WSR 00-06-028

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)

[ Filed February 24, 2000, 2:05 p.m. ]

Date of Adoption: February 24, 2000.

Purpose: The rules were revised to: Comply with the Governor's Executive Order 97-02 for clarifying, updating, and simplifying where possible; to consider stakeholder input where appropriate; to apply clear rule-writing techniques; to update with statutory changes since the last revision; and to reorganize the chapter to make it easier for users to find the information needed.

Citation of Existing Rules Affected by this Order: Repealing WAC 388-97-010 License application, 388-97-015 License qualification, 388-97-020 Nursing home fees, 388-97-025 License capacity, 388-97-030 Change of ownership, 388-97-035 Change in administrator or director of nursing services, 388-97-040 Name of nursing home, 388-97-045 License relinquishment upon closure, 388-97-050 License denial, modification, nonrenewal, revocation, 388-97-070 Resident rights, 388-97-080 Quality of life, 388-97-095 Dementia care unit, 388-97-100 Discharge planning, 388-97-105 Relocation due to decertification, license revocation closure, evacuation, 388-97-145 Early identification of persons with active tuberculosis, 388-97-150 Surveillance and management of tuberculosis, 388-97-200 Criminal history disclosure and background inquiries, 388-97-210 Respite services, 388-97-215 Adult day or night care, 388-97-225 Nursing facility care, 388-97-230 Discrimination prohibited, 388-97-235 Medical eligibility for nursing facility care, 388-97-240 Nursing facility admission, 388-97-245 Pre-admission screening, 388-97-250 Identification screening for current residents, 388-97-255 Pre-admission screening and annual resident review (PASARR), 388-97-265 Utilization review, 388-97-270 Individual transfer and discharge rights, procedures, appeals, 388-97-275 Resident assessment instrument, 388-97-280 Discharge or leave of a nursing facility resident, 388-97-300 Fire standards and approval, 388-97-305 Other standards, 388-97-320 Space and equipment, 388-97-380 Maintenance and repair, 388-97-390 General, 388-97-395 Design requirements, 388-97-435 Resident care unit, 388-97-440 Resident rooms, 388-97-445 Resident room equipment, 388-97-450 Resident toilet and bathing facilities and 388-97-475 Electrical; and amending WAC 388-97-005 Definitions, 388-97-055 Resident representative and decision making, 388-97-060 Informed consent, 388-97-065 Advance directives, 388-97-075 Nursing home practices -- Resident restraint and prevention of abuse, 388-97-085 Resident assessment, 388-97-090 Comprehensive care planning, 388-97-110 Quality of care, 388-97-115 Nursing services, 388-97-120 Dietary services, 388-97-125 Physician services, 388-97-130 Specialized habilitative and rehabilitative services, 388-97-135 Pharmacy services, 388-97-140 Infection control, 388-97-155 Care of residents with active tuberculosis, 388-97-160 General administration, 388-97-165 Staff and equipment, 388-97-170 Staff development, 388-97-175 Medical director, 388-97-180 Clinical records, 388-97-185 Disaster and emergency preparedness, 388-97-190 Quality assessment and assurance, 388-97-195 Policies and procedures, 388-97-205 Laundry services, 388-97-220 Dialysis services, 388-97-260 PASARR determination and appeal rights, 388-97-295 General, 388-97-310 IMR exceptions to physical plant requirements, 388-97-315 Emergency power, 388-97-325 Resident care unit, 388-97-330 Resident rooms, 388-97-335 Resident room equipment, 388-97-340 Resident toilet and bathing facilities or rooms, 388-97-345 Dining, day rooms, and resident activity areas, 388-97-350 Dementia care unit, 388-97-355 Food service areas, 388-97-360 Lighting, 388-97-365 Safety, 388-97-370 Water supply, 388-97-375 Pest control, 388-97-385 Sewage and liquid waste disposal, 388-97-400 General new construction documents, 388-97-405 Exemptions to new construction requirements, 388-97-410 State building code in new construction, 388-97-415 Electrical codes and standards in new construction, 388-97-420 Elevator codes in new construction, 388-97-425 Local codes and ordinances in new construction, 388-97-430 Entrances and exits in new construction, 388-97-455 Visiting and private spaces in new construction, 388-97-460 Pools in new construction, 388-97-465 Elevators in new construction, 388-97-470 Heating systems in new construction, and 388-97-480 Handwashing sinks in new construction.

Statutory Authority for Adoption: RCW 18.51.070 and 74.42.620.

Adopted under notice filed as WSR 99-24-045 on November 24, 1999.

Changes Other than Editing from Proposed to Adopted Version: The suggested addition was made for clarification.

WAC 388-97-005 Definitions.

Neglect: It was suggested that the federal definition of "neglect" be added to the state definition to clarify for skilled nursing facilities and nursing facilities that the federal definition of neglect must also be considered.
The suggested addition was made for clarification.
WAC 388-97-027 Nursing facility admission and payment requirements.

Concern was expressed about the lack of clarity of the timelines related to medical and financial eligibility and how this might effect the Medicaid payment to the nursing facility.
Home and Community Services Division (HCS) is in the process of changing their system for Medicaid applicants or recipients being discharged from the hospital to the nursing home. This process was not finalized in time to incorporate it into the proposed rule. As a result this section will be reopened after the chapter is final and we will work with HCS staff and providers to develop a clear rule outlining admission and payment issues. Some language clarification regarding payment for current nursing home residents converting to Medicaid in nursing homes was included.
WAC 388-97-042 Individual transfer and discharge rights for residents in Medicaid certified facilities.

There was a comment that the terms "nursing facility" and "nursing home," related to different notice requirements, were not distinct enough and needed clarification.
Subsection (1) was clarified by identifying the specific state laws the nursing home must follow, and the federal and state laws that the skilled nursing facility and nursing facility must follow. The definition section already includes definitions for nursing home, skilled nursing facility and nursing facility.
WAC 388-97-043 Transfer and discharge appeal rights for residents in Medicare or Medicaid certified facilities.

Title: It was suggested that "...Medicare or..." be added to the title in order to comply with federal regulations.
The suggested change was made.
(1): It was suggested that the word "payment" be changed to "payor."
The suggested change was made.
(3): There was a suggestion to add the term "skilled nursing facility" to this section.
The suggested change was made.
WAC 388-97-060 Informed consent.

(4) A stakeholder commented that the phrase "The nursing home must take into account..." was too vague and asked that it be changed to make it more specific.
The information in subsection (4) was deleted and placed under subsection (1)(b). We believe that this will clarify the issue.
WAC 388-97-075 Chemical and physical restraints.

Specific language was suggested to replace the entire section.
Much of the requested language was already in the section but some would be considered a substantive change that cannot be done at this stage of the rule-making process. However some clarifying language was added and the subsections reordered for clarity. Some of the specific areas addressed follow:
WAC 388-97-076 Prevention of abuse.

Some concern was expressed related to a possible conflict between federal and state law regarding abuse in this section.
The issue was reviewed and some clarifying changes made.
WAC 388-97-29510 New construction compliance.

It was suggested that "...and give approval..." be inserted between "...is contacted..." and "...for all new construction..."
This language was clarified to include the approval and applicable determination pieces that were implicit in the subsection.
WAC 388-97-315 Emergency power.

(2): It was suggested that the subsection would be clearer if the term "generator" were moved to the beginning of the subsection and unnecessary words deleted in (a) - (c) of this subsection. In addition there was a suggestion that we add clarifying new construction language to that subsection.
The suggested clarification to subsection (2) was done. The clarifying new construction language was added to subsection (5).
WAC 388-97-32510 Required service areas on resident care units.

(2): It was suggested that this was a new construction requirement and should have the words "in new construction" inserted in the beginning of the sentence.
The current 1994 WAC 388-97-325 (2)(b) had this requirement under existing facilities language, not under new construction. However we asked the Department of Health's construction review program for clarification and they agreed that this was an area applying to new construction only. The change has been made.
WAC 388-97-32550 Utility service rooms on resident care units.

(1)(b): There was a suggestion to "chunk" out the items listed and to add language to clarify that the clean and soiled utility rooms must be separate.
The "chunking" changes suggested for subsection (1) were done. Even though the intent of subsection (2) was to show that in new construction the clean utility room and the soiled utility room must be separate rooms it was not clearly understood. An additional subsection was added to clarify this.
WAC 388-97-32580 Janitor's closets on resident care units.

It was suggested that a reference to the ventilation requirements for new construction be added.
This suggested clarifying reference was made.
WAC 388-97-340 Resident toilet facilities or rooms.

(2)(e): Specific language was suggested related to the grab bars.
These clarifying changes were made.
WAC 388-97-345 Dining, dayrooms, and resident activity areas.

(2): It was suggested that language be added to require that in new construction these rooms be on the same floor as the residents who will use the rooms.
The language in WAC 388-97-325(2) supports this clarifying addition and the language has been included.
WAC 388-97-35030 Indoor areas on a dementia care unit.

(1): It was suggested that the language regarding the phrase "...maintained free of equipment..." be clarified.
The current language uses the phrase "...providing ambulation areas that meet the needs of residents and are maintained free of equipment..." The word "ambulation" was added to clarify.
WAC 388-97-35050 Physical plant on a dementia care unit.

(2)(a) and (b): It was suggested that specific language be added to exclude exit doors and doorways from being disguised and to delete the word "exterior" to clarify the Uniform Building Code requirements in this area.
These clarifying changes have been made.
WAC 388-97-35060 Special egress control devices on a dementia care unit.

It was suggested that the phrase "automatic door locks" be replaced with "special egress control devices" throughout. In addition specific language was suggested for subsection (2) regarding the circumstances under which approval is needed and regarding approval for the devices.
The meaning of the term "special egress control devices" is synonymous with the term "automatic locking devices" and the term used in current practice. We have made this and the other suggested clarifying changes.
WAC 388-97-370 Water supply.

It was suggested that another WAC reference be added to the section.
This clarifying change was made.
WAC 388-97-401 Final new construction documents.

(2): It was suggested that this subsection specify that the architect or engineer be licensed by the state of Washington.
It has been the practice of the Department of Health's construction review approval process that both professions be licensed by the state thus this clarifying change was made.
WAC 388-97-46550 Carpets in new construction.

(1)(a): It was suggested that some outdated language be deleted and that the formula for carpet density be written out for clarification.
The deletion was done and the clarifying change to the carpet density formula made.
WAC 388-97-48020 Mixing valves in new construction.

It was suggested that the term "mixing valves" to "water supply" be changed throughout. Additional language was also suggested.
Because both mixing valves and mixing faucets can be used to ensure acceptable water temperatures the term mixing faucet was added as an alternative choice for new construction. The water supply section is found at WAC 388-97-370.

Number of Sections Adopted in Order to Comply with Federal Statute: New 32, Amended 5, Repealed 32; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 3, Amended 1, Repealed 3.

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

Number of Sections Adopted on the Agency's Own Initiative: New 141, Amended 53, Repealed 41.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 141, Amended 53, Repealed 41.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 141, Amended 53, Repealed 41. Effective Date of Rule: Thirty-one days after filing.

February 24, 2000

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

((
KEY:

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.))

2667.12SUBCHAPTER 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":

(1) For a nursing home licensed under chapter 18.51 RCW, neglect means that an individual or entity with a duty of care for nursing home residents has:

(a) By 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

(b) By 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.

(2) For a skilled nursing facility or nursing facility, neglect also means a failure to provide the goods and services necessary to avoid physical harm, mental anguish, or mental illness.

"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.]

((NURSING HOME LICENSE)) ADMISSION, TRANSFER AND DISCHARGE
NEW SECTION
WAC 388-97-012
Nursing facility care.

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.

[]


NEW SECTION
WAC 388-97-017
Discrimination prohibited.

(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.

[]


NEW SECTION
WAC 388-97-022
Medical eligibility for nursing facility care.

(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 and positioning, transferring from one surface to another, walking, eating, toilet use, and bathing; or

(c) Be moderately impaired in cognitive decision making regarding tasks of daily life, and require 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.

[]


NEW SECTION
WAC 388-97-027
Nursing facility admission and payment requirements.

(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 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) The department authorizes payment for:

(a) Newly admitted Medicaid-eligible individuals, who are assessed and determined to be in need of nursing facility care, per WAC 388-97-022, on the date:

(i) Of the request for a department assessment; or

(ii) Nursing facility care actually begins, whichever is later.

(b) Current residents, who are converting to Medicaid from another payment source and are determined financial eligible, on the date of:

(i) Request for assessment; or

(ii) Financial application, whichever is earlier.

(iii) Exception: Payment back to the request date is limited to the certification period prior to the date of the financial application, per WAC 388-416-0015.

(3) If nursing facilities admit a Medicaid-eligible individual without a request for an assessment, they will not:

(a) Be reimbursed by the department; or

(b) Allowed to collect payment, including a deposit or minimum stay fee, from the client or the client's family or representative for any care provided before the date of request for assessment.

[]


NEW SECTION
WAC 388-97-032
Discharge planning.

(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 the:

(i) 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.

[]


NEW SECTION
WAC 388-97-037
Utilization review.

(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.

[]


NEW SECTION
WAC 388-97-042
Individual transfer and discharge rights and procedures.

(1) The skilled nursing facility and nursing facility must comply with all of the requirements of 42 C.F.R. 483.10 and 483.12, and RCW 74.42.450, or successor laws, and the nursing home must comply with all of the requirements of RCW 74.42.450(1) through (4) and (7), or successor laws, including the following provisions and must not transfer or discharge any resident 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 department's designated local office 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.

[]


NEW SECTION
WAC 388-97-043
Transfer and discharge appeals for residents in Medicare or Medicaid certified facilities.

(1) A skilled nursing facility and a nursing facility that initiates transfer or discharge of any resident, regardless of payor 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 skilled nursing facility or 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.

[]


NEW SECTION
WAC 388-97-047
Discharge or leave of a nursing facility resident.

(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.

[]


NEW SECTION
WAC 388-97-051
Resident rights.

(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.

[]


NEW SECTION
WAC 388-97-052
Free choice.

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.

[]


NEW SECTION
WAC 388-97-053
Statutes implemented in resident decision making, informed consent and advance directives.

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.

[]


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

WAC 388-97-055
Resident ((representative and)) decision making.

(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 and (5)(a) of this section.

(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 rely 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:

(i) The resident regains capacity;

(ii) The guardian is not respecting or promoting the resident's rights;

(iii) The guardianship should be modified; or

(iv) A different guardian needs to be 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.]


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

WAC 388-97-060
Informed consent.

(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. The surrogate decision maker must:

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

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

(iii) 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.

(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 take into account that if a resident's rights are being exercised by a surrogate decision maker, the surrogate decision maker shall:

(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.]


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

WAC 388-97-065
Advance directives.

(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)) organ tissue donation.

(2) The nursing home ((shall)) must carry out the provisions of this section in accordance with the applicable provisions of 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.]


NEW SECTION
WAC 388-97-07005
Notice of rights and services.

(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) 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.

[]


NEW SECTION
WAC 388-97-07010
Notification of changes.

(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).

[]


NEW SECTION
WAC 388-97-07015
Protection of resident funds.

(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.

[]


NEW SECTION
WAC 388-97-07020
Privacy and confidentiality.

(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.

[]


NEW SECTION
WAC 388-97-07025
Work.

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.

[]


NEW SECTION
WAC 388-97-07030
Self-administration of drugs.

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

[]


NEW SECTION
WAC 388-97-07035
Grievance rights.

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.

[]


NEW SECTION
WAC 388-97-07040
Examination of survey results.

(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 publicly post:

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

(b) A notice that the results of the survey and investigation are available and the location of the reports.

(3) The nursing home must post a copy or copies of survey and complaint investigations, with plans of correction, and notices, available for examination in a place or places:

(a) Readily accessible to residents, which does not require staff intervention to access; and

(b) In plain view of the nursing home residents, individuals visiting those residents, and individuals who inquire about placement in the facility.

[]


NEW SECTION
WAC 388-97-07045
Resident mail.

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.

[]


NEW SECTION
WAC 388-97-07050
Access and visitation rights.

(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).

[]


NEW SECTION
WAC 388-97-07055
Telephone.

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).

[]


NEW SECTION
WAC 388-97-07060
Personal property.

(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.

[]


NEW SECTION
WAC 388-97-07065
Roommates/rooms.

(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.

[]


NEW SECTION
WAC 388-97-07070
Refusal of certain transfers.

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.

[]


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

WAC 388-97-075
((Nursing home practices -- Resident restraint and prevention of abuse)) Chemical and physical restraints.

(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) 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.

(3) Physical restraints may be used in an emergency only when:

(a) It has been assessed as necessary to prevent a resident from inflicting injury to self or to others;

(b) The restraint is the least restrictive form of restraint possible;

(c) A physician's order is obtained:

(i) Within twenty-four hours; and

(ii) The order includes treatments to assist in resolving the emergency situation and eliminating the need for the restraint; and

(b) The resident is released from the restraint as soon as the emergency no longer exists.

(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.]


NEW SECTION
WAC 388-97-076
Prevention of abuse.

(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, and for skilled nursing facilities and nursing facilities 42 C.F.R. 483.13.

(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 and mandatory reporters 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 department, other applicable officials, and the administrator of the facility. 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 guidelines developed by the department; 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 and established procedures (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.

[]


NEW SECTION
WAC 388-97-077
Resident protection program.

(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.

(12) 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.

(13) 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.

(14) 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.

[]


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.

[]


NEW SECTION
WAC 388-97-08020
Environment.

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.

[]


NEW SECTION
WAC 388-97-08030
Self-determination and participation.

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.

[]


NEW SECTION
WAC 388-97-08040
Participation in resident and family groups.

(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.

[]


NEW SECTION
WAC 388-97-08050
Activities.

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.

[]


NEW SECTION
WAC 388-97-08060
Social services.

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.

[]


NEW SECTION
WAC 388-97-08070
Pets.

(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.

[]

RESIDENT ASSESSMENT AND PLAN((S)) OF CARE
AMENDATORY SECTION(Amending Order 3782, filed 9/15/94, effective 10/16/94)

WAC 388-97-085
Resident assessment.

(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.]


AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-090
Comprehensive plan of care ((planning)).

(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 of 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.]


NEW SECTION
WAC 388-97-097
Dementia care.

(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.

[]


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

WAC 388-97-110
Quality of care.

(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.]


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

WAC 388-97-115
Nursing services.

(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.]


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

WAC 388-97-120
Dietary services.

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.]


NEW SECTION
WAC 388-97-12010
Meal provision.

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.

[]


NEW SECTION
WAC 388-97-12020
Individual dietary needs.

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.

[]


NEW SECTION
WAC 388-97-12030
Dietary personnel.

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.

[]


NEW SECTION
WAC 388-97-12040
Dietary menus.

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 posted menu.

[]


NEW SECTION
WAC 388-97-12050
Diet orders.

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.

[]


NEW SECTION
WAC 388-97-12060
Modified diets.

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.

[]


NEW SECTION
WAC 388-97-12070
Tube feedings.

If the nursing home 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.

[]


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

WAC 388-97-125
Physician services.

(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.]


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

WAC 388-97-130
Specialized habilitative and rehabilitative services.

(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.]


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

WAC 388-97-135
Pharmacy services.

(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.]


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

WAC 388-97-140
Infection control.

(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.]


NEW SECTION
WAC 388-97-147
Surveillance, management and early identification of individuals with active tuberculosis.

(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.

[]


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

WAC 388-97-155
Care of residents with active tuberculosis.

(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.]


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

WAC 388-97-160
General administration.

(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

(4) 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) 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) 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)))(a) of this subsection 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))) 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.

(8) 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.]


NEW SECTION
WAC 388-97-162
Required notification and reporting.

(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 and mandatory reporters, where applicable, 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.

(3) 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).

(4) 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.

(5) 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.

(6) 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.

(7) 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.

[]


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.]


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

WAC 388-97-170
Staff development.

(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.]


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

WAC 388-97-175
Medical director.

(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.]


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

WAC 388-97-180
Clinical records.

(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.]


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

WAC 388-97-185
Disaster and emergency preparedness.

(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.]


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

WAC 388-97-190
Quality assessment and assurance.

(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.]


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

WAC 388-97-195
Policies and procedures.

(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.]


NEW SECTION
WAC 388-97-202
Criminal history disclosure and background inquiries.

(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.

[]


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

WAC 388-97-205
Laundry services.

(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.]


NEW SECTION
WAC 388-97-212
Short-term care, including respite services and adult day or night care.

(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.

[]


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

WAC 388-97-220
Dialysis services.

(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) 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:

(a) The provision of clinical and chemical laboratory services;

(b) The services of a qualified dietitian;

(c) Social services;

(d) Preventative maintenance and emergency servicing of dialysis and water purification equipment;

(e) The 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.]

((MEDICAID-CERTIFIED NURSING FACILITIES)) PRE-ADMISSION SCREENING AND RESIDENT REVIEW (PASRR) IN MEDICAID CERTIFIED FACILITIES
NEW SECTION
WAC 388-97-247
Pre-admission screening--Level I.

(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; or

(ii) Are being transferred from one nursing facility to another, with or without an intervening hospital stay.

(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 nursing facility level of care assessment and a Level II screening.

[]


NEW SECTION
WAC 388-97-249
Advanced categorical determinations, not subject to pre-admission screening--Level II.

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, or convalescent care, following treatment in an acute care hospital, not to exceed thirty days;

(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.

[]


NEW SECTION
WAC 388-97-251
Pre-admission screening--Level II.

(1) For individuals likely to have a serious mental illness or developmental disability, the department must determine their need for nursing facility level of care. If they 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) In the Level II screening, 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.

[]


NEW SECTION
WAC 388-97-253
Resident review.

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 mental health PASRR contractor or division of development disabilities;

(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 mental health PASRR contractor or division of developmental disabilities after a significant change in the physical or mental condition of any resident that is mentally ill or mentally retarded.

[]


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

WAC 388-97-260
((PASARR)) Pre-admission screening and resident review (PASRR) determination and appeal rights.

(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.]

INTERMEDIATE CARE FACILITIES FOR THE MENTALLY RETARDED
NEW SECTION
WAC 388-97-285
Intermediate care facilities for the mentally retarded.

(1) An ICF/MR nursing facilities must meet the requirements of 42 C.F.R. 483. Subpart I and 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.

[]

SUBCHAPTER II

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.]


NEW SECTION
WAC 388-97-29510
New construction compliance.

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 review and issues an applicable determination and approval 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.

[]


NEW SECTION
WAC 388-97-29520
Fire standards and approval, and other standards.

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.

[]


NEW SECTION
WAC 388-97-29530
Maintenance and repair.

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.

[]


NEW SECTION
WAC 388-97-29540
Noise.

(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.

[]


NEW SECTION
WAC 388-97-29550
Accessibility in new construction.

The nursing home must be readily accessible to a person with disability and comply with WAC 388-97-410.

[]


NEW SECTION
WAC 388-97-29560
Types of new construction.

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.

[]


AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-310
ICF/MR exceptions to physical plant requirements.

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.)) 388-97-33020, 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.]


AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-315
Emergency power.

(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 generator ((driven by a prime mover)):

(a) 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:

(a) Earthquake standards for the facility's geographic locale; and

(b) Requirements in NFPA 110, Generators.

[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.]

RESIDENT CARE UNIT
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-325
Location of the resident care unit.

(((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.]


NEW SECTION
WAC 388-97-32510
Required service areas on resident care units.

(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) In new construction 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.

[]


NEW SECTION
WAC 388-97-32520
Staff work stations on resident care units.

(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.

[]


NEW SECTION
WAC 388-97-32530
Call systems on resident care units.

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.

[]


NEW SECTION
WAC 388-97-32540
Telephones on resident care units.

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.

[]


NEW SECTION
WAC 388-97-32550
Utility service rooms on resident care units.

(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:

(i) A work counter;

(ii) A sink equipped with single use hand drying towels and soap for handwashing; and

(iii) 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) The clean utility room and the soiled utility room must be separate rooms;

(c) 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.

(d) The nursing home's space for waste containers, linen hampers, and other large equipment, must not block work areas; and

(e) The utility rooms must meet the ventilation requirements of Table 5, WAC 388-97-47020.

[]


NEW SECTION
WAC 388-97-32560
Drug facilities on resident care units.

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.

[]


NEW SECTION
WAC 388-97-32570
Linen storage on resident care units.

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.

[]


NEW SECTION
WAC 388-97-32580
Janitors closets on resident care units.

(1) 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.

(2) In new construction a janitor's closet must meet the ventilation requirements of Table 5, WAC 388-97-47020.

[]

RESIDENT ROOMS
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-330
Resident rooms.

(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 a hall or 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 usable floor area;

(ii) Located twenty-four feet 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 located on a floor level at or 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.]


NEW SECTION
WAC 388-97-33010
Capacity of resident rooms.

(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.

[]


NEW SECTION
WAC 388-97-33020
Size of resident rooms.

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.

[]


NEW SECTION
WAC 388-97-33030
Privacy in resident rooms.

The nursing home must ensure that each resident bedroom is designed or equipped to ensure full visual privacy for each resident.

[]


NEW SECTION
WAC 388-97-33040
Resident isolation rooms.

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) Its own adjoining toilet room containing a bathing facility; and

(3) In new construction, the handwashing sink must be located between the entry door and the nearest bed.

[]


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.

[]

RESIDENT ROOM EQUIPMENT
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-335
Resident room equipment.

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.]


NEW SECTION
WAC 388-97-33510
Resident bed and bedside equipment.

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.

[]


NEW SECTION
WAC 388-97-33520
Lockable storage space in a resident room.

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.

[]


NEW SECTION
WAC 388-97-33530
Wardrobes in a resident room.

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.

[]


NEW SECTION
WAC 388-97-33540
Seating in a resident room.

The nursing home must provide comfortable seating for residents and visitors, not including resident care equipment, that provides proper body alignment and support.

[]


NEW SECTION
WAC 388-97-33550
Lighting in resident rooms.

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.

[]


NEW SECTION
WAC 388-97-33560
Call signal device in resident rooms.

The nursing home must provide a resident call signal device that complies with WAC 388-97-32530.

[]


NEW SECTION
WAC 388-97-33570
Cubicle curtains in resident rooms.

The nursing home must provide:

(1) Flame-retardant cubicle curtains in multi-bed rooms that ensures full visual privacy for each resident;

(2) In a new building or addition, the cubicle curtain or enclosed space ensures 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.

[]


NEW SECTION
WAC 388-97-33580
Miscellaneous equipment in resident rooms in a new building or addition.

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.

[]

RESIDENT TOILET AND BATHING FACILITIES
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-340
Resident toilet ((and bathing)) facilities or rooms.

(((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 stall. Grab bars on the open side must be located twelve to eighteen inches from the center line of the toilet. Grab bars on the open side 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.]


NEW SECTION
WAC 388-97-34010
Resident bathing facilities or rooms.

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.

[]


NEW SECTION
WAC 388-97-34020
Locks in toilet and bathing facilities.

The nursing home must ensure:

(1) All lockable toilet facilities and bathrooms have a readily available means of unlocking from the outside; and

(2) Locks are operable from the inside with a single motion.

[]

DINING, DAYROOMS, AND RESIDENT ACTIVITY AREAS
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-345
Dining, dayrooms, and resident ((activities)) activity areas.

(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. These areas must be located on the same floor as the residents who will use the areas. 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.]

LAUNDRY SERVICES
NEW SECTION
WAC 388-97-347
Laundry services and storage.

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.

[]

DEMENTIA CARE UNIT
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-350
((Optional rooms and areas)) Dementia care unit.

(((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.]


NEW SECTION
WAC 388-97-35010
Dining areas on a dementia care unit.

(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.

[]


NEW SECTION
WAC 388-97-35020
Outdoor areas on a dementia care unit.

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.

[]


NEW SECTION
WAC 388-97-35030
Indoor areas on a dementia care unit.

The nursing home must provide the dementia care unit with:

(1) Indoor ambulation areas that meet the needs of the residents and are maintained free of equipment; and

(2) Nontoxic indoor plants in areas accessible to residents.

[]


NEW SECTION
WAC 388-97-35040
Ambulation route on a dementia care unit in a new building or addition.

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.

[]


NEW SECTION
WAC 388-97-35050
Physical plant on a dementia care unit.

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, except for exit doors and doorways; and

(b) 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.

[]


NEW SECTION
WAC 388-97-35060
Special egress control devices on a dementia care unit.

In dementia care units the nursing home must:

(1) Have proof that required approvals for any special egress control devices 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, or when adding special egress control devices to be used on doors and gates which are a part of the exit system, the building must:

(a) Have obtained approval from department of health construction review and the local official who enforces the Uniform Building Code and Uniform Fire Code;

(b) Have an approved automatic fire alarm system;

(c) Have an approved supervised automatic fire sprinkler system which is electrically interconnected with the fire alarm system; and

(d) 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

(e) Prohibit the use of keyed locks at all doors and gates in all egress pathways.

[]

SPECIALIZED AND OUTPATIENT REHABILITATION
NEW SECTION
WAC 388-97-352
Specialized rehabilitation.

(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.

[]


NEW SECTION
WAC 388-97-353
Outpatient rehabilitation.

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.

[]

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

WAC 388-97-355
Food service areas.

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.]

STORAGE
NEW SECTION
WAC 388-97-357
Storage of equipment.

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.

[]


NEW SECTION
WAC 388-97-35710
Storage of resident room equipment in a new building or addition.

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.

[]


NEW SECTION
WAC 388-97-35720
General storage in new construction.

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.

[]

LIGHTING AND ELECTRICAL
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-360
Lighting.

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.]


NEW SECTION
WAC 388-97-36010
Natural or artificial light.

(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.

[]


NEW SECTION
WAC 388-97-36020
Outside lighting.

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.

[]


NEW SECTION
WAC 388-97-36030
Light shields.

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.

[]


NEW SECTION
WAC 388-97-36040
Illumination levels in new buildings and additions.

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.

[]


NEW SECTION
WAC 388-97-36050
Night lights in new construction.

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

(5) Controlled by a switch at each resident room entrance door or by a master switch.

[]


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.

[]


NEW SECTION
WAC 388-97-36070
Electrical outlets.

(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 must be protected by a ground fault circuit interrupter.

[]

SAFETY
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-365
Safety.

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.]


NEW SECTION
WAC 388-97-36510
Safety -- Poisons and nonmedical chemicals.

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.

[]


NEW SECTION
WAC 388-97-36520
Safety -- Storage of equipment and supplies.

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.

[]


NEW SECTION
WAC 388-97-36530
Safety -- Handrails.

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.

[]

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

WAC 388-97-370
Water supply.

(((1))) The nursing home ((shall)) must comply with the requirements of the group A, Public Water ((Supply)) Systems, chapter 246-290 WAC or group B, Public Water Systems, chapter 246-291 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.]


NEW SECTION
WAC 388-97-37010
Hot water.

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.

[]


NEW SECTION
WAC 388-97-37020
Cross connections.

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.

[]

PEST CONTROL AND SEWAGE AND WASTE DISPOSAL
AMENDATORY SECTION(Amending Order 3782, filed 9/15/94, effective 10/16/94)

WAC 388-97-375
Pest control.

(((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.]


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

WAC 388-97-385
Sewage and liquid waste disposal.

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.]

NEW CONSTRUCTION DOCUMENTS
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-400
((Approval of plans)) General new construction documents.

(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 is 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.]


NEW SECTION
WAC 388-97-40010
Preliminary new construction documents.

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.

[]


NEW SECTION
WAC 388-97-401
Final new construction documents.

(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) An architect or engineer licensed by the state of Washington 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) 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 must be submitted.

[]


NEW SECTION
WAC 388-97-402
Pre-installation submissions for new construction.

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.

[]


NEW SECTION
WAC 388-97-403
New construction timelines.

(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.

[]


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

WAC 388-97-405
Exemptions to new construction requirements.

(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.]

CODES AND STANDARDS IN NEW CONSTRUCTION
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-410
State building code in new construction.

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.]


AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-415
Electrical codes and standards in new construction.

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.]


AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-420
Elevator codes in new construction.

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.]


AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-425
Local codes and ordinances in new construction.

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.]

ADMINISTRATION AND PUBLIC AREAS IN NEW CONSTRUCTION
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-430
((Administration and public areas)) Entrances and exits in new construction.

(((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.]


NEW SECTION
WAC 388-97-43010
Lobbies in new construction.

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) A reception and information area;

(3) Space to accommodate persons in wheelchairs;

(4) A public restroom;

(5) A drinking fountain; and

(6) A public telephone.

[]


NEW SECTION
WAC 388-97-43020
Interview space in new construction.

The nursing home must have interview spaces for private interviews relating to social service and admission.

[]


NEW SECTION
WAC 388-97-43030
Offices in new construction.

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.

[]


NEW SECTION
WAC 388-97-43040
Inservice education space in new construction.

The nursing home must provide space for employee inservice education that will not infringe upon resident space.

[]


NEW SECTION
WAC 388-97-43050
Staff areas in new construction.

The nursing home must ensure a lounge, lockers, and toilets are provided convenient to the work areas for employees and volunteers.

[]

VISITING, PRIVATE, AND OUTDOOR RECREATION SPACE AND WALKWAYS IN NEW CONSTRUCTION
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-455
((Required miscellaneous rooms and areas)) Visiting and private space in new construction.

(((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.]


NEW SECTION
WAC 388-97-45510
Outdoor recreation space and walkways in new construction.

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.

[]

POOLS AND PHARMACIES IN NEW CONSTRUCTION
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-460
((Optional rooms and areas)) Pools in new construction.

(((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.]


NEW SECTION
WAC 388-97-46010
Pharmacies in new construction.

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.

[]

GENERAL DESIGN REQUIREMENTS IN NEW CONSTRUCTION
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-465
((General design requirements)) Elevators in new construction.

(((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.]


NEW SECTION
WAC 388-97-46510
Stairways, ramps, and corridors in new construction.

The nursing home must ensure stairways, ramps and corridors conform with the Uniform Building Code.

[]


NEW SECTION
WAC 388-97-46520
Walking surfaces in a new building or addition.

The nursing must ensure that:

(1) An abrupt change in the walking surface level including at door thresholds which are greater than 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.

[]


NEW SECTION
WAC 388-97-46530
Doors in new construction.

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.

[]


NEW SECTION
WAC 388-97-46540
Floor finishes in new construction.

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.

[]


NEW SECTION
WAC 388-97-46550
Carpets in new construction.

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;

(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 times 36, divided by pile height in inches equals ounces per cubic yard of density; and

(d) A maximum pile height of .255 inches in resident use areas and .312 inches in nonresident use areas.

(2) Carpets must:

(a) Be cemented to the floor; and

(b) Have the edges covered and top set base with toe at all wall junctures.

(3) 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.

[]


NEW SECTION
WAC 388-97-46560
Coving in new construction.

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.

[]


NEW SECTION
WAC 388-97-46570
Walls in new construction.

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.

[]


NEW SECTION
WAC 388-97-46580
Accessories in new construction.

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.

[]


NEW SECTION
WAC 388-97-46590
Miscellaneous in new construction.

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.

[]

HEATING, VENTILATION, AND AIR CONDITIONING SYSTEMS IN NEW CONSTRUCTION
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-470
Heating((, ventilation, and air conditioning)) systems in new construction.

(((1) HEATING SYSTEM.)) The nursing home ((shall)) must ensure:

(((a))) (1) The heating system is capable of maintaining a temperature of seventy-five degrees Fahrenheit for areas occupied by residents and seventy degrees Fahrenheit for nonresident areas;

(((b))) (2) Resident rooms have individual temperature control, except in a dementia care unit controls may be covered, locked, or placed in an inconspicuous place;

(((c))) (3) The following is insulated within the building:

(((i))) (a) Pipes conducting hot water which are exposed to resident contact; and

(((ii))) (b) Air ducts and casings with outside surface temperatures below ambient dew point.

(((d))) (4) Insulation on cold surfaces includes an exterior vapor barrier; and

(((e))) (5) Electric resistant wall heat units are prohibited in new construction.

(((2) COOLING SYSTEM. The nursing home shall have:

(a) A mechanical cooling system capable of maintaining a temperature of seventy-five degrees Fahrenheit for areas occupied by residents; and

(b) A cooling system that has mechanical refrigeration equipment to provide summer air conditioning to resident areas, food preparation areas, laundry, medication rooms, and therapy areas by either a central system with distribution ducts or piping, or packaged room or zonal air conditioners.

(3) VENTILATION SYSTEM. The nursing home shall ensure:

(a) Ventilation of all rooms is designed to prevent objectionable odors, condensation, and direct drafts on the residents.

(b) All inside habitable space is mechanically ventilated including:

(i) All air-supply and air-exhaust systems;

(ii) Installation of air-handling duct systems which meet the requirements of the Uniform Mechanical Code and chapter 51-22 WAC;

(iii) Corridors are not used to supply air to, or exhaust air from, any room except that infiltration air from corridors may be used to ventilate bathrooms, toilet rooms, janitors' closets, and small electrical or telephone closets opening directly on corridors;

(iv) Room supply air inlets, recirculation, and exhaust air outlets are located not less than three inches above the floor. Exhaust outlets shall be near the ceiling; and

(v) Outdoor air intakes are located as far as practical, but a minimum of twenty-five feet, from the exhausts from any ventilating system, combustion equipment, or plumbing vent, or areas which may collect vehicular exhaust and other noxious fumes. The nursing home shall locate the bottom of outdoor air intakes serving central systems as high as practical but a minimum of three feet above grade level or, if installed through the roof, three feet above the roof level.

TABLE A

PRESSURE RELATIONSHIPS AND VENTILATION OF CERTAIN AREAS

AREA DESIGNATION

Pressure

Relationship

To Adjacent

Areas

Minimum Air Changes

of Outdoor Air

Per Hour

Supplied To Room

Minimum Total1

Air Changes

Per Hour

Supplied To Room

All Air

Exhausted Directly To

Outdoors

Recirculated

Within Area


Activities/Dining E or P 2 4 Optional Optional
Bathroom N Optional 10 Yes No
Clean linen storage P Optional 2 Optional Optional
Clean workroom and clean holding P 2 4 Optional Optional
Dietary day storage E or P Optional 2
Food prep center E 2 8(10) Yes No
Isolation anteroom NN 2 10 Yes No
Isolation resident room NN 2 2 Yes No
Janitors' closet N Optional 10 Yes No
Laundry, general V 2 10 Yes No
Linen and trash chute room N Optional 10 Yes No
Medicine prep room P 2 4 Optional Optional
Occupational therapy N 2 6 Optional Optional
Personal care room N 2 8 Optional Yes
Physical therapy and hydrotherapy N 2 6 Optional Optional
Resident area corridor P 2 2 Optional Optional
Resident room E or N 2 2 Optional Optional
Soiled linen sorting and storage N Optional 10 Yes No
Soiled workroom and soiled holding N 2 10 Yes No
Speech and hearing unit E or P 2 2 Optional Optional
Sterilizer equipment room N Optional 10 Yes No
TB isolation resident room NN 2 12 2 Yes No
TB isolation room anteroom NN 2 12 3 Yes No
Toilet room and locker rooms N Optional 10 Yes No
Treatment room E or N 2 6 Optional Optional
Warewashing room N Optional 8(10) Yes No
P=Positive N=Negative E=Equal V=May vary ( )=Recommended NN=Very negative
1/ The outdoor air quantities for central systems employing recirculating and serving more than a single area designation may be determined by summing the individual area quantity requirements rather than by providing the maximum listed ratio of outdoor air to total air. Maximum noise level caused by toilet room exhaust fans shall be fifty decibels on the A sound level as per ASHRAE Table 7.
2/ Temporary imbalance at resident rooms as caused by intermittent toilet room or bathroom exhaust fans is permissible.
3/ TB isolation room: a minimum of six air changes may be permitted with a properly installed and maintained ultraviolet generator irradiation system. Fixture installation shall conform to the recommendation of the Illuminating Engineering Society Handbook, 5th edition, Section 25, "Ultraviolet Energy."

(c) Minimum ventilation requirements. Meet the pressure relationship and ventilation rates shown in Table A as minimum acceptable balanced rates when these areas/rooms are a part of the nursing home. The nursing home shall ensure:

(i) Exhaust hoods in food preparation centers and dishwashing areas have an exhaust rate not less than fifty cubic feet per minute per square feet of face area. "Face area" means the open area from the exposed perimeter of the hood to the average perimeter of the cooking surfaces;

(ii) All hoods over commercial type cooking ranges are equipped with fire extinguishing systems and heat actuated fan controls;

(iii) Cleanout openings are provided every twenty feet in horizontal exhaust duct systems serving hoods;

(iv) Installation of equipment for removal of smoke and grease-laden vapors from cooking equipment comply with the Uniform Mechanical Code and chapter 51-22 WAC;

(v) Kitchen ventilation are adequate to provide comfortable working temperatures;

(vi) Boiler rooms, elevator equipment rooms, laundry rooms, and any other heat-producing spaces are provided with sufficient outdoor air to maintain combustion rates of equipment and to limit temperatures at the ceiling to ninety-seven degrees Fahrenheit; and

(vii) Individual toilet rooms and bathrooms are ventilated either by individual mechanical exhaust systems or by a central mechanical exhaust system.

(d) Individual exhaust systems.

(i) Where individual mechanical exhaust systems are used to exhaust individual toilet rooms or bathrooms, the individual ventilation fans are interconnected with room lighting to ensure a ventilation while room is occupied. The ventilation fan shall be provided with a time delay shutoff to ensure that the exhaust continues for a minimum of five minutes after the light switch is turned off;

(ii) Air discharge openings through roofs or exterior walls are protected against entry of weather elements and foreign objects. Automatic louvers or backdraft dampers are installed; and

(iii) The volume of air removed from the space by exhaust ventilation are replaced directly or indirectly by an equal amount of tempered/conditioned air.

(e) Central exhaust systems. The nursing home shall ensure:

(i) All fans serving central exhaust systems are located to prevent a positive pressure in the duct passing through an occupied area;

(ii) Fire and smoke dampers are located and installed in accordance with the Uniform Building Code chapter 51-20 WAC.

(f) Air filters. All central ventilation or air-conditioning systems are equipped with filters having efficiencies of at least eighty percent if the system supplies air to resident rooms, therapy areas, food preparation areas, or laundry areas. Filter efficiency is warranted by the manufacturer and is based on atmospheric dust spot efficiency per ASHRAE Standard 52-76. The filter bed is located upstream of the air-conditioning equipment, unless a prefilter is employed. In which case, the prefilter is upstream of the equipment and the main filter bed may be located downstream.

(i) Filter frames are durable and provide an airtight fit with the enclosing duct work. All joints between filter segments and enclosing duct work are gasketed or sealed.

(ii) All central air systems have a manometer installed across each filter bed with an alarm to signal high pressure differential.

(iii) Humidifiers, if provided, are a steam type.))

[Statutory Authority: RCW 18.51.070 and 74.42.620. 94-19-041 (Order 3782), 388-97-470, filed 9/15/94, effective 10/16/94.]


NEW SECTION
WAC 388-97-47010
Cooling systems in new construction.

The nursing home must have:

(1) A mechanical cooling system capable of maintaining a temperature of seventy-five degrees Fahrenheit for areas occupied by residents; and

(2) A cooling system that has mechanical refrigeration equipment to provide summer air conditioning to resident areas, food preparation areas, laundry, medication rooms, and therapy areas by either a central system with distribution ducts or piping, or packaged room or zonal air conditioners.

[]


NEW SECTION
WAC 388-97-47020
Ventilation systems in new construction.

The nursing home must ensure:

(1) Ventilation of all rooms is designed to prevent objectionable odors, condensation, and direct drafts on the residents;

(2) All habitable space is mechanically ventilated including:

(a) Air-supply and air-exhaust systems;

(b) Installation of air-handling duct systems according to the requirements of the Uniform Mechanical Code and chapter 51-42 WAC;

(c) Corridors not used to supply air to, or exhaust air from, any room except that infiltration air from corridors may be used to ventilate bathrooms, toilet rooms, janitors' closets, and small electrical or telephone closets opening directly on corridors;

(d) Installation of supply registers and return air grilles at least three inches above the floor;

(e) Installation of exhaust grilles on or near the ceiling; and

(f) Outdoor air intakes located a minimum of twenty-five feet from the exhaust from any ventilating system, combustion equipment, or areas which may collect vehicular exhaust and other noxious fumes, and a minimum of ten feet from plumbing vents. The nursing home must locate the bottom of outdoor air intakes serving central systems a minimum of three feet above adjoining grade level or, if installed through the roof, three feet above the highest adjoining roof level.


TABLE 5

PRESSURE RELATIONSHIPS AND VENTILATION OF CERTAIN AREAS OF NURSING HOMES

FUNCTION AREA

Pressure

Relationship

To Adjacent

Areas1,2

Minimum Air Changes

of Outdoor Air

Per Hour

Supplied To Room

Minimum Total

Air Changes

Per Hour

Supplied To Room

All Air

Exhausted Directly To

Outdoors

Air Recirculated

Within Room Units

PATIENT CARE
Isolation Room N 2 12 Yes No
Patient area corridor Optional 2 Optional Optional
Patient room 2 2 Optional Optional
Toilet room N Optional 10 Yes No
DIAGNOSTIC AND TREATMENT
Clean workroom or clean holding P 2 4 Optional Optional
Examination room 2 6 Optional Optional
Occupational therapy3 N 2 3 Optional Optional
Physical therapy3 N 2 3 Optional Optional
Soiled workroom or soiled holding N 2 10 Yes No
STERILIZING AND SUPPLY
Clean linen storage P Optional 2 Yes No
Laundry, general3 2 10 Yes No
Linen and trash chute room N Optional 10 Yes No
Soiled linen sorting and storage N Optional 10 Yes No
Sterilizer equipment room N Optional 10 Yes No
SERVICE
Bathroom N Optional 10 Yes No
Dietary day storage Optional 2 Yes No
Food preparation center3 2 10 Yes No
Janitor's closet N Optional 10 Yes No
Warewashing room3 N Optional 10 Yes No

1/ P=Positive N=Negative =Continuous directional control not required.
2/ Whether positive or negative, pressure must be a minimum of seventy cubic feet per minute (CFM).
3/ The volume of air may be reduced up to fifty percent in these areas during periods of nonuse. The soiled holding area of the general laundry must maintain its full ventilation capacity at all time.

(3) Minimum ventilation requirements. Meet the pressure relationship and ventilation rates per ASHRAE 95 HVAC Applications Chapter 7.11 Table 5 Pressure Relationships and Ventilation of Certain Areas of Nursing Homes. The nursing home must ensure:

(a) Exhaust hoods in food preparation areas comply with the Uniform Mechanical Code;

(b) All hoods over commercial type cooking ranges are equipped with fire extinguishing systems and heat actuated fan controls;

(c) Kitchen ventilation is adequate to provide comfortable working temperatures;

(d) Boiler rooms, elevator equipment rooms, laundry rooms, and any other heat-producing spaces are provided with sufficient outdoor air to maintain combustion rates of equipment and to limit temperatures at the ceiling to ninety-seven degrees Fahrenheit; and

(e) Individual toilet rooms and bathrooms are ventilated either by individual mechanical exhaust systems or by a central mechanical exhaust system.

(4) Individual exhaust systems.

(a) Where individual mechanical exhaust systems are used to exhaust individual toilet rooms or bathrooms, the individual ventilation fans are interconnected with room lighting to ensure ventilation while room is occupied. The ventilation fan must have a time delay shutoff to ensure that the exhaust continues for a minimum of five minutes after the light switch is turned off; and

(b) The volume of air removed from the space by exhaust ventilation is replaced directly or indirectly by an equal amount of tempered/conditioned air.

(5) Central exhaust systems. The nursing home must ensure:

(a) All fans serving central exhaust systems are located to prevent a positive pressure in the duct passing through an occupied area; and

(b) Fire and smoke dampers are located and installed in accordance with the Uniform Building Code chapter 51-40 WAC.

(6) Air filters.

(a) All central ventilation or air-conditioning systems are equipped with filters having efficiencies of at least eighty percent if the system supplies air to resident rooms, therapy areas, food preparation areas, or laundry areas;

(b) Central ventilation or air conditioning systems means any system serving more than a single room used by residents or by any group of rooms serving the same utility function (i.e., the laundry);

(c) Filter efficiency is warranted by the manufacturer and is based on atmospheric dust spot efficiency per ASHRAE Standard 52-76;

(d) The filter bed is located upstream of the air-conditioning equipment, unless a prefilter is employed. In which case, the prefilter is upstream of the equipment and the main filter bed may be located downstream; and

(e) The nursing home must ensure:

(i) Filter frames are durable and provide an airtight fit with the enclosing duct work. All joints between filter segments and enclosing duct work are gasketed or sealed;

(ii) All central air systems have a manometer installed across each filter bed with an alarm to signal high pressure differential; and

(iii) Humidifiers, if provided, are a steam type.

[]

PLUMBING AND FIXTURES IN NEW CONSTRUCTION
AMENDATORY SECTION(Amending WSR 94-19-041 (Order 3782), filed 9/15/94, effective 10/16/94)

WAC 388-97-480
((Plumbing, fixtures)) Handwashing sinks in new construction.

(((1) LAVATORIES.)) The nursing home ((shall)) must provide ((lavatories)) a handwashing sink in each toilet room ((except where provided in an adjoining single resident room, dressing room, or locker)) and exam room.

(((2) DRINKING FOUNTAINS. Where drinking fountains are installed, the nursing home shall ensure the fountains are of the inclined jet, sanitary type.

(3) MIXING VALVES. The nursing home shall provide each fixture, except toilet fixtures and special use fixtures, with hot and cold water through a mixing valve.

(4) SPOUTS. The nursing home shall ensure all lavatories and sinks in resident rooms, resident toilet rooms, and utility and medication areas have gooseneck spouts.

(5) WRIST BLADES. The nursing home shall provide four inch wrist blade controlled faucets or their equivalent at all sinks and lavatories. The nursing home shall:

(a) Install the wrist blades to provide four inches clear in full open and closed position; and

(b) Color-code and label faucet handles to indicate "hot" and "cold."

(6) BACKFLOW PREVENTION DEVICES. The nursing home shall:

(a) Provide backflow prevention devices on the water supply to fixtures or group of fixtures where extension hoses are installed or are anticipated to be installed; and

(b) Prohibit all cross connections.))

[Statutory Authority: RCW 18.51.070 and 74.42.620. 94-19-041 (Order 3782), 388-97-480, filed 9/15/94, effective 10/16/94.]


NEW SECTION
WAC 388-97-48010
Drinking fountains in new construction.

Where drinking fountains are installed, the nursing home must ensure the fountains are of the inclined jet, sanitary type.

[]


NEW SECTION
WAC 388-97-48020
Mixing valves or mixing faucets in new construction.

The nursing home must provide each fixture, except toilet fixtures and special use fixtures, with hot and cold water through a mixing valve or mixing faucet.

[]


NEW SECTION
WAC 388-97-48030
Spouts in new construction.

The nursing home must ensure all lavatories and sinks in resident rooms, resident toilet rooms, and utility and medication areas have gooseneck spouts, without aerators in areas requiring infection control.

[]


NEW SECTION
WAC 388-97-48040
Faucet controls in new construction.

The nursing home must provide wrist blade, single-lever controls or their equivalent at all sinks and lavatories. The nursing home must:

(1) Provide at least four inch wrist blades and/or single-levers;

(2) Provide sufficient space for full open and closed operation; and

(3) Color-code and label faucet controls to indicate "hot" and "cold."

[]

SUBCHAPTER III

NURSING HOME LICENSE

INITIAL LICENSE APPLICATION
NEW SECTION
WAC 388-97-550
Initial nursing home license.

(1) A complete nursing home license application must be:

(a) Submitted at least sixty days prior to the proposed effective date of the license on forms designated by the department;

(b) Signed by the proposed licensee or the proposed licensee's authorized representative;

(c) Notarized; and

(d) Reviewed by the department in accordance with this chapter.

(2) All information requested on the license application must be provided. At minimum, the nursing home license application will require the following information:

(a) The name and address of the proposed licensee, and any partner, officer, director, managerial employee, or owner of five percent or more of the proposed licensee;

(b) The names of the administrator, director of nursing services, and, if applicable, the management company;

(c) The specific location and the mailing address of the facility for which a license is sought;

(d) The number of beds to be licensed; and

(e) The name and address of all nursing homes that the proposed licensee or any partner, officer, director, managerial employee, or owner of five percent or more of the proposed licensee has been affiliated with in the past ten years.

(3) The proposed licensee must be:

(a) The individual or entity responsible for the daily operation of the nursing home;

(b) Denied the license if any individual or entity named in the application is found by the department to be unqualified.

(4) For initial licensure of a new nursing home, the proposed licensee must submit the annual license fee with the initial license application. The nonrefundable nursing home license fee is one hundred twenty-seven dollars per bed per year.

(5) If any information submitted in the initial license application changes before the license is issued, the proposed licensee must submit a revised application containing the changed information.

(6) If a license application is pending for more than six months, the proposed licensee must submit a revised application containing current information about the proposed licensee or any other individuals or entities named in the application.

[]

LICENSE RENEWAL
NEW SECTION
WAC 388-97-555
Nursing home license renewal.

(1) All nursing home licenses must be renewed annually.

(2) License renewals must be:

(a) Submitted at least thirty days prior to the license's expiration date on forms designated by the department;

(b) Signed by the current licensee or the current licensee's authorized representative;

(c) Notarized; and

(d) Reviewed by the department in accordance with this chapter.

(3) The current licensee must provide all information on the license renewal form or other information requested by the department.

(4) The application for a nursing home license renewal must be:

(a) Made by the individual or entity currently licensed and responsible for the daily operation of the nursing home;

(b) Denied if any individual or entity named in the renewal application is found by the department to be unqualified.

(5) The nursing home license renewal fee must be submitted at the time of renewal. The nonrefundable fee is one hundred twenty-seven dollars per bed per year.

(6) In unusual circumstances, the department may issue an interim nursing home license for a period not to exceed three months. The current licensee must submit the prorated nursing home license fee for the period covered by the interim license. The annual date of license renewal does not change when an interim license is issued.

(7) A change of nursing home ownership does not change the date of license renewal and fee payment.

[]

DEPARTMENT REVIEW OF LICENSE APPLICATIONS AND APPEALS
NEW SECTION
WAC 388-97-560
Department review of initial nursing home license applications.

(1) All initial nursing home license applications must be reviewed by the department under this chapter.

(2) The department will not begin review of an incomplete license application.

(3) The proposed licensee must respond to any department request for additional information within five working days.

(4) When the application is determined to be complete, the department will consider the proposed licensee or any partner, officer, director, managerial employee, or owner of five percent or more of the proposed licensee, separately and jointly, in its review. The department will review:

(a) The information contained in the application;

(b) Survey and complaint investigation findings in every facility each individual and entity named in the application has been affiliated with during the past ten years;

(c) Compliance history;

(d) Financial assessments;

(e) Actions against the proposed licensee (i.e., revocation, suspension, refusal to renew, etc.);

(f) All criminal convictions, and relevant civil or administrative actions or findings including, but not limited to, findings under 42 C.F.R. 488.335, disciplinary findings, and findings of abuse, neglect, exploitation, or abandonment; and

(g) Other relevant information.

(5) The department will notify the proposed licensee of the results of the review.

[]


NEW SECTION
WAC 388-97-565
Department review of nursing home license renewals.

(1) All renewal license applications must be reviewed by the department under this chapter.

(2) The department will not begin review of an incomplete license renewal application.

(3) The proposed licensee must respond to any department request for additional information within five working days.

(4) When the application is determined to be complete, the department will review:

(a) The information contained in the application;

(b) Actions against the license (i.e., revocation, suspension, refusal to renew, etc.);

(c) All criminal convictions, and relevant civil or administrative actions or findings including, but not limited to, findings under 42 C.F.R. 488.335, disciplinary findings, and findings of abuse, neglect, exploitation, or abandonment; and

(d) Other relevant information.

(5) The department will notify the current licensee of the results of the review.

[]


NEW SECTION
WAC 388-97-570
Reasons for denial, suspension, modification, revocation of, or refusal to renew a nursing home license.

(1) The department may deny, suspend, revoke, or refuse to renew a nursing home license if the proposed or current licensee, or any partner, officer, director, managing employee, or owner of five percent or more of the proposed or current licensee of the nursing home has:

(a) Not complied with all the requirements established by chapters 18.51, 74.42, or 74.46 RCW and rules adopted thereunder; (b) A history of significant noncompliance with federal or state regulations in providing nursing home care;

(c) No credit history or a poor credit history;

(d) Engaged in the illegal use of drugs or the excessive use of alcohol or been convicted of "crimes relating to drugs" as defined in RCW 43.43.830;

(e) Unlawfully operated a nursing home, or long term care facility as defined in RCW 70.129.010, without a license;

(f) Previously held a license to operate a hospital or any facility for the care of children or vulnerable adults, and that license has been revoked, or suspended, or the licensee did not seek renewal of the license following written notification of the licensing agency's initiation of revocation or suspension of the license;

(g) Obtained or attempted to obtain a license by fraudulent means or misrepresentation;

(h) Permitted, aided, or abetted the commission of any illegal act on the nursing home premises;

(i) Failed to meet financial obligations as the obligations fall due in the normal course of business;

(j) Been convicted of a felony, other than a felony that is a "crime against children or other persons," or a "crime relating to financial exploitation" as defined in RCW 43.43.830, if the crime reasonably relates to the competency of the individual to own or operate a nursing home;

(k) Failed to provide any authorization, documentation, or information the department requires in order to verify information contained in the application; or

(l) Failed to verify additional information the department determines relevant to the application.

(2) In determining whether there is a history of significant noncompliance with federal or state regulations under subsection (1)(b), the department may, at a minimum, consider:

(a) Whether the violation resulted in a significant harm or a serious and immediate threat to the health, safety, or welfare of any resident;

(b) Whether the proposed or current licensee promptly investigated the circumstances surrounding any violation and took steps to correct and prevent a recurrence of a violation;

(c) The history of surveys and complaint investigation findings and any resulting enforcement actions;

(d) Repeated failure to comply with regulations;

(e) Inability to attain compliance with cited deficiencies within a reasonable period of time; and

(f) The number of violations relative to the number of facilities the proposed or current licensee, or any partner, officer, director, managing employee, or owner of five percent or more of the proposed or current licensee of the nursing home, has been affiliated with in the past ten years.

(3) The department must deny, suspend, revoke, or refuse to renew a proposed or current licensee's nursing home license if the proposed or current licensee or any partner, officer, director, managing employee, or owner of five percent or more of the assets of the nursing home, has been:

(a) Convicted of a "crime against children or other persons" as defined under RCW 43.43.830;

(b) Convicted of a "crime relating to financial exploitation" as defined under RCW 43.43.830;

(c) Found by a court in a protection proceeding under chapter 74.34 RCW, or any comparable state or federal law, to have abandoned, abused, neglected or financially exploited a vulnerable adult;

(d) Found in any final decision issued by a disciplinary board to have sexually or physically abused or exploited any minor or an individual with a developmental disability or to have abused or financially exploited any vulnerable adult;

(e) Found in any dependency action to have sexually assaulted or exploited any minor or to have physically abused any minor;

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

(g) Found to have abused, neglected, or mistreated residents or misappropriated their property, and that finding has been entered on a nursing assistant registry.

[]


NEW SECTION
WAC 388-97-575
Appeal of the department's licensing decision.

(1) A proposed or current licensee contesting a department licensing decision must file a written request for an adjudicative proceeding within twenty days of receipt of the decision.

(2) Adjudicative proceedings will be governed by the Administrative Procedure Act (chapter 34.05 RCW), RCW 18.51.065, 43.20A.205, WAC 388-98-750, and chapters 388-08 and 388-97 WAC. If any provision in this chapter conflicts with chapter 388-08 WAC, the provision of this chapter will govern.

[]

MANAGEMENT AGREEMENTS AND CHANGES OF OWNERSHIP
NEW SECTION
WAC 388-97-580
Management agreements.

(1) If the responsibilities given to the manager by the management agreement are so extensive that the licensee is relieved of responsibility for the daily operations of the facility, then the department must determine that a change of ownership has occurred.

(2) The proposed licensee or the current licensee must notify the residents and their representatives sixty days before entering into a management agreement.

(3) The department must receive a written management agreement, including an organizational chart showing the relationship between the proposed or current licensee, management company, and all related organizations:

(a) Sixty days before the proposed change of ownership date as part of the initial license application or any change of ownership;

(b) Sixty days before the effective date when submitted by the current licensee; or

(c) Thirty days before the effective date of any amendment to an existing management agreement.

(4) Management agreements, at minimum must:

(a) Create a principal/agent relationship between the licensee and the manager;

(b) Describe the responsibilities of the licensee and manager, including items, services, and activities to be provided;

(c) Require the licensee's governing body, board of directors, or similar authority to appoint the facility administrator;

(d) Provide for maintenance and retention of all records as applicable according to rules and regulations;

(e) Allow unlimited access by the department to documentation and records according to applicable laws or regulations;

(f) Require the licensee to participate in monthly oversight meetings and quarterly on-site visits to the facility;

(g) Require the manager to immediately send copies of surveys and notices of noncompliance to the licensee;

(h) State that the licensee is responsible for ensuring all licenses, certifications, and accreditations are obtained and maintained;

(i) State that the manager and licensee will review the management agreement annually and notify the department of changes according to applicable rules and regulations; and

(j) Acknowledge that the licensee is the party responsible for meeting state and federal licensing and certification requirements.

(5) Upon receipt of a proposed management agreement, the department may require:

(a) The licensee or manager to provide additional information or clarification;

(b) Any changes necessary to:

(i) Bring the management agreement into compliance with this section; and

(ii) Ensure that the licensee has not been relieved of the responsibility for the daily operations of the facility; and

(c) More frequent contact between the licensee and manager under subsection (4)(f).

(6) The department may monitor the licensee's and manager's compliance with the terms of the management agreement and take any action deemed appropriate.

[]


NEW SECTION
WAC 388-97-585
Change of ownership.

(1) A change of ownership occurs when there is a substitution of the operator or operating entity responsible for the daily operational decisions of the nursing home, or a substitution of control of such operating entity. Events which constitute a change of ownership include, but are not limited to, the following:

(a) The form of legal organization of the licensee is changed (e.g., a sole proprietor forms a partnership or corporation);

(b) The licensee transfers ownership of the nursing home business enterprise to another party regardless of whether ownership of some or all of the real property and/or personal property assets of the facility is also transferred;

(c) Dissolution or consolidation of the entity, or merger if the licensee does not survive the merger;

(d) If, during any continuous twenty-four month period, fifty percent or more of the entity is transferred, whether by a single transaction or multiple transactions, to:

(i) A different party (e.g., new or former shareholders); or (ii) An individual or entity that had less than a five percent ownership interest in the nursing home at the time of the first transaction; or

(e) Any other event or combination of events that results in a substitution or substitution of control of the operator or the operating entity responsible for the daily operational decisions of the nursing home.

(2) Ownership does not change when the following, without more, occur:

(a) A party contracts with the licensee to manage the nursing home enterprise as the licensee's agent (i.e., as provided in WAC 388-97-580); or

(b) The real property or personal property assets of the nursing home are sold or leased, or a lease of the real property or personal property assets is terminated, as long as there is not a substitution or substitution of control of the operator or operating entity.

(3) When a change of ownership is contemplated, the current licensee must notify the department and all residents and their representatives at least sixty days prior to the proposed date of transfer. The notice must be in writing and contain the following information:

(a) Name of the current licensee and proposed licensee;

(b) Name and address of the nursing home being transferred; and

(c) Date of proposed transfer.

(4) The proposed licensee must comply with license application requirements. The operation or ownership of a nursing home must not be transferred until the proposed licensee has been issued a license to operate the nursing home.

[]

LICENSED BED CAPACITY, RELOCATION OF RESIDENTS AND LICENSE RELINQUISHMENT
NEW SECTION
WAC 388-97-590
Licensed bed capacity.

A nursing home must not be licensed for a capacity that exceeds the number of beds permitted under:

(1) This chapter;

(2) Chapter 70.38 RCW and regulations thereunder; or

(3) Applicable local zoning, building or other such regulations.

[]


NEW SECTION
WAC 388-97-595
Relocation of residents.

(1) In the event of license revocation or suspension, decertification, or other emergency closures the department must:

(a) Notify residents and, when appropriate, resident representatives of the action; and

(b) Assist with residents' relocation and specify possible alternative living choices and locations.

(2) When a resident's relocation occurs due to a nursing home's voluntary closure, or voluntary termination of its Medicare and/or Medicaid contract:

(a) The nursing home must:

(i) Send written notification, sixty days before closure or contract termination, to the department's designated local office and to all residents and resident representatives; and

(ii) Provide appropriate discharge planning and coordination for all residents.

(b) The department may provide residents assistance with relocation.

[]


NEW SECTION
WAC 388-97-600
License relinquishment.

(1) A nursing home licensee must voluntarily relinquish its license when:

(a) The nursing home ceases to do business as a nursing home; and

(b) Within twenty-four hours after the last resident is discharged from the facility.

(2) The license must be returned to the department.

(3) If a nursing home licensee fails to voluntarily relinquish its license, the department will revoke the license.

[]


REPEALER

     The following sections of the Washington Administrative Code are repealed:
WAC 388-97-010 License -- Application.
WAC 388-97-015 License -- Qualification.
WAC 388-97-020 Nursing home fees.
WAC 388-97-025 License capacity.
WAC 388-97-030 Change of ownership.
WAC 388-97-035 Change in administrator or director of nursing services.
WAC 388-97-040 Name of nursing home.
WAC 388-97-045 License relinquishment upon closure.
WAC 388-97-050 License denial, modification, nonrenewal, revocation.
WAC 388-97-070 Resident rights.
WAC 388-97-080 Quality of life.
WAC 388-97-095 Dementia care unit.
WAC 388-97-100 Discharge planning.
WAC 388-97-105 Relocation due to decertification, license revocation closure, evacuation.
WAC 388-97-145 Early identification of persons with active tuberculosis.
WAC 388-97-150 Surveillance and management of tuberculosis.
WAC 388-97-200 Criminal history disclosure and background inquiries.
WAC 388-97-210 Respite services.
WAC 388-97-215 Adult day or night care.
WAC 388-97-225 Nursing facility care.
WAC 388-97-230 Discrimination prohibited.
WAC 388-97-235 Medical eligibility for nursing facility care.
WAC 388-97-240 Nursing facility admission.
WAC 388-97-245 Pre-admission screening.
WAC 388-97-250 Identification screening for current residents.
WAC 388-97-255 Pre-admission screening and annual resident review (PASARR).
WAC 388-97-265 Utilization review.
WAC 388-97-270 Individual transfer and discharge rights, procedures, appeals.
WAC 388-97-275 Resident assessment instrument.
WAC 388-97-280 Discharge or leave of a nursing facility resident.
WAC 388-97-300 Fire standards and approval.
WAC 388-97-305 Other standards.
WAC 388-97-320 Space and equipment.
WAC 388-97-380 Maintenance and repair.
WAC 388-97-390 General.
WAC 388-97-395 Design requirements.
WAC 388-97-435 Resident care unit.
WAC 388-97-440 Resident rooms.
WAC 388-97-445 Resident room equipment.
WAC 388-97-450 Resident toilet and bathing facilities.
WAC 388-97-475 Electrical.

Washington State Code Reviser's Office