing facilities with showers have a water-resistant finish extending to the ceiling.

[]

The nursing home must provide the following accessories with the necessary backing, if required, for mounting:

(1) Usable countertop area and mirror at each handwashing sink in toilet rooms and resident rooms;

(2) Towel or robe hooks at each handwashing sink in resident rooms and at each bathing facility;

(3) A robe hook at each bathing facility, toilet room and in examination room or therapy area, including outpatient therapy rooms;

(4) A securely mounted toilet paper holder properly located within easy reach of the user at each toilet fixture;

(5) Sanitary seat covers at each public and employee use toilet;

(6) Open front toilet seats on all toilets;

(7) Dispensers for paper towels and handwashing soap at each handwashing sink, and bathing facility;

(8) Sanitary napkin dispensers and disposers in public and employee women's toilet rooms; and

(9) Grab bars that are easily cleanable and resistant to corrosion and securely mounted.

[]

The nursing home must ensure:

(1) Rooms and service areas are identified by visible and tactile signs, refer to WAC 388-97-35050(2) for possible exceptions; and

(2) Equipment and casework is designed, manufactured and installed for ease of proper cleaning and maintenance, and suitable for the functions of each area.

[]

(((1) HEATING SYSTEM.))     The nursing home ((shall)) must ensure: