WSR 00-17-133

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Children's Administration)

[ Filed August 21, 2000, 10:28 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 98-08-084.

Title of Rule: Chapter 388-148 WAC, Licensing requirements for foster homes, group care programs/facilities and agencies.

Purpose: Clarify the language of the licensing requirements for foster homes, group care programs/facilities and child-placing agencies licensed by Children's Administration, DSHS. The chapter incorporates changes in state and federal law, Children's Administration policy and current practice.

Statutory Authority for Adoption: RCW 74.15.030.

Statute Being Implemented: RCW 74.15.030.

Summary: Change in the format and organization adds to clarity. The major changes have to do with strengthening health and safety requirements regarding smoking, water hazards, psychotropic medications, securing a child's belongings, increasing staffing during sleeping hours in group care facilities, raising the age of child care staff, changing language to comply with changes in federal legislation.

Reasons Supporting Proposal: Overall clarity, elimination of duplicative and out-of-date regulations, and effectiveness of the rules affecting foster homes, group care facilities and child-placing agencies will be achieved.

Name of Agency Personnel Responsible for Drafting and Implementation: Jean L. Croisant, P.O. Box 45710, Olympia, WA 98504-5710, (360) 902-7992; and Enforcement: Division of Licensed Resources, Office of Foster Care Licensing, Children's Administration, DSHS.

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

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

Explanation of Rule, its Purpose, and Anticipated Effects: The purpose of the chapter is to define the minimum general and specific licensing requirements for foster homes, staffed residential homes, group facilities and child-placing agencies. Foster homes and group care facilities must be regulated to ensure that children experience safe and healthy care while in out-of-home placement.

The anticipated effect will be the overall clarification of the requirements licensing foster homes, group care facilities and child-placing agencies. The more clearly written question and answer format will improve understanding of the rules and consistency of interpretation of the WAC chapter. It is anticipated there will be greater compliance with the rules, more effective monitoring, and fewer corrective action plans needed as a result of the changes.

Proposal Changes the Following Existing Rules: Some of the changes are as follows:

Clarifying the use of psychotropic drugs.
Aligning the chapter with federal laws under the Multiethnic Placement Act of 1994 and the Interethnic Adoption Provisions Act of 1996.
Clarifying the difference between licensing and certification.
Requiring a child's belongings to be secured for up to thirty days when a child leaves a home or facility, which allows time for the child's personal belongings to be moved to the new placement.
Addition of the "awake staff" in settings where there are more than six children in care; or the focus of the program is behavioral in nature rather than transitional living or when the child's behavior is a risk.
Expansion of the behavior management policy to include requiring training prior to the use of any physical restraint.
Prohibiting smoking in any home or facility caring for children and in motor vehicles while transporting children.
Clarification of capacity for foster homes allowing licensing for up to six foster children with the approval of the department.
Have the same qualifications for the director, on-site program manager, and child care staff for all group care programs.
Raising the minimum age of the licensee from eighteen to twenty-one years old.
Raising the age of child care staff from eighteen to twenty-one years old, unless the person is nineteen or twenty and participating in an internship program with an accredited college or university.
Reducing the capacity for respite care to comply with the general foster home licensed capacity.

No small business economic impact statement has been prepared under chapter 19.85 RCW. Children's Administration only licenses one small business, Shamrock Acres, which is a group home. In a discussion with this small business, it has observed that Shamrock Acres already more than meets the requirements of the proposed changes of this chapter. Therefore, no new costs will be imposed on small businesses affected by these changes. The preparation of a comprehensive small business economic impact statement is not required.

RCW 34.05.328 applies to this rule adoption. The proposed rule changes for chapter 388-148 WAC, Licensing requirements for foster homes, group care programs/facilities and agencies, are "significant legislative rules" as defined in RCW 34.05.325 and therefore require a cost benefit analysis (CBA). A copy of the CBA may be requested by contacting Jean L. Croisant, at the Division of Program and Policy Development, Children's Administration, P.O. Box 45710, Olympia, WA 98504-5710, (360) 902-7992 or loje300@dshs.wa.gov.

Hearing Location: The hearing will be conducted using Washington Interactive Technologies' videoconferencing service. There will be four sites available for simultaneous hearing: SPOKANE, 1101 North Argonne, Suite 109, Spokane, WA 99201, (509) 921-2371; RENTON, 1107 S.W. Grady Way, Suite 112, Renton, WA 98055, (425) 277-7290; TRICITIES, 8551 West Gage Boulevard, Suite H, Kennewick, WA 99336, (509) 734-7180; and LACEY, DIS Interactive Technologies, 710 Sleater-Kinney Road S.E., Suite Q, Lacey, WA 98504, (360) 407-9487; on October 26, 2000, at 1:30 p.m. Please contact Kelly Cooper, DSHS Rules Coordinator at (360) 664-6094 for directions.

Assistance for Persons with Disabilities: Contact DSHS Rules Coordinator by October 19, 2000, phone (360) 664-6094, TTY (360) 664-6178, e-mail myercme@dshs.wa.gov [coopekd@dshs.wa.gov].

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by October 26, 2000.

Date of Intended Adoption: No sooner than October 27, 2000.

August 18, 2000

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

2763.4
Chapter 388-148 WAC

LICENSING REQUIREMENTS FOR CHILD FOSTER HOMES, GROUP CARE PROGRAMS/FACILITIES, AND AGENCIES

PURPOSE AND DEFINITIONS.
NEW SECTION
WAC 388-148-0005
What is the purpose of this chapter?

The department issues or denies a license or certification on the basis of compliance with licensing requirements. This chapter defines general and specific licensing requirements for foster homes, staffed residential homes, group facilities and child-placing agencies. We include licensing requirements for people who own or operate foster homes, staffed residential homes, group care facilities, and child-placing agencies. In addition, we describe our requirements for specialized services offered in these homes and facilities, including: maternity services, day treatment services, crisis residential centers and services for children with severe developmental disabilities. Unless noted otherwise, these requirements apply to people who want to be licensed, certified, re-licensed and re-certified.

The department is committed to ensuring that the children who receive care experience health, safety, and well-being. We want these children's experiences to be beneficial to them not only in the short run, but also in the long term. Our licensing requirements reflect our commitment to children.

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NEW SECTION
WAC 388-148-0010
What definitions do I need to know to understand this chapter?

The following definitions are important to understand these rules:

"Abuse or neglect" means the injury, sexual abuse, sexual exploitation, negligent treatment or mistreatment of a child where the child's health, welfare and safety are harmed.

"Capacity" means the maximum number of children that a home or facility is licensed to care for at a given time.

"Care provider" means any licensed or certified person or organization that provides twenty-four-hour care for children.

"Case manager" means the private agency employee who coordinates the planning efforts of all the persons working on behalf of a child. They are responsible for implementing the child's case plan, assisting in achieving those goals, and assisting with day-to-day problem solving.

"Certification" means:

(1) Department approval of a person, home, or facility that does not legally need to be licensed, but wishes to have evidence that they met the minimum licensing requirements.

(2) Department licensing of a child-placing agency to certify and supervise foster home and group care programs.

"Children" or "youth," means individuals who are:

(1) Under eighteen years old, including expectant mothers under eighteen years old; or

(2) Up to twenty-one years of age and enrolled in high school, equivalent course of study, or GED;

(3) Up to twenty-one years of age with developmental disabilities; or

(4) Up to twenty-one years of age if under the custody of the Washington state juvenile rehabilitation administration.

"Child-placing agency" means an agency licensed to place children for temporary care, continued care or adoption.

"Crisis residential center (CRC)" means an agency under contract with DSHS that provides temporary, protective care to children in a foster home, regular (semi-secure) or secure group setting.

"DCFS" means the division of children and family services.

"DDD" means division of developmental disabilities.

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

"Developmental disabilities" means the language used by DSHS, division of developmental disabilities as defined in RCW 71A.10.020.

"DLR" means the division of licensed resources.

"Firearms" means guns or weapons, such as BB guns, pellet guns, air rifles, stun guns, antique guns, bows and arrows, handguns, rifles, and shotguns.

"Foster-adopt" means placement of a child with a foster parent(s) who intends to adopt the child, if possible.

"Foster home or foster family home" means person(s) regularly providing care on a twenty-four-hour basis to one or more children in the person's home.

"Group care facility for children" means a location maintained and operated for a group of children on a twenty-four-hour basis.

"Hearing" means the department's administrative review process.

"I" refers to anyone who operates or owns a foster home, staffed residential home, and group facilities, including group homes, child-placing agencies, maternity homes, day treatment centers, and crisis residential centers.

"Infants" means children under one year of age.

"License" means a permit issued by the department affirming that a home or facility meets all the general licensing requirements.

"Licensor" means:

(1) A division of licensed resources (DLR) employee at DSHS who:

(a) Approves licenses or certifications for foster homes and group facilities; and

(b) Monitors homes and facilities to ensure that they continue to meet health and safety requirements.

(2) An employee of a child-placing agency who:

(a) Attests that a foster home and/or group home facility supervised by the child-placing agency meets licensing requirements; and

(b) Monitors the homes and facilities to ensure they continue to meet the licensing standards for the health and safety of the children in care.

(3) The department has the responsibility for final approval of homes and facilities that the child-placing agency certifies as meeting the full licensing standards for children in care.

"Maternity service" means an individual, program or facility providing or arranging for care for:

(1) Expectant mothers before and during pregnancy; and

(2) Mothers and their infants after pregnancy.

These services are provided to mothers who are up to eighteen years of age.

"Medically fragile" means the condition of a child who has a chronic illness or severe medical disabilities requiring regular nursing visits or regular medical check-ups, and is under a physician's care.

"Multidisciplinary teams (MDT)" means groups formed to assist children who are considered at-risk youth or children in need of services, and their parents.

"Nonambulatory" means not able to walk.

"Nonmobile" refers to children who are not yet walking, are unable to walk, or unable to use a wheelchair or other device to move about freely.

"Out-of-home placement" means a child's placement in a home or facility other than the child's parent, guardian, or legal custodian.

"Premises" means a facility's buildings and adjoining grounds that are managed by a person or agency in charge.

"Psychotropic medication" means a type of medicine that is prescribed to affect or alter thought processes, mood, sleep, or behavior. These include anti-psychotic, antidepressants and anti-anxiety medications.

"Relative" means a person who is related to the child as defined in RCW 74.15.020 (4)(a)(i), (ii), (iii), and (iv) only.

"Respite" means brief, relief care provided to foster parents with the respite provider fulfilling some or all of the functions of the care-taking responsibilities of the foster parent.

"Secure facilities" means a crisis residential center that has locking doors and windows, or secured perimeters intended to prevent children from leaving without permission.

"Severe developmental disabilities" means significant disabling, physical and/or mental condition(s) that cause a child to need external support for self-direction, self-support and social participation.

"Social service staff" means child placing agency or group care program staff who is an employee of the agency or hired to provide consultation on developing and implementing the child's individual service and treatment plans.

"Staffed residential home" means a licensed home providing twenty-four-hour care for six or fewer children or expectant mothers. The home may employ staff to care for children or expectant mothers.

"We" or "our" refers to the department of social and health services, including DLR licensors and DCFS social workers.

"You" refers to anyone who operates or owns a foster home, staffed residential home, and group facilities, including group homes, maternity programs, day treatment programs, crisis residential centers, and child-placing agencies.

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GENERAL LICENSING REQUIREMENTS
NEW SECTION
WAC 388-148-0015
Am I required to have a license to provide care to children?

(1) If you regularly provide care to a child who is not related to you, you must get a license from:

(a) Division of licensed resources (DLR) at DSHS; or

(b) A licensed child-placing agency (see WAC 388-148-1070 and 388-148-1075).

(2) The types of homes or facilities that need a license include:

(a) Foster homes;

(b) Group care facilities;

(c) Staffed residential homes;

(d) Day treatment programs; and

(e) Child-placing agencies.

Note: Homes and facilities offering maternity services, day treatment, crisis residential centers and/or services for children with severe developmental disabilities will need to follow our specific program requirements outlined in this chapter as well.

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NEW SECTION
WAC 388-148-0020
When is a license not required if I provide care to children?

The department does not require licenses for people providing care in any of the situations as defined in RCW 74.15.020.

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NEW SECTION
WAC 388-148-0025
Do you make exceptions to the licensing requirements?

(1) The department may make exceptions to licensing requirements for a good cause as long as you can ensure the safety and well-being of the persons receiving care.

(2) You must request an exception to a licensing regulation before an action is taken. All requests must be in writing.

(3) Exceptions are approved at the discretion of the department.

(4) If the department approves your request for an exception to the licensing requirements, a waiver is issued for:

(a) A specific child;

(b) A specified period of time not exceeding the expiration date of a license; and

(c) For nonsafety requirements only, such as bedroom size or ceiling height.

(5) Along with a waiver, the department may limit or restrict a license issued to you.

(6) You must keep a copy of the approved waiver for your files.

(7) You do not have appeal rights if the department denies your request for an exception to our requirements.

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NEW SECTION
WAC 388-148-0030
How do you decide how many children I may serve in my home or facility?

(1) The department approves the number of children that your home or facility may serve, based on an evaluation of these factors:

(a) Physical accommodations in your home or facility;

(b) The number of staff, family members and volunteers available for providing care;

(c) Your skills and the skills of your staff; and

(d) The ages and characteristics of the children you are serving.

(2) Based on the evaluation, the department may license you for the care of fewer children than you normally would serve in your category of care.

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GENERAL REQUIREMENTS -- STAFF QUALIFICATIONS
NEW SECTION
WAC 388-148-0035
How old do I have to be to apply for a license to provide care to children?

You must be at least twenty-one years old to apply for a license to provide care to children.

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NEW SECTION
WAC 388-148-0040
What personal characteristics do I need to provide care to children?

If you are requesting a license, certification, or a position as an employee or volunteer in a foster home, group care facilities, or child-placing agency you must have the following specific personal characteristics:

(1) You must demonstrate that you have the understanding, ability, physical health, emotional stability and personality suited to meet the physical, mental, emotional, and social needs of the children under your care.

(2) You must clear our criminal history background check (see chapter 388-146 WAC).

(3) You must have the ability to furnish the child with a nurturing, respectful, supportive, and responsive environment.

(4) The department may require you to give additional information. We may request this information at any time and it may include, but is not limited to:

(a) Substance and alcohol abuse evaluations and/or documentation of treatment;

(b) Psychiatric evaluations;

(c) Psycho-sexual evaluations; and

(d) Medical evaluations and/or medical records.

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GENERAL REQUIREMENTS -- TRAINING REQUIRED
NEW SECTION
WAC 388-148-0045
Is in-service training required?

If you have employees in your home or facility, you must offer in-service training programs for developing and upgrading staff skills.

(1) If you have five or more employees or volunteers, your training plan must be in writing.

(2) You must discuss with the staff your policies and procedures as well as the rules contained in this chapter.

(3) You must provide or arrange for your staff to have training for the services that you provide to children under your care.

(4) Your training on behavioral management must be approved by DLR and must include nonphysical, age-appropriate methods of redirecting and controlling behavior as described in the department's behavior management policy.

(5) You must record the type and time of staff training provided and keep this information in each employee's file or in a separate training file.

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NEW SECTION
WAC 388-148-0050
What first aid training is required?

You and your staff must have the following first-aid training:

(1) If you have a home or facility that provides care, the primary care givers must have current training in:

(a) Basic standard first aid; and

(b) Age-appropriate cardiopulmonary resuscitation (CPR).

(2) Approved first aid and CPR training must be in accordance with a nationally recognized standard such as the American Red Cross or American Heart Association.

(3) For any facilities other than foster homes, the person with first aid and CPR training must be on the premises at all times when children are present.

(4) The requirement for CPR training may be waived for persons with a statement from their physician that the training is not advised for medical reasons.

(5) You must keep records in your home or facility showing who has completed current first aid and CPR training.

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NEW SECTION
WAC 388-148-0055
What HIV/AIDS training is required?

(1) You must provide or arrange for training for yourself and any of your staff on the prevention, transmission, and treatment of HIV and AIDS. Such training must include infection control requirements.

(2) You must use infection control requirements and educational material consistent with the approved curriculum Know - HIV/AIDS Prevention Education for Health Care Facility Employees, published by the department of health, office on HIV/AIDS.

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GENERAL REQUIREMENTS -- APPLICATION AND LICENSING PROCESS
NEW SECTION
WAC 388-148-0060
How do I apply for a license?

To apply for a license, the person or legal entity responsible for your home or facility must follow these procedures:

(1) You must send the application form to your licensor at DLR or a child-placing agency.

(2) With the application form, you must send the following information:

(a) A completed "criminal history and background inquiry" form for each applicant, family member, staff person, board member, intern or volunteer who:

(i) Is at least sixteen years old;

(ii) Is not a foster child; and

(iii) Has unsupervised access to children (see chapter 388-146 WAC).

(b) Written verification of:

(i) A tuberculosis test or x-ray unless you can demonstrate religious reasons prohibiting the test;

(ii) First-aid and cardio-pulmonary resuscitation (CPR) training appropriate to the age of the children in care; and

(iii) HIV/AIDS training including infection control standards.

(c) If you have lived in Washington state less than three years, you must provide us with a completed FBI fingerprint form.

(d) We may require additional information from you including, but not limited to:

(i) Substance and alcohol abuse evaluations and/or documentation of completed treatment;

(ii) Psychiatric evaluations;

(iii) Psycho-sexual evaluations; and

(iv) Medical evaluations and/or medical records.

(3) If you are applying for a license renewal, you must send the application form to your licensor at least ninety days prior to the expiration of your current license.

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NEW SECTION
WAC 388-148-0065
How long do I have to complete the licensing application packet?

You must complete your licensing application with supporting documents, such as training certificates, within ninety days of first applying for your license. If you fail to meet this deadline and have not contacted your licensor, your licensor may consider your application withdrawn.

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NEW SECTION
WAC 388-148-0070
When am I not allowed to receive a license from a child-placing agency?

(1) You or your relatives, as defined under RCW 74.15.020 (4)(i), (ii), (iii), and (iv), are not allowed to receive a license from a child-placing agency if you or your relative is an employee or volunteer for that same child-placing agency.

(2) You or your relative may apply to a different child-placing agency for a license.

(3) Licensed foster parents who become employed by the department or a child-placing agency must be re-licensed through an agency other than their employer within six months of employment.

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NEW SECTION
WAC 388-148-0075
When may I be certified to provide care to children?

You may apply for certification of your home or facility, if you:

(1) Are exempt from needing a license (see WAC 388-148-0020);

(2) Meet the licensing requirements; and

(3) Wish to serve department-funded children.

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NEW SECTION
WAC 388-148-0080
Is there a difference between licensing and certification?

(1) The department has the sole legal authority to license or approve homes and facilities for the care of children in out-of-home placement.

(2) The department may license a child-placing agency, including a Tribal CPA, to operate foster home and/or group care facilities.

(3) The child-placing agency is only authorized to "certify" or attest to the department that the home or facility meets the licensing requirements.

(4) The licensing and certification process and requirements are the same and are contained in this chapter.

(5) The department has the final approval for licensing the home or facility that the CPA will be supervising.

(6) The department's representative signs the license of the home or facility.

(7) Homes and facilities "certified" by a CPA and licensed by the department must be supervised by that CPA to have a valid license to care for children.

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NEW SECTION
WAC 388-148-0085
May I be licensed with the department and a child placing agency at the same time?

You may not be licensed to provide care to children at the same time by both the department and a child-placing agency.

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NEW SECTION
WAC 388-148-0090
What may I do if I disagree with a child-placing agencies' decision that I do not meet the licensing requirements?

If you disagree with the child-placing agency's decision, you must abide by the child-placing agency's grievance process to challenge the decision.

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GENERAL REQUIREMENTS -- CORRECTIVE ACTION
NEW SECTION
WAC 388-148-0095
When are licenses denied, suspended or revoked?

A license must be denied, suspended or revoked if the department decide that you cannot provide care for children in a way that ensures their safety, health and well-being. The department must disqualify you for any of the following reasons:

(1) You have failed to meet our corrective requirements.

(2) You are using illegal drugs, or excessively using alcohol and/or prescription drugs.

(3) You have failed your background check (see chapter 388-146 WAC).

(4) You permit or assist in treating people under your care with cruelty, indifference, abuse, neglect or exploitation.

(5) You or anyone living on the premises had a license denied, or revoked from an agency that provides care to children.

(6) You have refused to allow our authorized staff and inspectors to have requested information or access to your facility, child and program files, and/or your staff and clients.

(7) You try to get a license by deceitful means, such as making false statements or leaving out important information on the application.

(8) You permit or assist in an illegal act on the premises of a home or facility providing children's care.

(9) You repeatedly lack qualified or an adequate number of staff to care for the number and types of children under your care.

(10) You are unable to manage the property, fiscal responsibilities, or staff in your agency.

(11) You knowingly allowed employees or volunteers who made false statements on their applications to work at your agency.

(12) You have failed to comply with the federal and state laws for any Native American children that you have under care.

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NEW SECTION
WAC 388-148-0100
Are there any other reasons that might cause me to lose my license?

The department may suspend or revoke your license if you exceed the conditions of your home or facility license by:

(1) Having more children than the license allows;

(2) Having children with ages different than the license allows;

(3) Failing to provide a safe, healthy and nurturing environment for children under your care;

(4) Failing to comply with any of our other licensing requirements; or

(5) Failing to meet health certification requirements are required by the department of health and/or state Fire Marshall requirements.

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NEW SECTION
WAC 388-148-0105
How do you notify me if you have modified, denied, suspended, or revoked my license?

The department sends you a certified letter informing you of the decision to modify, deny, suspend or revoke your license. In the letter, the department also tells you what you need to do if you disagree with the decision.

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NEW SECTION
WAC 388-148-0110
What may I do if I disagree with your decision to modify, deny, suspend or revoke my license?

You have the right to appeal any decision the department makes to deny, modify, suspend, or revoke your license.

(1) You may request an department administrative hearing to disagree with the department's decision to modify, suspend, revoke or deny your license.

(2) You must request a department administrative hearing within twenty-eight days of receiving a certified letter with the department's decision (see chapter 34.05 RCW).

(3) You must send a letter to the office of administrative hearings, P.O. Box 42489, Olympia, Washington 98504-2489, 1-800-583-8271 requesting an administrative hearing. The letter must have the following attachments:

(a) A specific statement of your reasons for disagreeing with the department decision and any laws that relate to your reasons; and

(b) A copy of the certified letter from the department that you are disputing.

(4) The administrative hearing will take place before an impartial administrative law judge.

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NEW SECTION
WAC 388-148-0115
May I appeal the decision of the department's administrative law judge?

(1) The decision of the administrative law judge (ALJ) will become the final decision of the department, unless either you or the department files a petition for review with DSHS board of appeals within twenty-one days after the ALJ's initial decision is mailed to the parties.

(2) The procedure for requesting, or responding to, a petition for review with the Board of Appeals is in WAC 388-02-0560 through 388-02-0635.

(3) If either party asks for a review, the decision of the Board of Appeals review judge will be the department's final decision.

(4) If you disagree with the decision of the Board of Appeals, you may file a petition in superior court and ask for judicial review. The procedure for judicial review is in RCW 34.05.510 to 34.05.598.

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GENERAL REQUIREMENTS -- RECORD-KEEPING/REPORTING/PERSONNEL POLICIES/POSTING OF LICENSE
NEW SECTION
WAC 388-148-0120
What incidents involving children must I report?

(1) You or your staff must report any of the following incidents immediately and in no instance later than forty-eight hours to your local children's administration intake staff:

(a) Any alleged incidents of child abuse or neglect;

(b) Any violations of the licensing or certification requirements;

(c) Death of a child;

(d) Any child's suicide attempt that results in injury requiring medical attention or hospitalization;

(e) Any use of physical restraint that is alleged improper or excessive;

(f) Sexual contact between two or more children that is not considered typical play between pre-school age children;

(g) Physical assaults between two or more children that result in injury requiring off-site medical attention or hospitalization;

(h) Unexpected health problems caused by medications that require off-site medical attention;

(i) Any medication that is given incorrectly and requires off-site medical attention;

(j) Serious property damage that is a safety hazard and is not immediately corrected; or

(k) Any emergent medical care.

(2) You or your staff must report immediately or in no instance later then forty-eight hours, any of the following incidents to the child's social worker:

(a) Suicidal ideas, gestures, or attempts that do not require professional medical attention;

(b) Unexpected health problems caused by medication that do not require professional medical attention;

(c) Any incident of medication incorrectly administered;

(d) Physical assaults between two or more children that result in injury but did not require professional medical attention;

(e) Runaways;

(f) Use of physical restraints for routine behavior management; and

(g) Disclosures of sexual or physical abuse by a child in care.

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NEW SECTION
WAC 388-148-0125
What are your requirements for keeping client records?

(1) Any identifying and personal information about a child and the child's family must be kept confidential.

(2) You must keep records about children and their families in a secure place. At the end of the child's placement, information about the child must be returned to department staff.

(3) In foster homes, your records must be kept at your home and contain, at a minimum, the following information:

(a) The child's name, birth date, and legal status;

(b) Name and telephone number of the social worker for each child in care;

(c) Names, address and telephone numbers of parents or persons to be contacted in case of emergency;

(d) Medical history including any medical problems, name of doctor, type of medical coverage and provider;

(e) Mental health history and any current mental health and behavioral issues, including medical and psychological reports when available;

(f) Other pertinent information related to the child's health;

(g) Record of immunizations. Crisis residential centers do not need to keep records of shots for children in their care;

(h) Child's school records, report cards, school pictures, and individual education plans (I&P);

(i) Special instructions including supervision requirements and suggestions for managing problem behavior;

(j) Inventory of personal belongings; and

(k) The child's visitation plan.

(4) In staffed residential homes and group care programs, your records must be kept at your site and contain, at a minimum, the following information in addition to the information in subsection (3)(a) through (k) of this section:

(a) Written consent from the child placing agency, if any, for providing medical care and emergency surgery (unless that care is authorized by a court order);

(b) Names, addresses, and telephone numbers of persons authorized to take the person under care out of the facility;

(c) A copy of the court order or voluntary placement agreement that gives approval to place the child;

(d) Case plans, such as children's administration's "individual service and safety plan;" and

(e) Daily logs of therapy treatment received by children.

(5) If you are operating a group care program or child-placing agency and have client files with information not returned to the department, you must keep them for six years following the termination or expiration of any contract you have with the department.

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NEW SECTION
WAC 388-148-0130
What information may I share about a child or a child's family?

(1) You may discuss information contained in the case plan only with:

(a) A representative of the department, including staff from DCFS and DLR;

(b) A child-placing agency case manager assigned to the child;

(c) The child's assigned guardian ad litem or court-appointed special advocate; or

(d) Others designated by the child's social worker.

(2) Confidential information about a child or the child's family must only be shared with people directly involved in the case plan for a child. Confidential information must not be shared with:

(a) Friends,

(b) Relatives,

(c) Neighbors.

(3) You may check with your child's social worker for guidance about sharing information with the child's teacher, counselor or doctor, respite care provider or any other professional.

(4) Child-placing agencies and the department must share with the child's care provider any information about the child and child's family related to the case plan.

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NEW SECTION
WAC 388-148-0135
What changes to my home or facility must I report to my licensor?

(1) You must report to your licensor immediately any changes in the original licensing application. Changes include any of the following:

(a) Changes in your location or designated space, including address;

(b) Changes in your phone number;

(c) Changes in the maximum number, age ranges, and sex of persons you wish to serve;

(d) Changes in the structure of your facility or premises from events causing damage, such as a fire, or from remodeling;

(e) Addition of any new staff person, employee or volunteer, who might have contact with the children in care; or

(f) Changes in household composition, such as:

(i) A marriage, separation or divorce;

(ii) Incapacity or serious illness of a foster parent or member of the household;

(iii) The death of anyone in the household;

(iv) A change in employment status; or

(v) A change in who resides in the household or is on the premises for more than fourteen days.

(2) A license is valid only for the person or organization named on the license. If you own or operate a group facility or child-placing agency, you must also report any of the following changes to your licensor:

(a) A change of your agency's executive director;

(b) The death, retirement, or incapacity of the person who holds the license;

(c) A change in the name of a licensed corporation, or the name by which your facility is commonly known; or

(d) Changes in an agency's articles of incorporation and bylaws.

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NEW SECTION
WAC 388-148-0140
What personnel policies must I have?

You must follow the personnel requirements listed below, at any home or facility we license.

(1) Each employee, intern, or volunteer who has unsupervised access to children must have completed an application for employment and signed a form enabling us to do a background check (see chapter 388-146 WAC).

(2) Misrepresentation by the prospective employee, interns, or volunteer must be grounds for termination or denial of employment or volunteer service.

(3) If you have five or more staff, volunteers, or interns you must have written policies covering qualifications and duties for employees and volunteers.

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NEW SECTION
WAC 388-148-0145
Where do I post my license?

Foster home parents do not need to post their license. If you own or operate any other kind of home, facility, or agency you must post your license in a place that is easily viewed by the public.

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GENERAL REQUIREMENTS -- HEALTH AND GENERAL SAFETY
NEW SECTION
WAC 388-148-0150
Are local ordinances part of your licensing requirements?

Local ordinances (laws), such as zoning regulations and local building codes, fall outside the scope of our licensing requirements.

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NEW SECTION
WAC 388-148-0155
What physical structure safety requirements must my home or facility meet?

You must keep your equipment and the physical structures in your home or facility safe and clean for the children you serve. You must:

(1) Maintain your buildings, premises, and equipment in a clean and sanitary condition, free of hazards, and in good repair;

(2) Provide adult and child height handrails for steps, stairways, and ramps;

(3) Have emergency lighting devices available and in operational condition;

(4) You must refinish all flaking or deteriorating lead-based paint with lead-free paint or other nontoxic material for:

(a) Exterior and interior wall surfaces; or

(b) Equipment and toys accessible to preschool-aged children.

(5) Furnish your home or facility appropriately, based on the age and activities of the children under care.

(6) Have washable, water-resistant floors in your facility's bathrooms, kitchens, and any other rooms exposed to moisture.

(7) Exception: The department may approve washable, short-pile carpeting that is kept clean and sanitary for your home or facility's kitchens.

(8) All homes and facilities must provide tamper proof or tamper resistant electrical outlets or blank covers installed in areas accessible to children under the age of six or other persons with limited mental capacity or who might be endangered by access to them.

(9) Have easy access to rooms occupied by children in case an emergency arises. Some examples are bedrooms, toilet rooms, shower rooms, and bathrooms.

(10) Have posted a written disaster plan for emergencies such as fire and earthquakes.

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NEW SECTION
WAC 388-148-0160
What measures must I take for pest control?

You must make reasonable attempts to keep the premises free from pests, such as rodents, flies, cockroaches, fleas, and other insects using the least toxic methods.

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NEW SECTION
WAC 388-148-0165
Do I need to be concerned about the location of my home or facility?

(1) Your address must be clearly visible on the home, facility, or mailbox so that firefighters or medics can easily find your location.

(2) Your home or facility must be located on a well-drained site, free from hazardous conditions. The safety of the children in care is paramount. You must discuss with the licensor any potential hazardous conditions, considering the children's ages, behaviors, and abilities.

(3) A supervision plan must be written for the children in care if it is decided that hazardous conditions are present. Some examples of hazards are natural or man-made water hazards such as lakes or streams, steep banks, ravines, and busy streets.

(4) Your home or facility must be accessible to emergency vehicles.

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NEW SECTION
WAC 388-148-0170
What steps must I take to ensure children's safety around outdoor bodies of water?

(1) You must ensure children in your care or placed in your home or facility are safe around bodies of water.

(2) A certified lifeguard must be in attendance at all times when children are using a swimming pool or swimming area at a home or facility other than a foster home.

(3) You must make the area around a body of water inaccessible to children when not in use.

(4) You must daily empty and clean any portable wading pool that children use.

(5) Children must be supervised at all times when they are swimming, wading, or boating by an adult with current age appropriate first aid and CPR.

(6) You must ensure appropriate supervision of any child that uses hot tubs, swimming pools, and spas.

(7) You must lock hot tub and spa areas when they are not in use.

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NEW SECTION
WAC 388-148-0175
What are your requirements regarding pets and animals in my home or facility?

(1) If you own or operate a foster home, staffed residential home, or group care facility, you must not have any common household pets, exotic pets, animals, reptiles, or fish that are dangerous to the children in care.

(2) The department, at its discretion, may limit the type and number of common household pets, exotic pets, animals, reptiles or fish accessible to children if there are risks to the children in care.

(3) You must ensure that common household pets, exotic pets, animals, reptiles, and fish are free from disease and cared for in a safe and sanitary manner.

(4) Common household pets, exotic pets, animals, reptiles, and fish must be cared for in compliance with state regulations and/or local ordinances.

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NEW SECTION
WAC 388-148-0180
Are alcoholic beverages allowed at my home or facility?

(1) If you own or operate a foster home, you may have alcoholic beverages on the premises as long as they are inaccessible to children.

(2) Any other facility must not have alcohol on the premises. The staff of these facilities may not consume alcohol on the premises or during breaks.

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NEW SECTION
WAC 388-148-0185
Is smoking permitted around children?

(1) You must prohibit smoking in any home or facility caring for children and in motor vehicles transporting children.

(2) You may permit adults to smoke outdoors away from children.

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NEW SECTION
WAC 388-148-0190
May I have firearms in my home or facility?

(1) Unless you are licensed for a foster home, you must not permit firearms, ammunition, and other weapons on the premises of homes or facilities that provide care to children.

(2) If you are licensed as a foster home, firearms, ammunition, and other weapons must be kept in locked container, gun cabinet, gun safe, or another storage area made of strong, unbreakable material when not in use.

(a) If the storage cabinet has a glass or another breakable front, the guns must be secured with a locked cable or chain placed through the trigger guards.

(b) Ammunition must be stored in a place that is separate from weapons or locked in a gun safe.

(c) Weapons and ammunition must be accessible only to authorized persons.

(3) You may allow a child to use a firearm use only if:

(a) The child's social worker approves;

(b) Competent adults are supervising use; and

(c) Youth have completed an approved gun safety or hunter safety course.

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NEW SECTION
WAC 388-148-0195
What are your requirements for storing dangerous items?

(1) You must store the following items in a place that is not accessible to preschool children or other persons with limited mental capacity or who might be endangered by access to these products:

(a) Cleaning supplies;

(b) Toxic or poisonous substances;

(c) Aerosols; and

(d) Items with warning labels.

(2) When containers are filled with toxic substances from a stock supply, you must label containers filled from a stock supply.

(3) Toxic substances must be stored separately from food items.

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NEW SECTION
WAC 388-148-0200
Do I need first-aid supplies?

You must keep first aid supplies on hand for immediate use, including unexpired syrup of ipecac that is to be used only when following the instruction of the poison control center.

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NEW SECTION
WAC 388-148-0205
Where do I keep medications?

(1) You must keep all medications, including pet medications, vitamins and herbal remedies, organized and in locked storage.

(2) Pet and human medications must be stored in separate places.

(3) You must store external medications separately from internal medications.

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NEW SECTION
WAC 388-148-0210
What requirements do I need to follow when I transport children?

When you transport children under your care, you must follow these requirements.

(1) The vehicle must be kept in a safe operating condition.

(2) The driver must have a valid driver's license.

(3) There must be at least one adult other than the driver in a vehicle when:

(a) There are more than five preschool-aged children in the vehicle;

(b) Staff-to-child ratio guidelines or your contract require a second staff person; or

(c) The child's specific needs require a second adult person.

(4) The driver or owner of the vehicle must be covered under an automobile liability and insurance policy.

(5) Your vehicles must be equipped with first aid kits, seat belts, car seats and booster seats, and/or other appropriate safety devices for all passengers as required by law.

(6) The number of passengers must not exceed the vehicle's seating capacity.

(7) Buses approved by the state patrol are not required to have seat belts.

(8) All persons in the vehicle must use seat belts or approved child passenger restraint systems, as appropriate for age, whenever the vehicle is in motion.

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NEW SECTION
WAC 388-148-0215
May I use wheeled baby walkers?

We prohibit the use of wheeled baby walkers in foster homes and facilities.

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GENERAL REQUIREMENTS -- FIRE SAFETY
NEW SECTION
WAC 388-148-0220
What fire safety requirements must I follow to qualify for a license?

(1) If you own or operate a group care facility, you must follow the regulations developed by the Washington State Fire Marshal's office. The regulations are minimum requirements for protecting life and property against fire. You can find these contained in the current state building code.

(2) Foster homes only need inspections by fire marshals if either:

(a) Licensors request the inspections; or

(b) City ordinances require these inspections.

(3) If you own or operate a staffed residential home you must follow the requirements in WAC 388-148-1005 through 388-148-1065 regarding staffed residential homes.

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NEW SECTION
WAC 388-148-0225
What are your fire safety requirements for inside a home or facility?

You must comply with our fire safety requirements within your foster home or group facility.

(1) Every room used by children under care must have easy entry and exit, including one of these features:

(a) Two separate doors;

(b) One door leading directly to the outside; and

(c) A window that opens to the outside and is large enough for emergency escape or rescue.

(2) Every occupied area must have access to at least one exit that does not pass through rooms or spaces that can be locked or blocked from the opposite side.

(3) No space may be lived by the children in care that is accessible only by a ladder, folding stairs, or a trap door.

(4) Every bathroom door lock must be designed to permit the opening of the locked door from the outside.

(5) Every closet door latch must designed to be opened from the inside.

(6) Stoves or heaters must not block escape or exit routes.

(7) Flammable, combustible, or poisonous material must be stored away from exits and away from areas that are accessible to children under care.

(8) Open-flame devices and fireplaces, heating and cooking appliances, and products capable of igniting clothing must not be left unattended or used incorrectly.

(9) Fireplaces, wood stoves and other heating systems that have a surface hot enough to cause a burn must have gates or protectors around them when.

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GENERAL REQUIREMENTS -- ROOM REQUIREMENTS
NEW SECTION
WAC 388-148-0230
What are the general requirements for bedrooms?

You must meet all of the following requirements for bedrooms if you provide full-time care in a home or facility.

(1) An adult must be on the same floor or within easy hearing distance and accessibility to where children under six years of age are sleeping.

(2) You must use only bedrooms that have unrestricted direct access to hallways, corridors, living rooms, day rooms, or other such common use areas.

(3) You must not use hallways, kitchens, living rooms, dining rooms, and unfinished basements as bedrooms.

(4) For facilities licensed after December 31, 1986, bedrooms must have both:

(a) A minimum ceiling height of seven and a half feet; and

(b) A window of not less than one-tenth of the required floor space that can open into the outside, allowing natural light into the bedroom and permitting emergency access or exit.

(5) For any children six years of age and over, you must furnish separate sleeping quarters for each gender.

(6) Children in care must not share the same bed.

(7) In group care facilities , single occupancy bedrooms must provide at least eighty square feet of floor space.

(8) In foster homes, single occupancy bedrooms must provide at least fifty square feet of floor space.

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NEW SECTION
WAC 388-148-0235
What are additional requirements for bedrooms having more than one person?

(1) You must not allow a child over one year of age to share a bedroom with an adult who is not the child's parent.

(2) You must follow all of these requirements for multi-occupancy bedrooms:

(a) There must be no more than four persons to a bedroom;

(b) Multiple occupancy bedrooms must provide at least fifty square feet of floor area per occupant, not including closets; and

(c) There must be at least thirty inches between beds.

(3) When a mother and her infant sleep in the same room, the room must contain at least eighty square feet of usable floor space.

(4) You must allow only one mother and her newborn infant(s) to occupy a bedroom.

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NEW SECTION
WAC 388-148-0240
What are your requirements for beds?

(1) Each child in care must have a bed of his or her own.

(2) For each child in care, you must provide a bed at least thirty inches wide with a clean and comfortable mattress in good condition, pillow, sheets, blankets, and pillowcases. Each child's pillow must be covered with waterproof material or be washable.

(3) Bedding must be clean, and sheets and pillowcases must be laundered weekly.

(4) You must provide waterproof mattress covers or moisture resistant mattresses, if needed.

(5) You must provide an infant with a crib that ensures the safety of the infant and follows each of these requirements:

(a) Cribs must have clean, firm mattresses covered with waterproof material that is easily sanitized;

(b) Crib mattresses must fit snugly to prevent the infant being caught between the mattress and crib side rails;

(c) Cribs must be made of wood, metal, or approved plastic with secure latching devices;

(d) Cribs must have no more than two and three-eighths inches space between vertical slats when used for infants under six months of age;

(6) You may use toddler beds with a standard crib mattress that is sufficient in length and width for the comfort of children under six years of age.

(7) You must not allow children to use the loft style beds or upper bunks of double-deck beds if they could be hurt by using them. Examples: Preschool age children, expectant mothers and children with disabilities.

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GENERAL REQUIREMENTS -- TELEPHONE/LIGHTING/VENTILATION/WATER/LAUNDRY/SEWAGE
NEW SECTION
WAC 388-148-0245
Do I need a telephone at my home or facility?

The department has two requirements for the telephone that you must meet at your home or facility.

(1) You must have at least one telephone on the premises for incoming and outgoing calls. The telephone must be accessible for emergency use at all times.

(2) You must post emergency phone numbers next to the phone.

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NEW SECTION
WAC 388-148-0250
What are the lighting requirements for my home or facility?

(1) You must locate light fixtures and provide lighting that promotes good visibility and comfort for the children under your care.

(2) In addition, group care facilities must have nonbreakable light fixture covers or shatter resistant light bulbs or tubes.

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NEW SECTION
WAC 388-148-0255
Do I need a housekeeping sink?

Facilities licensed to provide group care services must have and use a method of drawing clean mop water and have and use an appropriate method of wastewater disposal.

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NEW SECTION
WAC 388-148-0260
What does the room temperature for my home or facility need to be?

You must maintain the temperature within your home or facility at a reasonable level while occupied. You must consider the age and needs of the children under your care.

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NEW SECTION
WAC 388-148-0265
How must I ventilate my home or facility?

You must ensure that your physical facility is ventilated for the health and comfort of the persons under your care. A mechanical exhaust to the outside must ventilate toilets and bathrooms that do not have windows opening to the outside.

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NEW SECTION
WAC 388-148-0270
What are your requirements for laundry facilities?

The department has specific requirements for laundry facilities at your home or facility.

(1) You must have separate and adequate facilities for storing soiled and clean linen.

(2) You must provide adequate laundry and drying equipment, or make other arrangements for getting laundry done on a regular basis.

(3) You must locate laundry equipment in an area separate from the kitchen and child-care areas unless you are doing foster care in your home.

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NEW SECTION
WAC 388-148-0275
What are the requirements for washing clothes?

You must use an effective way to sanitize laundry contaminated with urine, feces, lice, scabies, or other potentially infectious materials. You must sanitize laundry through temperature or chemicals.

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NEW SECTION
WAC 388-148-0280
What are your requirements for toilets, sinks, and bathing facilities?

You must meet certain requirements for toilets, sinks, and bathing facilities.

(1) You must provide at least one indoor flush-type toilet, one nearby hand-washing sink with hot and cold running water, and a bathing facility.

(2) You must comply with all of the following requirements for toilet and bathing facilities:

(a) Toilet and bathing facilities must allow privacy for children who are five years of age or older and opposite genders.

(b) Toilet, urinals, and hand-washing sinks must be the appropriate height for the children served, or have a safe and easily cleaned step stool or platform that is water-resistant.

(c) Hand-washing and bathing facilities must be provided with hot running water that does not exceed one hundred twenty degrees.

(d) All bathing facilities must have a conveniently located grab bar unless we approve other safety measures, such as nonskid pads.

(e) You must provide potty-chairs and toilet training equipment for toddlers. You must regularly maintain this equipment and keep it in sanitary condition. You must put potty-chairs, when in use, on washable, water-resistant surfaces.

(f) In group care facilities, whenever urinals are provided, the number of urinals must not replace more than one-third of the total number of required toilets.

(g) You must provide soap and clean towels, disposable towels or other approved hand-drying devices to the persons under your care.

(h) In programs providing care to expectant mothers:

(i) Bathing facilities must have adequate grab bars in convenient places; and

(ii) All sleeping areas must have at least one toilet and hand-washing sink on the same floor.

(3) There shall be at least one indoor flush-type toilet and one nearby handwashing sink with hot and cold or tempered running water. The following ratios of persons normally on the premises to bathrooms at the facilities shall apply:

Toilets Handwashing Sinks Bathing Facilities
Group care programs and facilities two minimum and 1:8 or major fraction two minimum and 1:8 or major fraction one minimum and 1:8 or major fraction
Foster family home and staffed residential home one minimum one minimum one minimum

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NEW SECTION
WAC 388-148-0285
What are the requirements about my drinking water?

(1) You must provide the following:

(a) A public water supply or a private water supply approved by the local health authority at the time of licensing or relicensing; and

(b) Disposable paper cups, individual drinking cups or glasses, or angled jet type drinking fountains.

(2) You must not use bubbler type fountains or common drinking cups.

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NEW SECTION
WAC 388-148-0290
What are the requirements for sewage and liquid wastes?

You must discharge sewage and liquid wastes into a public sewer system or into a functioning septic system.

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GENERAL REQUIREMENTS -- MEDICAL CARE AND MEDICATION MANAGEMENT
NEW SECTION
WAC 388-148-0295
Am I required to get a child's health history?

(1) You must request a health history for all children that are under your care at the time they are accepted into your home or facility. You may obtain the health history from the social worker or agency making the placement.

(2) The health history must include:

(a) The date of the person's last physical examination;

(b) Allergies;

(c) Any special health problems;

(d) A history of immunizations(for children);

(e) Clinical and medical diagnoses and treatment plans; and

(f) All currently prescribed medications.

(3) When leaving the home or facility, the health history of the child must go with the child for continuity of care.

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NEW SECTION
WAC 388-148-0300
When must I get medical exams for the children under my care?

(1) You, together with the child's social worker, must schedule a medical exam for any child who, within the past year, has not:

(a) Been under regular medical supervision; or

(b) Had a physical exam by a physician, a physician's assistant, or an advanced registered nurse practitioner (ARNP).

(2) A physical exam (EPSDT) must be completed within thirty days of placement and annually thereafter.

Note: You may contact the child's social worker for information on this.

(3) A physician must see each child with severe developmental disabilities regularly, according to the physician's plan of care required in WAC 388-148-0765.

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NEW SECTION
WAC 388-148-0305
What are your requirements for immunizations for children?

(1) To receive care from you, children must have proof of current immunizations. Contact the child's social worker before beginning any immunization schedule to avoid duplication of immunizations.

(2) You may accept a child who has not received all shots on a conditional basis if immunizations are started as soon as medically possible.

(3) If you are providing care and have minor children of your own who are on the premises of a home or facility, your children must have proof of current immunizations.

(4) The department may give conditional approval for any of your own children who have not received all immunizations as long as their immunizations are started soon as medically possible.

(5) The department may grant exceptions to this requirement for immunizations for your children in two situations:

(a) If you, as parent or guardian, have signed a statement indicating your religious, philosophical or personal objections to the requirement; or

(b) If you have a physician's statement indicating that a valid medical reason exists for not getting these immunizations.

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NEW SECTION
WAC 388-148-0310
What must I do to prevent the spread of infections and communicable diseases?

You must take precautions to guard against infections and communicable diseases infecting the children under care in your home or facility.

General communicable diseases and infections

(1) In each home or facility, other than a foster home, staff with a reportable communicable disease in an infectious stage must not be on duty until they have a physician's approval for returning to work.

(2) Each home or facility, other than a foster home, that cares for severely and multiple-handicapped children must have an infection control program supervised by a registered nurse.

(3) Foster homes with medically fragile children may use other alternatives, such as in-home nursing services, to control infections.

Tuberculosis

(4) Those who have regular contact with children in care in a home or facility must have a tuberculin (TB) skin test by the Mantoux method of testing. They must have this skin test upon being employed or licensed unless:

(a) The person has evidence of testing within the previous twelve months;

(b) The person has evidence that they have a negative chest x-ray since a previously positive skin test;

(c) The person has evidence of having completed adequate preventive therapy or adequate therapy for active tuberculosis.

(5) The department does not require a tuberculin skin test if:

(a) A person has a tuberculosis skin test that has been documented as negative within the past twelve months; or

(b) A physician indicates that the test is medically unadvisable.

(6) Persons whose tuberculosis skin test is positive must have a chest x-ray within ninety days following the skin test.

(7) The department does not require retesting unless a person believes they have been exposed to someone with tuberculosis or if testing is recommended by their health care provider.

(8) You must keep a record of skin test results, x-rays, or exceptions to this requirement in your home or facility.

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NEW SECTION
WAC 388-148-0315
What medical policies and procedures must I have?

All facilities

(1) Staffed residential homes and group care facilities must have written policies and procedures about the control of infections. This must include, but is not limited to, the following areas:

(a) Isolation;

(b) Aseptic procedures;

(c) Reporting communicable diseases;

(d) Hygiene, including hand washing, using the toilet, diapering, and laundering.

(2) Group care facilities must maintain current written medical policies and procedures to be followed on:

(a) Prevention of the transmission of communicable diseases including:

(i) Hand washing for staff and children;

(ii) Management and reporting of communicable diseases.

(b) Medication management;

(c) First aid;

(d) Care of minor illnesses;

(e) Actions to be taken for medical emergencies;

(f) Infant care procedures when infants are under care; and

(g) General health practices.

(3) Policies and procedures for staff orientation must be in writing and made readily available for implementation.

(4) If you are licensed as a group home or as a facility that can care for thirteen or more persons at once, you must arrange to have one of the following help you develop and periodically review your medical policies and procedures:

(a) An advisory physician,

(b) A physician's assistant, or

(c) A registered nurse.

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NEW SECTION
WAC 388-148-0320
How do I manage medications for children under my care?

(1) You must meet the department's requirements for managing prescription and nonprescription medication for children under your care.

(2) Only you or another authorized care provider may give or have access to medications for the child under your care;

(3) Give medications, prescription and nonprescription, only on the written approval of a parent, person, or agency having authority by court order to approve medical care;

(4) Except for foster homes, keep a record of all medications you dispense;

(5) Foster homes must keep a record of all prescription medication dispensed; and

(6) Properly dispose of medications that are no longer being taken or have expired.

Prescription medications

(7) You or another authorized care provider must:

(a) Give prescription medications:

(i) Only as specified on the prescription label; or

(ii) As otherwise approved by a physician or another person legally authorized to prescribe medication.

(b) Check with the physician or pharmacist about possible side effects for any prescription medications and interactions with nonprescription drugs the child is taking.

Psychotropic medications

(8) Care providers must not approve giving psychotropic medications to a child in care. Approval can only be given by one of these:

(a) The child's parent;

(b) A court order; or

(c) The child's social worker, if:

(i) The child is legally free and in the permanent custody of the department; or

(ii) It is impossible to obtain informed parental consent after normal work hours, on weekends, or on holidays.

(9) Children who are at least thirteen years old may decline to take prescription psychotropic medication. Contact the child's social worker immediately.

Nonprescription medications

(10) Children taking psychotropic medications must have the prescribing physician's authorization before any nonprescription drugs are given.

(11) You or another authorized care provider must follow these requirements for nonprescription medications. You must:

(a) Give certain classifications of nonprescribed medications, only with the dose and directions on the manufacturer's label for the age and/or weight of the child needing the medication. These nonprescribed medications include but are not limited to:

(i) Nonaspirin antipyretics/analgesics, fever reducers/pain relievers;

(ii) Nonnarcotic cough suppressants;

(iii) Decongestants;

(iv) Anti-itching ointments or lotions intended specifically to relieve itching;

(v) Diaper ointments and powders intended specifically for use in the diaper area of children;

(vi) Sun screen; and

(vii) Antibacterial ointments for first aid use.

(b) Give any other nonprescription medications only when approved in writing by a physician. These nonprescription medications must be given with a physician's standing order. Physician's standing orders must be patient specific.

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NEW SECTION
WAC 388-148-0325
May I accept medicine from a child's parent or guardian?

(1) The only medicine you may accept from the child's parent, guardian, or responsible relative is medicine in the original container labeled with:

(a) The child's first and last names;

(b) The date the prescription was filled;

(c) The medication's expiration date; and

(d) Legible instructions for administration (manufacturer's instructions or prescription label).

(2) You must notify the child's social worker when you receive a prescription from a child's parent or guardian.

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NEW SECTION
WAC 388-148-0330
Whom do I notify about medication changes and reactions?

(1) You must notify the child's social worker of changes in prescribed medications.

(2) You must notify the child's social worker and physician about any adverse reactions the child has to medications.

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NEW SECTION
WAC 388-148-0335
When may children take their own medicine?

(1) You may permit children under your care to take their own medicine as long as:

(a) They are physically and mentally capable of properly taking the medicine; and

(b) The social worker approves in writing.

(2) You must keep the written approval by the child's social worker in your records.

(3) When a child is taking their own medication, the medication and medical supplies must be kept so they are inaccessible to unauthorized persons.

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GENERAL REQUIREMENTS -- FOOD/DIET/INFANT CARE
NEW SECTION
WAC 388-148-0340
What food and meal guidelines must I follow?

You must provide food to children in your care using the requirements that follow.

(1) Food served must be planned to meet the needs of the children under care, considering the children's:

(a) Ages;

(b) Developmental levels;

(c) Individual metabolic differences;

(d) Cultural backgrounds; and

(e) Any special dietary needs.

(2) For an educational and social environment during mealtimes, children must not be routinely separated from the adults and/or required to have separate menus unless ordered by the child's health care provider.

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NEW SECTION
WAC 388-148-0345
How often must I feed children?

(1) You must provide all children a minimum of three meals in each twenty-four-hour period. You may vary from this guideline only if you write to us requesting a change and we approve your request.

(2) The time interval between the evening meal and breakfast must not be more than fourteen hours.

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NEW SECTION
WAC 388-148-0350
How do I handle children's special diets?

You must have written instructions by a physician, parent or guardian before serving nutrient concentrates, nutrient supplements, and modified diets (therapeutic and allergy diets).

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NEW SECTION
WAC 388-148-0355
Do you have special requirements for serving milk?

You must follow these requirements for serving milk:

(1) Serve only pasteurized milk or a pasteurized milk product.

(2) Not serve or provide raw milk to children in care.

(3) Not serve the following types of milk to any child less than twenty-four months of age unless you have written permission by a physician:

(a) Skim milk;

(b) Reconstituted nonfat dry milk; and

(c) One and two percent butterfat milk.

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NEW SECTION
WAC 388-148-0360
What home-canned foods may I use?

You may use home canned, high-acid foods with a pH of less than 4.6 (such as canned fruits, jams, jellies, and pickles).

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NEW SECTION
WAC 388-148-0365
What requirements must I meet for feeding babies?

You must meet the following requirements for feeding babies:

(1) In group care settings, all formulas must be in sanitized bottles with nipples and labeled with the child's name and date prepared if more than one child is bottle-fed.

(2) You must refrigerate filled bottles if bottles are not used immediately and contents must be discarded if not used within twenty-four hours.

(3) If you reuse bottles and nipples, you must sanitize bottles and nipples.

(4) If breast milk is provided by anyone other than a baby's biological mother, approval must be obtained from the child's social worker.

(5) Infants who are six months of age or over may hold their own bottles as long as an adult remains in the room and within observation range. You must take bottles from the child when the child finishes feeding or when the bottle is empty.

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NEW SECTION
WAC 388-148-0370
What are your requirements for diapers and diaper-changing areas?

If you operate a foster home, group care facility, or program that serve children with severe developmental disabilities, you must follow our requirements for diapers, diaper-changing rooms and potty-chairs.

(1) You must separate diaper-changing areas from food preparation areas.

(2) You must sanitize diaper-changing areas between each use or you must use a nonabsorbent, disposable covering that is discarded after each use.

(3) For cleaning children, you must use either disposable towels or clean cloth towels that have been laundered between each use.

(4) You and any caregiver must wash hands before and after diapering each child.

(5) In group care programs, you must use disposable diapers, a commercial diaper service, or reusable diapers supplied by the child's family.

(6) In group care programs, diaper-changing procedures must be posted at the changing areas.

[]

GENERAL REQUIREMENTS -- CLOTHING AND PERSONAL HYGIENE
NEW SECTION
WAC 388-148-0375
Do I have responsibility for a child's clothing?

You must provide for appropriate clothing for the children under your care.

[]


NEW SECTION
WAC 388-148-0380
May a child take personal belongings after being discharged from a home or facility?

You must permit a child who is discharged from your home or facility to take personal belongings. This includes clothing, personal mementos, bicycles, gifts, and any saved money or regular allowance. There are two ways this may occur:

(1) The child may take these belongings upon leaving your home or facility; or

(2) You must secure the child's belongings for up to thirty days and cooperate with the child's social worker to transfer the belongings to the child.

[]


NEW SECTION
WAC 388-148-0385
Do I have responsibility for a child's personal hygiene?

You must provide or arrange for children under your care to have items needed for grooming and personal hygiene. You must assist these children in using these items, based on the child's developmental needs.

[]

GENERAL REQUIREMENTS -- CLIENT RIGHTS
NEW SECTION
WAC 388-148-0390
What are your requirements for protecting a child under my care from abuse and neglect?

As part of ensuring a child's health, welfare and safety, you must protect children under your care from all forms of child abuse and neglect (see RCW 26.44.020(12) and chapter 388-15 WAC for more details).

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NEW SECTION
WAC 388-148-0395
What are the requirements about nondiscrimination?

You must follow all state and federal laws regarding nondiscrimination while providing services to children in your care.

[]


NEW SECTION
WAC 388-148-0400
What religious activities are allowed?

You must respect the religious rights of the children under your care.

(1) Children have the right to practice their own faith.

(2) Children have the right not to practice your faith without consequences.

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NEW SECTION
WAC 388-148-0405
Do I have to admit or retain all children?

No child has to be admitted to or be retained in a program if a different program can serve that child more effectively. A joint decision may be made by the provider and the placement agency to serve the child elsewhere, for the health and safety of the child or others.

Exception: Individual programs may have contracts which specify that a child can not be denied admission.

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NEW SECTION
WAC 388-148-0410
What must I consider in assigning work to children in my home or facility?

(1) Children may do regular household tasks without payment.

(2) The children in your care must not be required to do basic maintenance of equipment, or of the home or facility.

(3) Children may do work assignments other than household tasks that are appropriate to their age and physical conditions and are part of their service plan. You must provide adequate monetary compensation for the work they do.

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NEW SECTION
WAC 388-148-0415
What activities must I provide to children?

(1) You must provide children with safe and suitable activities that contribute to developing their physical, mental, social, and emotional skills. Activities must be designed for the developmental stages of the children you serve.

(2) The scope of activities must include:

(a) Exercise;

(b) Large and small muscle development;

(c) Crawling and exploring;

(d) Sensory stimulation;

(e) Social interaction;

(f) Development of communication skills; and

(g) Development of self-help skills.

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NEW SECTION
WAC 388-148-0420
What types of toys must I provide to children?

You must provide safe and suitable toys and equipment for all children in your care. You must have toys that relate to the different developmental stages of the children you serve.

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NEW SECTION
WAC 388-148-0425
Do I need permission to travel on an extended trip or out-of-state with my foster child?

Permission for the dependent child to travel on an extended trip or out-of-state requires written permission from the court having jurisdiction over the child. Contact the child's CA social worker prior to extended trips or out-of-state travel.

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GENERAL REQUIREMENTS -- SUPERVISION
NEW SECTION
WAC 388-148-0430
What requirements do you have for supervising children?

(1) You must provide or arrange for care and supervision that is appropriate for the child's age, developmental level, and condition.

(2) You must supervise children who help with food preparation in the kitchen, based on their age and skills.

(3) Preschool children and children with severe developmental disabilities must not be left unattended in a bathtub or shower.

(4) Foster parents and facility staff must provide the children in their care with adult supervision, emotional support, personal attention, and structured daily routines and living experiences.

(5) Children must be supervised during sleeping hours by at least one awake staff when:

(a) There are more than six children in care; or

(b) The major focus of the program is behavioral rather than the development of independent living skills such as a teen parent program or responsible living skills program; or

(c) The youth's behavior poses a risk to self or others.

(6) Adequate supervision should be maintained during times of crisis when one or more family members or staff members may be unavailable to provide the necessary supervision or coverage for other children in care.

(7) When special supervision is required and agreed upon between the department and the agency or foster parent, the agency or foster parent provides the necessary supervision. This supervision may require auditory or visual supervision at all times.

(8) When children exhibit behaviors that pose a safety risk to other children in care, the child must not share a bedroom with other children.

[]


NEW SECTION
WAC 388-148-0435
May my foster children participate in routine activities without a licensed provider supervising the activity?

Children may participate in routine childhood activities, such as clubs, sports activities and social outings with classmates or friends, without the presence of a licensed provider or approval from the social worker when all of the following conditions occur:

(1) You must have a plan for the supervision of the child under care developed by the social worker and you in advance;

(2) The activity must be appropriate to the age and social skills for the child in care; and

(3) You must have basic information about the adults who will be supervising the child in activities, including names of adults, their phone numbers and address of the place where the activity is held.

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GENERAL REQUIREMENTS -- DISCIPLINE
NEW SECTION
WAC 388-148-0440
What requirements must I follow when disciplining children?

(1) You are responsible for disciplining children in your care. This responsibility may not be delegated to any child.

(2) Discipline must be based on an understanding of the child's needs and stage of development.

(3) Discipline must be designed to help the child under your care to develop inner control, acceptable behavior and respect for the rights of others.

(4) Discipline must be fair, reasonable, consistent, and related to the child's behavior.

[]


NEW SECTION
WAC 388-148-0445
What types of disciplinary practices are forbidden?

(1) You must not use cruel, unusual, frightening, unsafe or humiliating discipline practices, including but not limited to:

(a) Spanking children with a hand or object;

(b) Biting, jerking, kicking, hitting, or shaking the child;

(c) Pulling the child's hair;

(d) Throwing the child;

(e) Purposely inflicting pain as a punishment;

(f) Name calling, using derogatory comments;

(g) Threatening the child with physical harm; or

(h) Threatening or intimidating the child.

(2) You must not use methods that interfere with a child's basic needs. These include, but are not limited to:

(a) Depriving the child of sleep;

(b) Providing inadequate food, clothing or shelter;

(c) Restricting a child's breathing;

(d) Interfering with a child's ability to take care of their own hygiene and toilet needs; or

(e) Providing inadequate medical or dental care.

(3) You must not use methods that deprive a child of necessary services. These include, but are not limited to, contacting:

(a) The assigned social worker;

(b) The assigned legal representative;

(c) Parents or other family members who are identified in the case plan; or

(d) Individuals providing the child with therapeutic activities as part of the child's case plan.

(4) You must not use medication in an amount or frequency other than that prescribed by a physician or psychiatrist.

(5) You must not use medications for a child that has been prescribed for someone else.

(6) You must not physically lock doors or windows in a way that prohibits a child from exiting.

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GENERAL REQUIREMENTS -- PHYSICAL RESTRAINT
NEW SECTION
WAC 388-148-0450
What types of physical restraint are acceptable for children in homes and group care settings?

All home and facility settings

(1) You must use efforts other than physical restraint to redirect or de-escalate a situation, unless the child's behavior poses an immediate risk to physical safety.

(2) In emergencies and only when the child's behavior poses an immediate risk to physical safety may you use physical restraint. The restraint must be reasonable and necessary to:

(a) Prevent a child on the premises from harming themself or others; or

(b) Protect property from serious damage.

(3) The licensee and staff must be trained in using appropriate restraining techniques in accordance with the department's behavior management policy at a home or group care facility before restraining a child.

(4) Medication prescribed by a physician to control behavior must be only given as prescribed.

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NEW SECTION
WAC 388-148-0455
What types of physical restraint are not acceptable for children?

(1) Homes and facilities must follow these requirements. You must not:

(a) Use physical restraint as a form of punishment or discipline.

(b) Use mechanical restraints, such as handcuffs and belt restraints.

(c) Use locked time-out rooms.

(d) Place or require a child to stand under a cold water shower.

(e) Use physical restraint techniques that restrict breathing, inflict pain as a strategy for behavior control, or that might injure a child. These include, but are not limited to:

(i) Restriction of body movement by placing pressure on joints, chest, heart, or vital organs;

(ii) Sleeper holds, which are holds used by law enforcement officers to subdue a person;

(iii) Arm twisting;

(iv) Hair holds;

(v) Throwing a child or youth against a wall, furniture, or other large immobile objects;

(vi) Choking or putting arms around the throat; or

(vii) Chemical restraints, including but not limited to pepper spray.

[]


NEW SECTION
WAC 388-148-0460
Do you require a written statement describing my discipline methods?

You must send a written statement with your application and re-application for licensure describing the discipline methods you use.

[]


NEW SECTION
WAC 388-148-0465
What must I do following an incident that involved using physical restraint?

(1) After using physical restraint with a child, the foster parent or child care staff must explain to the child why physical restraint was used to help the child learn from the experience.

(2) For group care programs, the director or program supervisor must review any incident with the staff who used physical restraint to ensure that the decision to use physical restraint and its application were appropriate.

(3) In foster homes, the foster parent must send a copy of the documented use of physical restraint to the child's social worker within forty-eight hours; or if the foster home is supervised by a child-placing agency to the case manager. The CPA case manager will furnish a copy to the child's DCFS social worker.

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NEW SECTION
WAC 388-148-0470
Must I document instances when physical restraint is used?

You must document each instance of using physical restraints and notify the child's social worker; or in the case of a child-placing agency, notify the case manager. You must keep a copy of the document for the child's file at your home or facility. At a minimum, you must record:

(1) The child's name and age;

(2) The date of using the restraint;

(3) The time in and out of the restraint;

(4) The events preceding the behavior that lead to using the restraint;

(5) The de-escalation methods that were used;

(6) Names of those involved in the restraint and any observers;

(7) A description of the type of restraint used;

(8) A description of any injuries to the child, other children or caregivers;

(9) An analysis of how the restraint might have been avoided; and

(10) The signature of the person making the report.

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FOSTER HOME REQUIREMENTS
NEW SECTION
WAC 388-148-0475
May I receive more than one in-home care license?

If you have a foster home license, you may not hold a license for any other type of in-home care, such as child day care or adult care.

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NEW SECTION
WAC 388-148-0480
What services must a foster parent be able to provide?

(1) Foster parents must be able to meet the child's basic needs and have the knowledge and skills to:

(a) Protect and nurture children in a safe, healthy environment with unconditional positive support;

(b) Support relationships among children and their parents, siblings, and kin;

(c) Meet the developmental needs of the child by:

(i) Helping the child cope with separation and loss;

(ii) Helping the child build positive attachments to appropriate adults;

(iii) Building self-esteem;

(iv) Giving positive guidance;

(v) Supporting cultural identity;

(vi) Using discipline appropriate to the child's age and stage of development;

(vii) Supporting intellectual and educational growth;

(viii) Encouraging and modeling positive social relationships and responsibilities; and

(ix) Helping the child gain age appropriate skills for independence.

(2) Foster parents must support the permanent placement plan for the child, focusing first on the birth family reuniting, and then, on options leading to a permanent placement.

(3) Foster parents may participate as members of the child's treatment team.

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NEW SECTION
WAC 388-148-0485
What educational support must I provide to children under my care?

If you own or operate a foster home, you must:

(1) Assist the child to attend school on a regular basis if this is part of the child's service plan;

(2) Provide a suitable study area for the children under your care; and

(3) Provide opportunities to learn appropriate skills for the development of self-sufficiency.

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FOSTER HOMES -- FOSTER PARENT QUALIFICATIONS/TRAINING/CAPACITY ALLOWED
NEW SECTION
WAC 388-148-0490
What is the minimum age to be a foster parent?

You need to be at least twenty-one years old to be a foster parent.

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NEW SECTION
WAC 388-148-0495
What are the training requirements for prospective foster parents?

(1) To receive a foster home license, you must attend required orientation and pre-service training programs that the department sponsors, or that your licensed child-placing agency offers.

(2) You need proof of completion of current first-aid/CPR training that is geared for the ages of the foster children you want in your home.

(3) You need proof of completion of HIV/AIDS training.

(4) The primary care giver must complete all required DLR-approved training.

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NEW SECTION
WAC 388-148-0500
How many children may my foster home serve?

(1) The department restricts the number of children a foster home may be licensed to serve. The age of the foster and birth children, and the physical and emotional condition of the children are considered. These requirements are for all foster homes, including those that only have foster children for a short time (sometimes called a "receiving home").

(2) You may have only two children under two years of age in your home at a time. This includes foster children, your own biological and adopted children.

(3) You may be licensed for up to four foster children in your home. The total number of children in your home must not exceed six children, including your own children, in a two-parent household. The total number of children in your home must not exceed four children, including your own children, in a single parent household.

(4) With the approval of a DLR licensing supervisor, a two-parent household may be licensed for up to six foster children. The total number of children must not exceed six including your own.

(5) A home may be licensed for the care of at least one child or a sibling group when they have more of their own children than specified in subsection (3) above, if they meet the other licensing requirements. The sibling group must not exceed a total of three children.

Children with severe developmental disabilities

(6) The department may license a foster home for up to two foster children with mental or physical disabilities as prescribed by a physician that are severe enough to require nursing care if:

(a) Your training and/or experience qualifies you to provide proper care;

(b) The children's treatment requires nursing service oversight; and

(c) The total number of children with mental or physical disabilities in your home is two or fewer.

Nonmobile children

(7) The department may license a foster family for up to two nonmobile children.

Respite care

(8) While providing respite care, you must not exceed the number of children you are licensed to serve.

(9) The department may license a foster home to serve up to four children with developmental disabilities as defined in RCW 71A.10.020, at any one time.

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FOSTER HOMES -- FOSTER PARENT EMPLOYMENT
NEW SECTION
WAC 388-148-0505
May I be employed if I am a foster parent?

(1) You may be employed while you are a foster parent if you follow the department's requirements.

(2) If one or two parents are employed outside the home, you must give the child-placing agency or the department a written outline of your plan for supervising the children under your care while you are working. This pertains to a home either with two parents or a single parent.

(3) At least one parent must be available to respond to school crisis.

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NEW SECTION
WAC 388-148-0510
Do I need to have income separate from foster care payments?

You must have sufficient regular income to maintain your own family, without the foster care payments made for the children in care.

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FOSTER HOMES -- RESPITE CARE PROVIDED
NEW SECTION
WAC 388-148-0515
When may I use respite care?

(1) Foster families may arrange for respite (brief relief) care only with the prior consent of the child's social worker.

(2) Respite care may be arranged in advance or on an emergency basis.

(3) Respite care may be arranged to support the care a foster parent is providing or to provide substitute care in the absence of foster parents.

(4) Respite care provided outside the foster parent's home must be provided by licensed providers.

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NEW SECTION
WAC 388-148-0520
May I place my foster child with another family temporarily?

Foster parents must not place a child in another home temporarily or otherwise without the written consent of:

(1) The child's social worker; or

(2) The child placing agency case manager; if any.

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FOSTER HOMES -- FIRE SAFETY
NEW SECTION
WAC 388-148-0525
What fire safety instructions must I give to children?

You must instruct all children under your care in emergency evacuation procedures and conduct fire drills at regular intervals to test and practice the procedures.

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NEW SECTION
WAC 388-148-0530
What are your requirements for fire extinguishers?

(1) You must have a readily available and approved 2A-rated or better, all purpose (ABC) fire extinguisher filled with five pounds or more of fire retardant chemicals.

(2) The fire extinguisher must be in good operating condition, with verification of regular maintenance.

(3) If local fire authorities require installation of a different type or size of fire extinguisher, those requirements apply instead of the departments, as long as at least the minimum size is maintained.

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NEW SECTION
WAC 388-148-0535
What are your requirements for smoke detectors?

(1) You must place a smoke detector in good working condition in each bedroom or in areas close to where children sleep, such as a hallway. If the smoke detector is mounted on the wall, it must be twelve inches from the ceiling and a corner.

(2) If question arises concerning fire danger, the local fire protection authority must be consulted.

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NEW SECTION
WAC 388-148-0540
What fire escape measures must be taken for multi-level dwellings?

Multi-level dwellings must have a means of escape from an upper floor. If a fire ladder is needed to escape from an upper story window, it must be stored in a location that is easily accessible for the family members who may need it.

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REQUIREMENTS FOR ALL LICENSES, EXCEPT FOSTER HOMES -- PROGRAM AND SERVICES
NEW SECTION
WAC 388-148-0545
Do I need a social summary for children under my care?

(1) If you own or operate a child-placing agency, a staffed residential home, or a group care program, you must develop a written diagnostic social summary for each child accepted for care.

(2) The social summary must serve as the basis of the child's admission to care.

(3) If a child needs to be accepted for emergency care, the department does not require the social study to be completed prior to admission. In these cases, if the child remains in care beyond twenty days, the summary must be completed within thirty days after admission.

(4) The study must contain the following information for the child:

(a) Copies of psychological or psychiatric evaluations, if any, on the child under care.

(b) A narrative description of the child's background and family that identifies the immediate and extended family resources;

(c) The child's interrelationships and the problems and behaviors that have required care away from his or her own home;

(d) The child's primary and alternate permanency plan;

(e) Previous placement history, if any; and

(f) An evaluation of the child's need for the particular services and type of care you provide.

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NEW SECTION
WAC 388-148-0550
Do I need a treatment plan for children under my care?

(1) If you own or operate a child-placing agency, a staffed residential home, or a group care program, you must assist in developing and implementing a written treatment plan for each child accepted for care in any of the programs you provide.

(2) The treatment plan must:

(a) Identify the service needs of the child, parent or guardian;

(b) Describe the treatment goals and strategies for achieving those goals;

(c) Include a running account of the treatment received by the child and others involved in the treatment plan, such as any group treatment or individual counseling; and

(d) Be updated at least quarterly to show the progress toward meeting goals and list barriers to the permanent plan.

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NEW SECTION
WAC 388-148-0555
Do you need to approve the program that I offer for children under my care?

(1) The department must approve the program that you have developed for children under your care.

(2) You must send to DLR a detailed written program description outlining educational, recreational, and therapeutic services you will provide to children and their families. A sample of the schedule of daily activities for children under care must be included.

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NEW SECTION
WAC 388-148-0560
What education and vocational instruction must I provide to the children under my care?

If you own or operate a staffed residential home or a group care program, you must meet the following requirements for providing education and vocational instruction to the children under your care. You must:

(1) Develop or arrange for an educational plan for each child in care who has not completed high school and/or the GED (high school equivalency examination);

(2) Support each child participating in their education plan;

(3) Provide suitable study areas for children under your care; and

(4) If the instruction is given on your premises, have the program certified by the office of the superintendent of public instruction and provide classrooms separate from the living area;

(5) Send the department a written description of how you will provide an educational program for children under your care;

(6) Provide or arrange for independent living skills education for developing self-sufficiency for the children under your care.

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NEW SECTION
WAC 388-148-0565
What nursing services must I provide?

(1) If you own or operate a staffed residential home or facility caring for chronically ill children or medically fragile children, you must arrange for regular nursing visits.

(a) These must include at least monthly visits unless a different agreement is specified in the individual child's treatment plan.

(b) The nurse must be registered and currently licensed in the state of Washington.

(2) The nurse's name, address and telephone number must be readily available to the staff at your home or facility.

(3) The nurse must assist the agency in setting up a program that provides for regular medical check-ups and follow-up for special health care needs specified by the child's physician or your staff.

(4) The nurse must advise and assist nonmedical staff at your home or facility in maintaining child health records, meeting daily health needs and caring for children with minor illnesses and injuries.

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ALL LICENSES EXCEPT FOSTER HOMES -- STAFF QUALIFICATIONS AND STAFFING RATIOS
NEW SECTION
WAC 388-148-0570
What social service staff do I need for my home or facility?

You must provide or arrange for social services by qualified persons who have specific educational training. Social service staff must meet education and training requirements that follow:

(1) One person who provides social services must have a master's degree in social work or a closely related field from an accredited school.

(2) Social service staff without a master's degree in social work or closely related field must have a bachelor's degree in social work or a closely related field. A person with a master's degree must consult at least eight hours per month with any social service staff who have only a bachelor's degree.

(3) When social services are provided by another agency, you must have a written agreement with the agency describing the scope of service they provide. Written agreements must meet the requirements of this rule.

(4) A social service staff person must review and sign approving the child's treatment plan.

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NEW SECTION
WAC 388-148-0575
What clerical, accounting and administrative services do I need for my home or facility?

You must have sufficient clerical, accounting and administrative services to maintain proper records and carry out your program.

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NEW SECTION
WAC 388-148-0580
What support and maintenance staff do I need for my home or facility?

If you own or operate a home or facility other than a foster home, you must have sufficient support and maintenance services to maintain and repair your facility, prepare and serve meals.

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NEW SECTION
WAC 388-148-0585
Do I need professional consultants for my program?

You must have consultants available to work with your staff, the children you serve, and the children's family. The consultants that are used by your program must meet the full professional competency requirements in their respective fields. The consultant or consultants must have:

(1) A master's degree from a recognized school of social work or similar academic training;

(2) The experience, knowledge and demonstrated skills in each area that he or she will be supervising; and

(3) The ability to ensure your staff develop their skills and understanding needed to effectively manage their cases (see WAC 388-148-0045).

(4) Consultants may be hired as staff or operate under a contract with your program.

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NEW SECTION
WAC 388-148-0590
What are the required ratios of social service staff to children under care?

You must meet the minimum ratios of social service staff to children under care as shown in the chart below:

Type of Program Minimum Ratio of Full-Time Social Service Staff to Children Under Care
Day treatment program 1 to 15
Group homes 1 to 20
Child-placing agency 1 to 25
Maternity services 1 to 25
Regular and secure crisis residential centers 1 to 5

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ALL LICENSES, EXCEPT FOSTER HOMES AND CHILD PLACING AGENCIES -- FOOD AND MEALS
NEW SECTION
WAC 388-148-0595
Do you require a written food plan?

You must record all food served. This record is kept as part of the daily log.

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NEW SECTION
WAC 388-148-0600
Do mealtimes need to be established?

You must establish and post a schedule of mealtimes.

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NEW SECTION
WAC 388-148-0605
Do you have general menu requirements?

The department has menu requirements for staffed residential homes and facilities that care for children.

(1) If you own or operate a home or facility other than a foster home, you must prepare and date daily menus, including snacks, at least one week in advance.

(2) A menu must specify a variety of foods for adequate nutrition and meal enjoyment.

(3) You must keep the menus on file for a minimum of six months so that we can review your menus.

(4) You must post each person's dietary restrictions, if any, for staff to follow.

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GROUP CARE -- PROGRAM REQUIREMENTS AND SERVICES
NEW SECTION
WAC 388-148-0610
Do I need a license to provide group care?

An individual or agency must be licensed to provide group care services to children.

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NEW SECTION
WAC 388-148-0615
What types of group care programs are licensed to provide care to children?

The following types of programs may be licensed as group care to provide care for children on a twenty-four-hour basis:

(1) Group home programs;

(2) Independent living skills programs;

(4) Maternity services;

(5) Services to children with severe developmental disabilities and medically fragile children; and

(6) Crisis residential centers and secure crisis residential centers; and

(7) Day treatment programs. Day treatment programs are considered group care programs under this chapter, though they are not twenty-four-hour residential programs.

Notes: The rules in WACs 388-148-1040 through 388-148-1110 apply exclusively to licensing of group care facilities. You must also comply with the general licensing requirements specified in this chapter.

The "I" and "you" in this section refers to people who operate or own group facilities for children.

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Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-148-0620
What basic elements must a group care program include?

(1) Your group care program must provide a safe and healthy group living environment that meets the developmental needs of the children in your care, including;

(a) A clean, homelike environment;

(b) Basic necessities such as adequate food, appropriate clothing and recreational opportunities;

(c) Safety;

(d) An age-appropriate environment with necessary structure, routine, and rules to provide for a healthy life, growth and development.

(2) Your program must be staffed with employees who are competent to provide for the safety and needs of the children in your care.

(3) Your program must have a written statement that includes your mission, goals, and a description of the services you provide.

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NEW SECTION
WAC 388-148-0625
Who may I serve as a group care program provider?

(1) If you are a group care program provider, you may serve children who are at least six years of age and meet one of the following conditions:

(a) Have behavior that cannot be safely or effectively managed in foster care;

(b) Need temporary placement awaiting a more permanent placement;

(c) Need emergency placement during a temporary disruption of a current placement; or

(d) Have emotional, physical, or mental disabilities.

(2) Exception: If your staffed residential home or group care facility serves children with severe developmental disabilities, medically fragile children, or maternity services, the children may be younger than six years of age.

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NEW SECTION
WAC 388-148-0630
What services must I provide if I have a group care license?

You must provide specialized services that are needed by the group that you serve. These services may be provided through your own program or through using other community resources.

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NEW SECTION
WAC 388-148-0635
Must I give a child an allowance?

Group care facilities must give the children under their care allowances based on age, needs and ability to handle money. These facilities must keep track of allowances given to children in a ledger.

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GROUP CARE -- STAFF QUALIFICATIONS AND STAFFING RATIOS
NEW SECTION
WAC 388-148-0640
What qualifications must a director for a group care program have?

The director for group care program is responsible for the agency administration, agency oversight, and fiscal operation. The director must meet, at a minimum, the requirements that follow.

(1) The director must be:

(a) Able to communicate to the department the roles, expectations and purposes of the program; and

(b) Able to work with representatives of other agencies.

(2) The director must also meet one of these education or experience requirements:

(a) Have a bachelor's degree in business management or closely allied field from an accredited school, and have at least two years' full-time relevant experience; or

(b) Have a minimum of five years' successful, full-time relevant experience.

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NEW SECTION
WAC 388-148-0645
Do I need an on-site program manager at each group care facility?

Each group care facility must have an on-site program manager or person with the equivalent training and experience at each facility.

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NEW SECTION
WAC 388-148-0650
What are the responsibilities of the on-site program manager for a group care program have?

The on-site program manager has the following responsibilities:

(1) Coordinates the day-to-day operations of the facility;

(2) Supervises the child care staff; and

(3) Oversees the completion of each child's plan of care or treatment.

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NEW SECTION
WAC 388-148-0655
What qualifications must the on-site program manager for a group care program have?

Each on-site program manager must have the following qualifications:

(1) A bachelor's degree in a social science or closely allied field from an accredited school; and

(2) Supervisory abilities that promote effective staff performance; and

(3) Relevant experience, training, and demonstrated skills in each area that he or she will be supervising.

(4) The responsibilities of the director or the on-site program manager may be provided by the same person if that person meets the qualifications for both positions.

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NEW SECTION
WAC 388-148-0660
What qualifications must the child care staff for a group care program have?

The child care staff is responsible for the care, supervision and behavior management of children under your care. The department requires the child care staff of each group care program:

(1) Be at least twenty-one years old;

(2) Exception: Child care staff may be nineteen or twenty years old if enrolled in an internship program with an accredited college or university; and be supervised by staff twenty-one years or older;

(3) Have a high school diploma or GED;

(4) Have one year of experience working with children;

(5) Have the skills and abilities to work successfully with the challenging behaviors of children in care; and

(6) Have effective communication and problem solving skills.

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NEW SECTION
WAC 388-148-0665
What is the ratio of child care staff to children in group care facilities?

The department has specific requirements for the ratio of child care staff to children in group care.

(1) The ratio for group homes is at least one child care staff member on site for every eight children during waking hours.

Note: Crisis residential centers, staffed residential homes, maternity programs, and programs for children with severe developmental disabilities have different requirements.

(2) For certified juvenile detention facilities, at least one child care staff member must be on duty for every ten children in care during the sleeping and waking hours.

(3) At least two adults, including at least one child care staff person, must be on site whenever more than eight children are on the premises.

(4) To keep the proper ratio of staff to children, the director, support staff and maintenance staff may serve temporarily as child care staff if they have adequate training.

(5) During sleeping hours of youth, at least one staff person must be awake in all group home programs when:

(a) There are more than six youth in care; or

(b) The major focus of the program is behavioral change rather than the development of independent living skills, such as teen parent and independent living skills programs; or

(c) The youth's behavior poses a safety risk to self or others.

(6) When only one child care staff is on site, a second staff must be on call.

(7) You must have relief staff so that all staff can have the equivalent of two days off a week.

(8) If you have more than one program at your facility, such as a group care program and a crisis residential center, you must follow the most stringent staffing ratio requirements.

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GROUP CARE -- ROOM REQUIREMENTS
NEW SECTION
WAC 388-148-0670
Do you have room requirements for group care facilities?

You must meet the following room requirements to operate or own a group care facility.

(1) You must provide rooms that are ample in size and properly furnished for the number of children you serve.

(2) You must have a comfortably furnished living room.

(3) You must have a dining room area that is ample in size and suitably furnished for your residents.

(4) Exception: Juvenile detention facilities are not required to meet these first three standards.

(5) With more than twelve children, you must provide at least one separate indoor recreation area. Its size and location must be sufficient for the age and number of the children to engage in recreational and informal education activities.

(6) You must provide a room or area that is used as an administrative office. In addition, suitable offices must be provided for social service staff. In facilities caring for fewer than thirteen children, these offices may be combined with the administrative office.

(7) You must provide a space that can be used as a visiting area.

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NEW SECTION
WAC 388-148-0675
When do I need a special care room?

(1) If you own or operate a group facility, you must provide a special care room reserved for the care of a person who needs to be separated from the group due to injury, illness or the need for additional rest.

(2) A special care room must:

(a) Be located in a place that easily allows the person to be supervised;

(b) Have toilet and lavatory facilities that are easily accessible to any person staying in the special care room.

(3) After each use have the area and equipment sanitized if used by any person who is suspected of having a communicable disease.

(4) You may use the special care room for other purposes when it is not needed for the separation and care of an ill or injured person.

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NEW SECTION
WAC 388-148-0680
What are the kitchen requirements?

(1) You must provide facilities to properly store, prepare, and serve food to meet the needs of the children under your care.

(2) All food service facilities and food handling practices in day treatment programs and group care facilities must comply with rules and regulations of the state board of health governing food service sanitation.

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SPECIFIC PROGRAM REQUIREMENTS -- MATERNITY SERVICES
NEW SECTION
WAC 388-148-0685
Who may provide maternity services?

The following programs, homes, facilities, and agencies that may provide or arrange for maternity services include:

(1) Foster homes;

(2) Staffed residential homes;

(3) Group homes for new mothers with infants; and

(4) Child placing agencies.

Note: The rules in WAC 388-148-0685 through 388-148-0730 apply exclusively to licensing requirements for agencies providing or arranging maternity service.

The "I" and "you" in this section refers to people who provide maternity services through their agency.

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NEW SECTION
WAC 388-148-0690
What maternity services must I provide?

If you operate a licensed program for expectant mothers and new mothers with infants, you must provide or arrange for the following services.

(1) You must provide information and referral services to every expectant and new mother who applies for care.

(2) You must offer individual or group counseling sessions, if necessary, about the following topics:

(a) Pregnancy counseling;

(b) Independent living education;

(c) Infant and child care training;

(d) Living arrangements;

(e) Medical care planning;

(f) Legal issues;

(g) Vocational or educational guidance;

(h) Plans for the child;

(i) Financial, emotional or psychological problems;

(j) Relations with parents and birth father; and

(k) Home management and consumer education.

(3) You must arrange for an expectant mother's delivery in a licensed hospital or licensed birthing facility.

(4) You must ensure that postpartum medical examinations, as prescribed by a physician, are provided to a new mother.

(5) You must provide childcare, as needed.

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NEW SECTION
WAC 388-148-0695
How are maternity services delivered?

(1) Maternity services must not be contingent upon a parent's decision to keep or relinquish her child.

(2) If you do not directly provide maternity services to an expectant or new mother in your facility, you must either:

(a) Arrange for these services through formal agreements with other community agencies; or

(b) Assist the clients in your program to get these services.

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NEW SECTION
WAC 388-148-0700
Do you need to approve daily activities that I offer to expectant or new mothers?

The department must approve the program of daily activities that you've developed for expectant or new mothers, whether your program is residential or nonresidential.

(1) the department requires that you provide us with a written program description about the daily activities you offer. The program description must outline educational, recreational, and therapeutic services that you intend to provide to expectant mothers and new mothers with infants.

(2) You must also provide us with a schedule of typical daily activities for the mothers under your care.

Exception: Foster homes are not required meet the standard in this section.

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NEW SECTION
WAC 388-148-0705
What types of health education must I offer expectant and new mothers?

You need to offer or arrange health education for expectant and new mothers that includes the following areas:

(1) Pregnancy hygiene;

(2) Suitable preparation for childbirth;

(3) The physiological changes during pregnancy;

(4) Examinations and childbirth procedures;

(5) Postnatal and pediatrics care;

(6) Contraception and family planning;

(7) Nutritional requirements for mother and child;

(8) Child health and development; and

(9) Psychological and emotional changes during and after pregnancy.

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NEW SECTION
WAC 388-148-0710
Am I required to provide childcare?

(1) If your program serves parents with children, you must provide or assist the parent in arranging for licensed childcare when appropriate. An example is when parents are working or are in school and need childcare.

(2) The childcare facility must meet licensing requirements (see chapter 388-130 and 388-155 WAC).

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NEW SECTION
WAC 388-148-0715
Do expectant and new mothers need to be under a physician's care?

Expectant and new mothers must be under a physician's care to receive maternity services from department licensed programs or facilities.

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NEW SECTION
WAC 388-148-0720
What are my responsibilities if a specialist is required?

You must provide or arrange for consultation by specialists when the physician requests them.

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MATERNITY SERVICES -- STAFF QUALIFICATIONS AND STAFFING RATIOS
NEW SECTION
WAC 388-148-0725
What is the proper ratio of staff to children in home or group care facilities offering maternity services?

Residential programs provide twenty-four-hour care to expectant mothers and to new mothers with infants. These programs must employ sufficient numbers of residential staff to meet the physical, safety, health and emotional needs of the residents. Residential staff are in charge of supervising the day-to-day living situation for residents.

Note: Residential staff may carry out any maintenance tasks that do not detract from their primary function.

(1) During waking hours, when youth are on the premises, the ratio of staff to residents must be as follows:

(a) At least one residential staff member must be on duty for every four mothers.

(b) Additional staff may be required under certain circumstances if specified by the department.

(2) During the sleeping hours of youth, the ratio of staff to residents must be as follows:

(a) In homes caring for more than six persons, at least one staff person must be awake, with an additional person "on call" at all times.

(b) On-duty staff may include persons sleeping on the premises and available to the residents.

(3) You must have relief staff so that all staff can have the equivalent of two days off a week.

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MATERNITY SERVICES -- ROOM REQUIREMENTS
NEW SECTION
WAC 388-148-0730
Do you have room requirements for facilities offering maternity services?

(1) If you have a residential program for expectant mothers or new mothers with infants, you must meet the room requirements for group facilities (WAC 388-148-0670).

(2) If your facility offers medical clinics, you must have a separate, adequately equipped examination room with adequate nursing equipment.

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DAY TREATMENT PROGRAMS -- PROGRAM AND SERVICES
NEW SECTION
WAC 388-148-0735
What is the purpose of day treatment programs?

(1) A day treatment program must provide educational and therapeutic group experiences for emotionally disturbed children who are not in need of residential care. These services are provided during part of the twenty-four-hour day, usually during a five-day week.

(2) Day treatment is for children who are:

(a) Unable to adjust to school programs due to disruptive behavior, family stress, learning disabilities or other serious emotional disabilities; and/or

(b) Are unable to profit from outpatient child guidance clinic services and related programs.

Notes: The rules in WAC 388-148-0740 through 388-148-0750 apply exclusively to licensing day treatment programs. Day treatment programs must also follow general licensing requirements (see WACs 388-148-0545 through 388-148-0605). If a day treatment program is contained within a group care facility, the facility also must follow group care regulations (see WACs 388-148-0610 through 388-148-0680.)

"I" and "you" refers to people who operate day treatment programs.

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DAY TREATMENT PROGRAMS -- STAFF QUALIFICATIONS AND STAFFING RATIOS
NEW SECTION
WAC 388-148-0740
What staff must my day treatment program have?

(1) Your day treatment program must have a director to manage facilities and operations and a program supervisor to supervise the child care and treatment program at the facility.

Note: The director and program supervisor may be the same person if that person is qualified for both positions.

(2) Either the director or program supervisor must be on the premises while the children are in care. Another competent person must be left in charge during the director's and/or program supervisor's temporary absence.

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NEW SECTION
WAC 388-148-0745
What consultants must my day treatment program have?

If you operate a day treatment program, you must use psychiatrists, psychologists, teachers, and group counselors for children under care as follows. Your day treatment program must:

(1) Receive regular consultation from a child psychiatrist;

(2) Provide or arrange for a psychologist for psychological testing and related services if these services are not provided by a child's school;

(3) Provide or arrange for teaching by certified teachers qualified by training or experience in remedial education; and

(4) Use group counselors who are qualified by training or by experience in the care of disturbed children.

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NEW SECTION
WAC 388-148-0750
What is the ratio of counselor and teaching staff to children?

There must be one counselor or teacher for every six children who are in a day treatment program.

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GROUP CARE PROGRAMS FOR MEDICALLY FRAGILE CHILDREN AND CHILDREN WITH SEVERE DEVELOPMENTAL DISABILITIES -- PROGRAM AND SERVICES
NEW SECTION
WAC 388-148-0755
What type of care is offered for medically fragile children and children with severe developmental disabilities?

Specialized group care programs are designed to provide residential care to children who need intensive personal care due to medical fragility and/or severe developmental disabilities. The children may require skilled health care, physical therapy, or other forms of therapy.

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NEW SECTION
WAC 388-148-0760
Who provides services for medically fragile children and children with severe developmental disabilities?

Individuals and agencies are licensed to provide services to medically fragile children and children with severe developmental disabilities.

Notes: The rules in WAC 388-148-0755 through 388-148-0805 apply exclusively to facilities that care for children with severe developmental disabilities and medically fragile children.

"I" and "you" refers to people who own or operate facilities that provide care to medically fragile children and children with severe developmental disabilities.

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NEW SECTION
WAC 388-148-0765
What services must you provide for medically fragile children and children with severe developmental disabilities?

(1) You must ensure the following services are provided, if prescribed by a physician, if you care for medically fragile children and children with severe developmental disabilities:

(a) An individualized treatment plan suited to the unique needs of each child in care; and

(b) Care by physicians, including surgeons, general and family practitioners, and specialists in the child's particular diagnosis on either a referral, consultative, or ongoing treatment basis.

(2) You must also provide the following nursing services, if prescribed by a physician, if you care for medically fragile children, or children with severe developmental disabilities unless these children are in a foster home:

(a) Sufficient licensed nursing staff to meet the nursing care needs of the children;

(b) Regular nursing consultation that includes at least one weekly on-site visit by a registered nurse.

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NEW SECTION
WAC 388-148-0770
Do I need to have a multidisciplinary care plan for children with severe developmental disabilities?

If you operate a program licensed for the care of children with severe developmental disabilities, you must maintain a multidisciplinary plan of care for each child in care.

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NEW SECTION
WAC 388-148-0775
What must the multidisciplinary care plan for a child with severe developmental disabilities include?

The multidisciplinary care plan must address the social service, medical, nutritional, rehabilitative, and educational needs of each child.

(1) The plan must describe:

(a) The care given for each child;

(b) The goals to be accomplished; and

(c) The professional services that are responsible for each element of care.

(2) The care plan must be reviewed, evaluated, and updated annually by professional staff involved in the care of the child to re-evaluate each child's condition, progress, prognosis and need for ongoing care and services.

(3) You must record progress reports in the child's record on a quarterly basis.

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NEW SECTION
WAC 388-148-0780
What are the requirements for nurses in programs who care for medically fragile children or children with severe developmental disabilities?

The department has several requirements for nursing services for programs that care for medically fragile children or children with severe developmental disabilities, if nursing services are prescribed by a physician.

(1) The registered nurse's name, address, and telephone number must be readily available.

(2) The agency or program must have the nurse assist in implementing a regular health care program that both:

(a) Oversees the health of all children; and

(b) Provides follow-up care of special health needs identified by the child's physician or facility or program staff.

(3) The agency or program must have the nurse advise and assist nonmedical personnel in maintaining medical records, meeting daily health needs, and caring for children with minor illnesses and injuries.

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NEW SECTION
WAC 388-148-0785
When do I use a nurse?

You must use a nurse to consult with you at your home or facility if you have infants, medically fragile children or children with severe developmental disabilities under your care and meet these specific conditions:

(1) If you have four or more infants, you must arrange for monthly on-site visits with a registered nurse that is trained or experienced in the care of young children.

(2) You must have a written agreement with the registered nurse about your infant care program.

(3) If you have children with severe developmental disabilities, you must have a registered nurse on staff or under contract.

(4) The nurse must advise you and your staff on your infant care program and your child health program.

(5) You must document the nurse's on-site visits.

(6) The nurse's name and telephone number must be posted or otherwise available in your home or facility.

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GROUP CARE PROGRAMS FOR MEDICALLY FRAGILE CHILDREN OR CHILDREN WITH SEVERE DEVELOPMENTAL DISABILITIES -- ROOM REQUIREMENTS
NEW SECTION
WAC 388-148-0790
Do I need to provide a therapy room for children with severe developmental disabilities?

(1) If you care for children with severe developmental disabilities, you must provide them with a room for physical and occupational therapy, if these services are prescribed by a physician. The room must be adequate for storing equipment used during therapy sessions.

(2) If you do not have a room for physical and occupational therapy, you must arrange for these therapies outside of your facilities.

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NEW SECTION
WAC 388-148-0795
Are there additional room requirements if I serve children with severe developmental disabilities?

If you operate a group care program that serves children with severe developmental disabilities, you must follow these additional room requirements.

(1) If you are licensed to care for thirteen or more children, you must provide separate, safe play areas for children under one year of age or children not walking. The department must approve the rooms ro areas.

(2) Children under one year of age must be cared for in rooms or areas separate from older children.

(3) No more than eight children under one year of age may be in the room at a time.

(4) Hand-washing facilities must be available in these rooms.

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GROUP CARE PROGRAMS FOR MEDICALLY FRAGILE CHILDREN AND CHILDREN WITH SEVERE DEVELOPMENTAL DISABILITIES -- FOOD AND MEALS
NEW SECTION
WAC 388-148-0800
What food requirements exist for medically fragile children and children with severe developmental disabilities?

There may be specific food requirements if you operate a home or facility that cares for medically fragile children and children with severe developmental disabilities:

(1) All modified diets must be planned, reviewed, and approved by a dietitian. You must use the services of a dietitian who meets current registration requirements of the American dietetic association.

(2) You must follow the dietary plan for each child as prescribed by the child's physician. You must document in the child's file that staff are following the physician's order.

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GROUP CARE PROGRAMS FOR MEDICALLY FRAGILE CHILDREN AND CHILDREN WITH SEVERE DEVELOPMENTAL DISABILITIES -- RECORD-KEEPING
NEW SECTION
WAC 388-148-0805
What additional record-keeping requirements exist for medically fragile and children with severe developmental disabilities?

(1) In addition to meeting standard requirements for keeping records (see WAC 388-148-0120 through 388-148-0145), you must also keep the following information for any medically fragile child and child with severe developmental disabilities:

(a) Information you received upon admission including family background, current diagnosis and medical status, an inventory of personal belongings, medical history, and a report of a physical examination and diagnosis by a physician;

(b) Information about the child's daily care including treatment plans, medications, observations, medical examinations, physicians' orders, allergic responses, consent authorizations, releases, diagnostic reports, and revisions of assessments;

(c) Upon discharge, a summary including diagnoses, treatments, and prognosis by the person responsible for providing care, and any instructions and referrals for continuity of care; and

(d) Evidence of meeting criteria for eligibility for services from the division of developmental disabilities.

(2) If the child has died, you must also have the following information:

(a) The time and date of death;

(b) Apparent cause of death;

(c) Notification of the physician and relevant others (including the coroner if necessary); and

(d) Regarding the disposal of the child's body and how the child's personal effects will be dealt with.

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CRISIS RESIDENTIAL CENTERS -- PROGRAM/LEVELS OF SECURITY/PLACEMENT AND SERVICES
NEW SECTION
WAC 388-148-0810
What types of CRCs may be licensed?

(1) A foster home may be licensed as a family CRC. The foster home licensed as a CRC must meet the licensing standards for foster homes outlined in this chapter.

(2) A facility may be licensed as a regular crisis residential center (CRC) or a secure crisis residential center.

(3) Family CRCs and regular CRCs are not locked facilities, but are operated in a way that reasonably assures that youth placed there will not run away.

Note: Regular CRCs are also known as semi-secure CRCs, as referred to in RCW 13.32A.030 (13) and (14).

(4) A secure facility is designed and operated to prevent a youth from leaving without permission of the staff. This facility has locking doors, locking windows, or secured perimeters.

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NEW SECTION
WAC 388-148-0815
What levels of secure CRCs exist?

The department licenses two types of secure crisis residential centers (CRCs): Level one and level two. Level one is the most secure facility and level two is the least secure facility.

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NEW SECTION
WAC 388-148-0820
What are the requirements for a level-one secure CRC?

A level-one crisis residential center (CRC) must meet each of these requirements:

(1) Be a free-standing facility, separate unit, or separate building within a campus with windows and exterior doors that prevent exit.

(2) Meet or exceed the current state building code when locking doors and windows prevent exit.

(3) Ensure that no youth is kept in a locked room that isolates the youth from the general population and/or staff.

(4) Maintain a recreation area, within the secured facility or secured on the property of the facility, that can support youth's vigorous physical activity. (Any fences used to secure the recreation area must meet or exceed the specifications of the level-two CRCs referenced in WAC 388-148-0825(3).)

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NEW SECTION
WAC 388-148-0825
What are the requirements for a level-two secure CRC?

A level-two secure crisis residential center (CRC) must meet each of these requirements:

(1) Prevent unauthorized entering and exiting with a nonscalable fence around the perimeter of the facility property;

(2) Not prevent exit by locking facility doors or windows;

(3) Design the nonscalable fence that does not cause injury, such as avoiding use of electrification, razor wire or concertina wire;

(4) Ensure that no youth is kept in a locked room that isolates him or her from the general population and/or staff; and

(5) Maintain a recreation area surrounded by a nonscalable fence that can support youth's vigorous physical activity.

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NEW SECTION
WAC 388-148-0830
May a juvenile detention center operate as a secure CRC?

(1) A juvenile detention center may operate as a secure crisis residential center (CRC). The physical facility must be operated so that no direct communication or physical contact can be made between a resident of the secure crisis residential center and a person held in the detention facility.

(2) Staff assigned to the secure crisis residential center youth must not be simultaneously assigned to the juvenile detention center residents on the same shift.

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NEW SECTION
WAC 388-148-0835
What youth may a CRC serve?

All CRCs

A crisis residential center (CRC) provides emergency, temporary residence to youth ages twelve through seventeen who meet one of the following criteria:

(1) Are beyond the control of their parents or guardians and behave in a way that endangers any person's welfare;

(2) Need assistance getting food, shelter, health care, clothing, educational services, and/or resolving family conflicts;

(3) Need temporary protective custody; or

(4) Have parents who are not able or willing to continue efforts to keep the family together.

Secure CRCs

Youth ordered by the court to serve time for contempt on CHINS, APY, or training orders may be ordered into a secure CRC that is co-located with a detention facility.

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NEW SECTION
WAC 388-148-0840
Can law enforcement officers place youth in secure CRCs?

Law enforcement officers must place youth in secure crisis residential centers (CRCs) when youth:

(1) Are runaways;

(2) Are in dangerous situations; or

(3) Are in violation of curfew.

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NEW SECTION
WAC 388-148-0845
What hours do CRCs have to be open?

Crisis residential centers (CRC) must be open twenty-four hours a day, seven days a week.

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NEW SECTION
WAC 388-148-0850
What steps must be taken after a youth is admitted into a CRC?

All CRCs

(1) The director or designee of a crisis residential center (CRC) must immediately notify the parents of the youth who has been admitted.

(2) If the director or designee of any CRC is unable to contact the youth's parents within, forty-eight hours, he or she must:

(a) Contact the department and request that the case be reviewed for dependency filing under chapter 13.34 RCW or "child in need of services" filing under chapter 13.32A RCW; and

(b) Document the contact with the department in the youth's case record.

Secure CRCs

(3) Within the first twenty-four hours after admitting a youth to a secure crisis residential center, and each twenty-four hours after, the director or designee must assess the youth's risk of running.

(4) The CRC director or designee must determine what type of CRC, regular or secure, would be best for the youth.

(5) The CRC director must use the following criteria in making the decision, considering the safety, health and welfare of the youth and others:

(a) The youth's age and maturity;

(b) The youth's physical, mental, and emotional condition upon arrival at the center;

(c) The circumstances that led to the youth's placement at the facility;

(d) The youth's behavior;

(e) The youth's history of running away;

(f) The youth's willingness to cooperate in conducting the assessment;

(g) The youth's need for continued assessment, protection, and intervention services in a CRC; and

(h) The likelihood the youth will remain at a CRC.

(6) The CRC director or designee must put the decision about the youth's status in writing in the youth's file.

(7) After a youth is admitted, the CRC director or designee must ensure that a youth is assessed for any health needs requiring immediate attention.

(8) By the first school day after admission, the crisis residential center staff must:

(a) Notify the youth's school district about the youth's placement; and

(b) Assess the youth for any educational needs as a part of the treatment plan referenced in WAC 388-148-1320 (1)(a).

[]


NEW SECTION
WAC 388-148-0855
What if a youth seems unlikely to remain in a regular CRC?

If a crisis residential center (CRC) director or designee decides that a youth is unlikely to stay in a regular facility, he or she must make reasonable efforts to transfer the youth to a secure facility.

[]


NEW SECTION
WAC 388-148-0860
What happens when no space exists at a secure CRC?

If space is not available in a secure crisis residential center (CRC), the director or designee of the secure CRC may transfer a different youth from that facility to a regular CRC as long as the youth:

(1) Has been in the secure facility for at least twenty-four hours; and

(2) Is considered likely to remain at a regular CRC facility.

[]


NEW SECTION
WAC 388-148-0865
How is a youth transferred from one type of CRC to another?

After deciding that a youth needs to be transferred from one type of crisis residential center (CRC) to another, the director initiating the change must take these steps:

(1) Obtain the department's agreement with the transfer decision.

(2) Communicate with the CRC where the youth is being relocated to:

(a) Assure mutual agreement with the transfer decision; and

(b) Make sure that space for the youth is available to support the transfer.

(3) Document all communication related to the transfer into the youth's file.

(4) The CRC director initiating the transfer must establish and maintain the following written documents:

(a) Transfer procedures for the transfer of youth to another crisis residential center; and

(b) Protocols/agreements with the other crisis residential center's director for youth transfers.

[]


NEW SECTION
WAC 388-148-0870
How long may a youth stay at a CRC?

All CRCs

(1) Youth may stay in any crisis residential center (CRC) for up to five days.

(2) If a youth has been transferred between CRCs, the total number of days spent in both CRCs may not exceed five days.

Secure CRCs

(3) Any youth admitted to a secure CRC must remain there for at least twenty-four hours, unless their parent or guardian removes them.

[]


NEW SECTION
WAC 388-148-0875
What does a youth's orientation into CRCs need to include?

(1) As part of admission to a crisis residential center (CRC), the CRC staff must give an orientation to youth that includes, but is not limited to:

(a) A description of the CRC's program and services;

(b) The physical facility;

(c) The department-approved policy that states that youth may not have guns and other weapons, alcohol, tobacco, and drugs within the facility; and

(d) The department-approved policy on client visitation that includes access by the youth's attorney.

(2) Written documentation of this orientation must be in each youth's file.

[]


NEW SECTION
WAC 388-148-0880
What intervention services must be provided or arrange for by the CRC?

(1) Crisis residential centers (CRCs) must provide or arrange, at a minimum, the following services:

(a) Assessment of the family in order to develop a treatment plan for the youth;

(b) Family counseling focused on communication skills development and problem solving;

(c) Individual and/or group counseling; and

(d) Referrals to transition the family to community-based services.

(2) Intervention services must be documented, in writing, in the youth's case record.

[]


NEW SECTION
WAC 388-148-0885
What behavior management practices are required for CRCs?

(1) Crisis residential centers (CRCs) must follow the department's behavioral management policy as specified in the general licensing requirement section of this chapter (see WAC 388-148-0440 through 388-148-0470).

(2) CRCs must develop policies and procedures when the behavior management practices include use of physical restraint, including:

(a) Who may authorize the use of physical restraint; and

(b) Under what circumstances physical restraint may be used, including time limitations, re-evaluation procedures, and supervisory monitoring.

(3) Written policies and procedures about using physical restraint must be submitted to the department for approval before the policies and procedures are implemented.

(4) All staff must be trained in behavior management techniques prior to using physical restraint.

[]

CRISIS RESIDENTIAL CENTERS -- MULTIDISCIPLINARY TEAM
NEW SECTION
WAC 388-148-0890
What is the purpose of a multidisciplinary team in a CRC?

(1) Crisis residential centers (CRCs) must have multidisciplinary teams available as a service to youth and their families, if they request the service.

(2) The purpose of the multidisciplinary team is to evaluate the youth and family, and agreed to by the parents, and assist the family with any of the following services:

(a) Developing a plan for accessing available social and health-related services;

(b) Obtaining referrals to a chemical dependency specialist and/or county-designated mental health professional;

(c) Recommending no further intervention because the youth and family have worked out the problems that were causing family conflicts; and

(d) Reconciling the youth and family.

(3) Members of multidisciplinary teams may include:

(a) Educators;

(b) Law enforcement personnel;

(c) Court personnel;

(d) Family therapists or mental health providers;

(e) Chemical dependency treatment providers;

(f) Licensed health care practitioners;

(g) Social service providers;

(h) Youth residential placement providers;

(i) Other family members;

(j) Church representatives; and

(k) Members of the family's community.

[]


NEW SECTION
WAC 388-148-0895
When may a multidisciplinary team be requested?

(1) After a youth is admitted into a crisis residential center (CRC), the CRC director or designee must advise the parent or guardian and the youth of their rights to request a multidisciplinary team.

(2) The director or designee also may set up a multidisciplinary team when he or she:

(a) Believes that the:

(i) Youth is a "child in need of services" under RCW 13.32A.030; and

(ii) Parent is unavailable or unwilling to continue efforts to maintain the family structure.

(b) Needs help contacting the youth's parents. If the director or designee is unable to contact the parent or guardian within forty-eight hours, the director or designee must:

(i) Contact the department and request the case be reviewed for a dependency filing under chapter 13.34 RCW or a "child in need of services" filing under chapter 13.32A WAC; and

(ii) Document this information in the child's case file.

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NEW SECTION
WAC 388-148-0900
How is a multidisciplinary team convened?

(1) The crisis residential center (CRC) director or designee must notify the members of the multidisciplinary team of the need to convene.

(2) The director or designee must:

(a) Tell the youth's parents or guardians about the multidisciplinary team if the parents did not make the initial request to form a team;

(b) Advise the parents of their right to select additional members; and

(c) Assist in getting prompt involvement of additional persons that the parent or youth have requested to be added to the multidisciplinary team.

[]


NEW SECTION
WAC 388-148-0905
May a parent disband the multidisciplinary team?

(1) The crisis residential center (CRC) director must advise the parents of their right to disband the multidisciplinary team within twenty-four hours after they receive notice of the team forming, excluding weekends and holidays.

(2) Parents may disband the multidisciplinary team:

(a) Unless a dependency petition has been filed (under RCW 13.32A.140); or

(b) After a dispositional hearing has taken place ordering out-of-home placement for the youth.

[]

CRISIS RESIDENTIAL CENTERS -- STAFF QUALIFICATIONS AND STAFFING RATIOS
NEW SECTION
WAC 388-148-0910
What qualifications must a CRC director have?

Crisis residential center (CRC) directors must meet the same qualifications that are specified for group care directors (see WAC 388-148-0640).

[]


NEW SECTION
WAC 388-148-0915
Do I need a program manager on-site at each facility?

Each facility must have an on-site program manager to coordinate the day-to-day operations of the facility.

[]


NEW SECTION
WAC 388-148-0920
What qualifications must the on-site program manager for a crisis residential program have?

Each on-site program manager must meet the qualifications outlined under WAC 388-148-0655.

[]


NEW SECTION
WAC 388-148-0925
What additional qualifications must the CRC youth care staff have?

(1) At a crisis residential center (CRC), the primary duties of the youth care staff are the care, supervision, and behavioral management of youth. All youth care staff in a CRC must meet the qualifications for youth care staff in a group care program (see WAC 388-148-0660).

Additional CRC youth care staff qualifications

(2) Additional requirements for youth care staff that work in a crisis residential center are as follows:

(a) At least fifty percent of the youth care staff must have completed:

(i) A bachelor's degree; or

(ii) At least two years of college and one year of work in a residential care program for adolescents.

Note: Youth care staff may substitute experience for education on a year-for-year basis. A Bachelor of Arts degree in behavioral or social science may substitute for experience.

(3) The remaining youth care staff must have at least a high school diploma or GED and one of the following:

(a) One year of successful experience working with youth in a group setting;

(b) One year of successful experience as a foster parent for three or more children;

(c) Have skills and abilities to work successfully with the challenging behaviors of children in care; and

(d) Have effective communication and problem solving skills.

Note: Two years of college may be substituted for the required experience.

(4) Each youth care staff person must be at least twenty-one years of age, unless they are nineteen or twenty and enrolled in an internship program with an accredited college or university.

[]


NEW SECTION
WAC 388-148-0930
What are the ratio requirements of youth care staff to youth in CRCs?

You must ensure the safety of the youth that are residing in crisis residential centers (CRCs) by maintaining staffing ratios. This may require a staffing ratio higher than the minimum listed if necessary for the health and safety of youth and/or staff.

All CRCs

(1) All crisis residential centers must have at least two staff on site at all times when youth are present.

Regular CRCs

(2) Regular crisis residential centers must have at least one youth care staff must be on duty for every four youth in care during the waking and sleeping hours of the youth.

Secure CRCs

(3) Secure crisis residential centers must have at least one youth care staff on duty for every three youth during the waking and sleeping hours of the youth.

(4) Secure crisis residential centers that are located in the same facility as detention facilities must have the at least:

(a) One awake youth care staff on duty for every four youth during waking and sleeping hours;

(b) Two staff present at all times when a youth is placed in a secure CRC that is co-located with a detention center.

[]

CRISIS RESIDENTIAL CENTERS -- STAFF TRAINING
NEW SECTION
WAC 388-148-0935
What training must staff at a CRC take?

(1) All staff working at a CRC must complete a minimum of sixteen hours of pre-service job orientation prior to beginning unsupervised child care responsibilities. Training must include:

(a) Presentation of the CRC agency's policies and procedures manual;

(b) Behavior management techniques;

(c) Crisis intervention techniques;

(d) Family intervention techniques;

(e) Child abuse and neglect reporting requirements;

(f) Youth supervision requirements; and

(g) HIV/blood-borne pathogen training.

(2) Staff working at a CRC must complete a minimum of twenty-four hours of on-going education and in-service training annually. This training must include:

(a) Crisis intervention techniques, including verbal de-escalation, positive behavior support, and physical response/restraint training as approved by the department;

(b) Behavior management techniques;

(c) Substance abuse;

(d) Suicide assessment and intervention;

(e) Family intervention techniques;

(f) Cultural diversity;

(g) Mental health issues and interventions;

(h) Mediation skills;

(i) Conflict management/problem solving skills;

(j) Physical and sexual abuse; and

(k) Emergency procedures.

(3) All staff working at a CRC must have current first aid and CPR training.

(4) The director or designee of the CRC must document completion of all training in each staff person's personnel file.

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CRISIS RESIDENTIAL CENTERS -- RECORD-KEEPING
NEW SECTION
WAC 388-148-0940
What record keeping is required for CRCs?

(1) Crisis residential centers (CRC) must follow the general licensing requirements for record keeping (see WAC 388-148-0125).

(2) In addition, crisis residential centers must record:

(a) The time and date a placement is made;

(b) The names of the person and organization making the placement; and

(c) Reasons for the placement.

[]


NEW SECTION
WAC 388-148-0945
What additional record-keeping requirements exist for secure crisis residential centers?

(1) If you own or operate secure crisis residential centers, you must maintain, at a minimum, hourly logs of where the youth are physically located.

(2) You must have a policy on the use and retention of these logs, including but not limited to staff briefings between shifts to verify:

(a) Where youth are physically located at each shift change; and

(b) Weekly inspections of any security devices.

(3) You must retain these logs for seven years.

(4) You must also maintain a log and written report that identifies all incidents requiring physical restraints for a youth (see WAC 388-148-0470).

(5) Within seven days of a youth's discharge, you must send the child's social worker a written summary that includes, but is not limited to:

(a) Community-based referrals;

(b) Assessment information on the family and child;

(c) Family reconciliation attempts;

(d) Contacts with families and professionals involved;

(e) Recommendations for all family members;

(f) Medical and health related issues; and

(g) Any other concerns, such as legal issues and school problems.

(6) You must retain a copy of any discharge summaries in the youth's case record at the secure crisis residential center.

[]

CRISIS RESIDENTIAL CENTERS -- ADDITIONAL CONSTRUCTION AND FIRE SAFETY REQUIREMENTS
NEW SECTION
WAC 388-148-0950
Are there different construction and fire safety requirements for facilities that have mixed groups?

(1) If a facility, such as a regular or a secure crisis residential center (CRC) or group home and a CRC, has mixed groups, the facility has to follow the most stringent construction and fire safety requirements of the two groups.

(2) If a facility is licensed by the department of health, such as a secure residential treatment center, the facility must meet construction and fire safety standards for psychiatric hospital security rooms when they have a secure CRC or a secure residential treatment center within the physical structure.

[]

STAFFED RESIDENTIAL HOMES -- PROGRAM AND SERVICES
NEW SECTION
WAC 388-148-0955
What is the purpose of a staffed residential home?

A staffed residential home employs staff to provide twenty-four-hour care to children who:

(1) Need foster care but cannot adjust to the close, personal relationships in a foster home; or

(2) Have emotional disturbances or physical or mental disabilities; or

(3) Are medically fragile.

[]


NEW SECTION
WAC 388-148-0960
Who may operate a staffed residential home for children?

A staffed residential home for children may operate only in conjunction with a licensed child-placing agency or under a contract or written agreement with children's administration.

[]


NEW SECTION
WAC 388-148-0965
What must be included in a written agreement to provide services as a staffed residential home?

A written agreement with children's administration to provide services to children as a staffed residential home must include but is not limited to:

(1) The number of children served at one time;

(2) The expectations of services to be provided;

(3) The steps to be taken to include the child's family;

(4) The plan on how coordination will occur with community partners;

(5) The plan on how permanency planning for the children will take place;

(6) A safety and supervision plan or each child; and

(7) A behavior management plan for each child, as appropriate.

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NEW SECTION
WAC 388-148-0970
What services must a staffed residential home provide?

(1) You must be able to give the specialized services required by the group that you serve in your staffed residential home. These services may be provided through your own program or through using other community resources.

(2) You must provide care and supervision for children you serve in a staffed residential home, considering their ages and physical conditions.

(3) You must submit a written program description for our approval that includes:

(a) A list of services that you will provide to children and their families;

(b) Who and how these services will be carried out; and

(c) A schedule of typical daily activities for the children under your care.

(4) Services for children must include:

(a) Transportation;

(b) Teaching social and living skills;

(c) Opportunities for play and recreation; and

(d) Opportunities to participate in community and cultural activities.

[]

STAFF RESIDENTIAL HOMES -- STAFF QUALIFICATIONS, STAFFING RATIOS, AND CAPACITY
NEW SECTION
WAC 388-148-0975
Must the director be on the premises when children are under care at a staffed residential home?

The director, on-site program manager, or a person meeting the same qualifications, must be on the premises of the staffed residential home during daytime hours when children are under care.

[]


NEW SECTION
WAC 388-148-0980
What are the qualifications for child care staff at a staffed residential home?

Child care staff at a staffed residential home must meet the qualifications outlined for group care programs (see WAC 388-148-0660).

[]


NEW SECTION
WAC 388-148-0985
What are your supervision requirements for staffed residential homes?

(1) On-site program manager or a supervisor must be on-site at all times.

(2) In staffed residential homes, child care staff under twenty-one years of age must be supervised by staff that are at least twenty-one years old.

[]


NEW SECTION
WAC 388-148-0990
What is the ratio of child care staff to children in staffed residential homes?

You must meet the minimum ratios of child care staff to children under care at a staffed residential home.

(1) To keep the proper ratio of staff to children, the director, support staff and maintenance staff may serve as child care staff if they have adequate training.

(2) The ratio for staffed residential homes is, at least, one child care staff for every six children during waking hours of children.

(3) During sleeping hours of youth, at least, one staff person must be awake when:

(a) There are more than six children in care; or

(b) The major focus of the program is behavioral rather than the development of independent living skills such as teen parent and responsible living skills programs; or

(c) The youth's behavior poses a safety risk to self and/or others.

(4) When only one child care staff person is on duty, a second person must be on call and available to respond within one half-hour.

(5) You must have relief staff so that all staff can have the equivalent of two days off a week.

[]


NEW SECTION
WAC 388-148-0995
How many children may I serve in my staffed residential home?

The department restricts the number of children that a licensed staffed residential home may serve.

(1) The department may license a staffed residential home for six or fewer children. The total number of children in your home or facility must not exceed six at any time.

(2) The department may restrict the number of children in a staffed residential home according to the age and needs of the children.

(3) If only one staff person is on duty at a staffed residential home, that home must not care for more than four children. An additional staff person is required to care for more than four children.

(4) You may have only two children under two years of age in your home at a time.

(5) The department may license a staffed residential home for up to three children with mental or physical disabilities that are severe enough to require nursing care if you meet the following conditions:

(a) You provide staff that are qualified by training and experience to provide proper care, including necessary medical procedures; and

(b) The children's treatment is under the supervision of physicians.

[]

STAFFED RESIDENTIAL HOMES -- ROOM REQUIREMENTS
NEW SECTION
WAC 388-148-1000
Are there room requirements for staffed residential homes?

The department has certain requirements for rooms that you must meet in order to operate or own a staffed residential center.

(1) You must provide rooms that are ample in size and properly furnished for the number of children you serve.

(2) You must provide each of the following rooms or areas:

(a) Bedrooms that meet general licensing requirements (see WAC 388-148-0230 through 388-148-0240) and have additional space for any special medical equipment needed by children;

(b) At least one comfortably furnished living room;

(c) A dining room area that is ample in size and suitably furnished for your residents;

(d) A room for staff on night supervision that is separate from but close to the sleeping rooms of the children;

(e) At least one separate indoor recreation area with a size and location that is suitable for recreational and informal education activities;

(f) A room or area that may be used as an administrative office; and

(g) A visiting area where visitors can have privacy.

(3) The licensor and staffed residential home director may decide what rooms may have multiple uses (for example, dining room and recreation area or visiting area and living room).

[]

STAFFED RESIDENTIAL HOMES -- FIRE SAFETY
NEW SECTION
WAC 388-148-1005
Are there specific fire safety requirements for the care of nonmobile children?

(1) Floors located more than four feet above ground (one-half story up) or in the basement must not be used for care of nonmobile children for safety reasons.

(2) In your staffed residential home, if you care for more than one nonmobile child at a time, the care for both children must be on the ground floor.

[]


NEW SECTION
WAC 388-148-1010
What safety features do I need for hazardous areas?

The department requires hazardous areas in your staffed residential home to have certain safety features.

(1) Hazardous areas must be separated from the staffed residential home facility by at least a "one-hour" fire-resistant wall. Hazardous areas include rooms or spaces containing:

(a) A commercial-type cooking kitchen;

(b) A boiler;

(c) A maintenance shop;

(d) A janitor closet;

(e) Laundry;

(f) A woodworking shop;

(g) Flammable or combustible materials; or

(h) Painting operations.

(2) Exception: We do not require a fire-resistant wall when:

(a) A kitchen contains only a domestic cooking range; and

(b) Food preparation does not produce smoke or grease-laden vapors.

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NEW SECTION
WAC 388-148-1015
What requirements do you have regarding windows?

You must follow our requirements for windows in your staffed residential home.

(1) Every sleeping or napping room in your home must have at least one window that opens for emergency rescue.

(2) You do not need to meet the window requirement if sleeping or napping rooms in your facility have:

(a) Doors leading to two separate exit ways; or

(b) A door leading directly to the exterior of the building.

(3) For safety, all escape or rescue windows must not be less than twenty-four inches high by twenty inches wide and not more than forty-four inches off the floor for exits.

(4) You may install bars, grilles, grates or similar devices on emergency escape or rescue windows or doors. However, these devices must have approved release mechanisms that can be opened easily from the inside without using a key or special instructions for operating these devices.

[]


NEW SECTION
WAC 388-148-1020
What requirements do you have for exits in staffed residential homes?

(1) Each staffed residential home must have at least one swinging exit door that is pivoted or hinged on the side.

(2) Other exit doors in your home may be sliding doors.

(3) Each home used for child care must have two exits, located at opposite ends of the building or one on each floor.

(4) The requirement for one of the two exits may be deleted if:

(a) A residential sprinkler system (complying with the state fire Marshall standards) is provided throughout the entire building; and

(b) The remaining exit is a door.

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NEW SECTION
WAC 388-148-1025
What requirements are there for exits?

For a staffed residential home, you must follow our requirements for exits from the home and certain rooms.

(1) Exit doors and rescue windows must be easily opened to the fully open position.

(2) Exit doors and rescue windows must be opened easily from the inside without requiring a key or special instructions.

(a) Night latches, dead bolts, security chains, manually operated edge or surface-mounted flush bolts and surface bolts must not be used.

(b) Locks on outside exit doors must automatically unlock when the doorknob is turned from the inside.

(3) Obstacles must not be placed in corridors, aisles, doorways, exit doors, stairways, ramps, or rescue windows.

(4) You must not use space that is accessible only by ladder, folding stairs, or trap doors.

(5) Every bathroom door lock must permit opening the locked door from the outside in an emergency. The key or opening device must be readily accessible to the staff.

(6) Every closet door latch must be designed so children can open the door from the inside of the closet.

(7) Barriers to exiting must be restricted to gates or other approved devices that are easily opened and do not delay exiting.

[]


NEW SECTION
WAC 388-148-1030
Where do I place smoke detectors?

(1) For your staffed residential home, you need to have smoke detectors in:

(a) All sleeping and napping rooms; and

(b) A corridor or area that is centrally located and gives access to each separate sleeping or napping area.

(2) If a sleeping or napping room has a ceiling height that is at least twenty-four inches higher than its adjoining hallway, you must install a smoke detector in both the hallway and the room next to the sleeping or napping room.

[]


NEW SECTION
WAC 388-148-1035
What other requirements must I follow for smoke detectors?

For a staffed residential home, you must follow additional requirements for smoke detectors:

(1) Smoke detectors must sound an alarm that is audible in all sleeping and napping areas. The minimum acceptable audibility level is sixty decibels.

(2) In new construction, required smoke detectors must receive their primary power from building wiring from a commercial source. Wiring must be permanent, with a disconnecting switch only for overcurrent protection.

(3) Smoke detectors must also:

(a) Be equipped with a battery backup; and

(b) Emit a signal when the batteries are low.

(4) If installed in existing buildings or buildings without commercial power, smoke detectors may be solely battery operated.

(5) Single-station smoke detectors must be tested at monthly intervals or in a manner specified by the manufacturer. Records of such testing must be maintained upon the premises.

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NEW SECTION
WAC 388-148-1040
What are your requirements for fire extinguishers?

You must follow department standards for fire extinguishers in your staffed residential home.

(1) You must have readily available at least one approved rated or larger all purpose (ABC) fire extinguisher.

Note: Approved 2A10BC-rated means a fire extinguisher with an Underwriters' Laboratory label on the name plate classifying the extinguisher as 2A10BC-rated. These extinguishers are usually multi-purpose, five-pound dry chemical units.

(2) Approved fire extinguisher(s) must be located in the area of the normal path of exiting. The maximum travel distance to an extinguisher from any place on the premises must not exceed seventy-five feet. When the travel distance exceeds seventy-five feet, we require an additional extinguisher(s).

(3) Fire extinguishers must be ready for use at all times.

(4) Fire extinguishers must be kept on a shelf or mounted in a bracket so that the top of the extinguisher is not more than five feet above the floor.

(5) Fire extinguishers must receive yearly maintenance certification by a licensed firm specializing in this work. Maintenance means a thorough check of the extinguisher for:

(a) Mechanical parts;

(b) Extinguishing agent; and

(c) Expelling means.

(6) Exception: New fire extinguishers do not need to receive an additional certification test during the first year.

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NEW SECTION
WAC 388-148-1045
What fire prevention measures must I take?

The department requires that you must take the following fire prevention measures for your staffed residential home:

(1) You must request the local fire department to visit your home to:

(a) Assist care givers in meeting all necessary fire safety requirements; and

(b) Become familiar with your home.

(2) You must assure that furnace rooms are:

(a) Maintained free of lint, grease, and rubbish; and

(b) Suitably isolated, enclosed, or protected.

(3) Flammable or combustible materials must be stored away from exits and in areas that are not accessible to children. Combustible rubbish must not be allowed to collect and must be removed from the building or stored in closed, metal containers away from building exits.

(4) All trash must be removed daily from the building and thrown away in a safe manner outside the building. All containers used for the disposal of waste material must consist of noncombustible materials and have tops.

(5) All electrical motors must be kept free of dust.

(6) Open-flame devices capable of igniting clothing must not be left on, unattended or used in a manner that could result in an accidental ignition of children's clothing.

(7) Candles must not be used.

(8) All electrical circuits, devices and appliances must be properly maintained. Circuits must not be overloaded. Extension cords and multi-plug adapters must not be used in place of permanent wiring and proper outlets.

(9) House numbers must be clearly visible from the street or road in front of the property. Where the home is not clearly visible from the road, the address must be posted at the head of the driveway.

Note: This is to allow emergency vehicles and fire trucks to easily find addresses.

(10) Fireplaces, woodstoves, and similar devices must be installed and approved according to the rules that were in effect at the time of installation (see the local building permit). These devices must be properly maintained and must be cleaned and certified at least once a year or maintained according to the manufacturer's recommendations.

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NEW SECTION
WAC 388-148-1050
What are the requirements for fire sprinkler systems?

If you have sprinkler systems installed in your staffed residential home for fire prevention, you must have them tested and certified yearly by a Washington state licensed fire sprinkler contractor.

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NEW SECTION
WAC 388-148-1055
What are the requirements for a fire evacuation plan?

(1) You must develop a written fire evacuation plan for your staffed residential home. The evacuation plan must include an evacuation floor plan, identifying exit doors and windows. The plan must be posted at each exit door.

(2) You must ensure that the plan includes:

(a) Action to take by the person discovering a fire;

(b) Methods for sounding an alarm on the premises;

(c) Action to take for evacuating the building that ensures responsibility for the children; and

(d) Action to take while waiting for the fire department.

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NEW SECTION
WAC 388-148-1060
What are the requirements for fire drills?

(1) You must conduct a fire drill in your staffed residential home at least once each month.

(2) You must maintain a written record on the premises that indicates the date and time that drill practices were completed.

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NEW SECTION
WAC 388-148-1065
What fire safety procedures do staffed residential home staff need to know?

You and your staff at the staffed residential home must be familiar with safety procedures related to fire prevention.

(1) You and your staff must be familiar with all aspects of the fire drill.

(2) You and your staff must be able to:

(a) Operate all fire extinguishers installed on the premises;

(b) Test smoke detectors (single station types); and

(c) Conduct frequent inspections of the home to identify fire hazards and take action to correct any hazards noted during the inspection.

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CHILD PLACING AGENCIES -- PROGRAM/SERVICES/OUT-OF-STATE PLACEMENTS
NEW SECTION
WAC 388-148-1070
What services may a child-placing agency provide?

The department licenses child-placing agencies to provide:

(1) Certification of eligible foster homes meeting full licensing requirements;

(2) Maternity services to expectant mothers;

(3) Specialized (treatment) foster care;

(4) Adoption services; and

(5) Residential care programs, such as group homes, crisis residential centers, and independent living skills programs.

"I" and "you" refers to a person who operates or owns a child-placing agency.

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NEW SECTION
WAC 388-148-1075
Do child-placing agency foster homes and group care facilities need to be licensed before placements?

All foster homes and group care facilities that are used by child-placing agencies must be licensed by the department before any children are placed in them (see WAC 388-148-0015).

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NEW SECTION
WAC 388-148-1080
What health histories do I need to provide to foster or adoptive parents?

(1) To meet our requirements, your child-placing agency must provide adoptive (per WAC 388-25-0615) or foster parents with the following information at the time of placement:

(a) The mental and physical health histories of the birth parents;

(b) A written health history for each child prior to placement, including a history of shots, allergies, previous illnesses, and conditions that may adversely affect the child's health; and

(c) A developmental and psychological history for adoptive children.

Note: You must arrange for the child's medical examinations, immunizations, and health care as required by WAC 388-148-0295 and 388-148-0335 General requirements: Medical care and medication management.

(2) The adoptive parent(s) must sign one copy of the report, showing that they have received the information. You must retain this signed copy in the child's permanent file.

(3) When the child is being placed for adoption, your report must not contain information that might identify the birth parents.

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NEW SECTION
WAC 388-148-1085
When may child-placing agencies from outside the state place children in this state?

Child-placing agencies with offices in other states or another country may arrange to place children in Washington state under each of the following conditions:

(1) The out-of-state agency must be fully licensed, certified, or recognized for child-placing functions in its own home state or country.

(2) All public and private agencies must comply with the requirements of the "interstate compact on the placement of children (ICPC)" (see RCW 26.34.011).

Note: Contact the ICPC program manager with children's administration for more information.

(3) The in-state facility receiving children is responsible for:

(a) Conducting a study of the home where the child will be placed;

(b) Related case management; and

(c) Supervising the placement until the child is legally adopted, reaches eighteen years of age, or returns to the originating state.

(4) An out-of-state agency must give us copies of the following written documents:

(a) Written agreements with Washington state agencies;

(b) Evidence of the agency's legal authority to place the child; and

(c) Certification that the agency will assume financial responsibility for any child placed in Washington state until the child is adopted, financially independent, or reaches the age of eighteen.

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CHILD PLACING AGENCIES -- ROOM REQUIREMENTS
NEW SECTION
WAC 388-148-1090
Are child-placing agencies required to have office space?

You must be housed in offices that are adequately equipped to carry out your child-placing agency's programs and that can offer privacy for interviews with parents and children.

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CHILD PLACING AGENCIES -- FOSTER CARE SERVICES
NEW SECTION
WAC 388-148-1095
How may my child-placing agency certify a foster home for licensing by the department?

(1) To certify a foster home for licensing by the department, you must use applications, home study forms, and procedures that are approved by DLR (see WAC 388-148-0060 through 388-148-0090).

(2) The foster home must meet the licensing requirements for certification by your child-placing agency in order to be licensed by the department.

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NEW SECTION
WAC 388-148-1100
What children may child-placing agency foster homes accept?

As part of our requirements, foster homes that child-placing agencies certify as meeting our licensing requirements may accept children only from:

(1) The licensed child-placing agency that certified the foster home; or

(2) The department, as long as these conditions are met:

(a) The child is in the legal custody of, or is under the department's supervision; and

(b) The child placements are approved in writing by the child-placing agency responsible for supervising the foster home or facility.

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NEW SECTION
WAC 388-148-1105
May different child-placing agencies share eligible foster parents and children for placement?

(1) Different child-placing agencies may share eligible foster parents for placement as long as safety and health requirements are met.

(2) The participating agencies must have written agreements between them specifying the criteria and conditions for sharing foster parents prior to the placement of the children.

(3) The written agreements must specify roles and responsibilities of each agency.

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NEW SECTION
WAC 388-148-1110
What do I need to consider in making foster care placements?

(1) In planning foster care placements for children, you must consider:

(a) The children's basic right to their own home and family;

(b) The importance of providing skillful professional service to the child's birth parents to help them meet each child's needs in the home;

(c) Each child's individual needs, cultural and religious background and family situation;

(d) The wishes and participation of each child's parent(s); and

(e) The selection of a foster home that will enhance each child's capacities and meet each child's individual needs.

(2) You must use a written social summary for each child as the basis for acceptance for foster care and related social services.

(3) Every foster care placement that you facilitate must be based on well-planned, individual preparation of the child and the child's family. However, in an emergency situation, you may place a child in a foster home prior to preparing the child and the child's family.

(4) A child may be placed in foster care only with the written consent of the child's parents or under a court order. This consent or order must include approval for emergency medical care or surgery.

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NEW SECTION
WAC 388-148-1115
May I share information about the child with the foster parents?

(1) You must give foster parents any information that may be shared about the child and the child's family. This helps foster parents make an informed decision about whether or not to accept a child in their home. Sharing information about behavioral and emotional problems is especially important.

(2) You must inform the foster parents that this information is confidential and can not be shared with persons who are not involved with the child's care.

(3) You must document in the child's file that you have shared this information at the time of placement.

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NEW SECTION
WAC 388-148-1120
How often should the case manager contact the foster child and family?

The case manager must contact a foster child and the foster child's foster family, according to a case plan that reflects the child's needs. Case managers must make at least one in-home health and safety visit every ninety days. Each foster child and one or both foster parents must be seen at each visit.

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CHILD PLACING AGENCIES -- ADOPTION SERVICES
NEW SECTION
WAC 388-148-1125
Do you have requirements for adoptive services?

(1) As a child-placing agency providing adoption services, you must meet the department's requirements related to adoption services (see chapter 388-25 WAC), to provide adoptive services to children.

(2) You must recruit potential adoptive families that reflect the diversity of children in your community.

(3) You must provide adoptive applicants with the following services, at a minimum:

(a) Information about the adoption process;

(b) Your agency's policies, practices and legal procedures;

(c) Types of children available for adoption and implications for parenting different types of children; and

(d) Information on adoption support programs.

(4) You must document that you provided this information to the adoptive applicant in the applicant's file.

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NEW SECTION
WAC 388-148-1130
What is the process for adoptions?

You must go through the following steps to place a child for adoption.

(1) The applicants must submit an application and a completed "criminal history and background inquiry" form to the child-placing agency.

(2) Once you have received an application, but before you have sign a contract for services, you must give the applicants a written statement about:

(a) The adoption agency's fixed fees and fixed charges to be paid by the applicant;

(b) An estimate of additional itemized expenses to be paid by applicant; and

(c) Specific services covered by fees that you offer for child placement or adoption.

(3) Your staff must complete an adoptive home study as required in RCW 26.33.190 with the participation of the applicant(s). For the study, your staff and the applicants need to decide about:

(a) The suitability of the applicant(s) to be adoptive parent(s); and

(b) The type of child(ren) for which the applicant or applicants are best suited.

(4) Your staff must accept or deny the application and give an explanation for your decision.

(5) You must file preplacement (home study) reports with the court (as required by RCW 26.33.180 through 26.33.190).

(6) Your staff must prepare the potential adoptive parent(s) for placement of a specific child by:

(a) Locating and providing information about the child and the birth family to the prospective adoptive family as described in chapter 388-25 WAC.

(b) Discussing the likely implications of the child's background for adjusting in the adoptive family.

(7) Your staff must re-evaluate the applicant(s) suitability for adopting a child each time an adoptive placement is considered.

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NEW SECTION
WAC 388-148-1135
What requirements exist for specialized adoptive services?

Specialized adoptive services are inter-country adoption, interstate adoption and adoptions for children with special needs (such as developmental disability or emotional disability).

(1) If your child-placing agency is providing specialized adoptive services, you must have:

(a) Supervisory staff who have specialized training in the particular area of adoption that you want to provide; and

(b) A written in-service training program for staff in these specialized adoptive services.

(2) If you are facilitating the adoptive placement of children who have special needs, you must:

(a) Have adoptive families who are able to meet the children's special needs, such as behavioral disturbance, medical problems or developmental disabilities; or

(b) Have a plan for active recruitment of suitable adoptive families.

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CHILD PLACING AGENCIES -- ADOPTION RECORDS
NEW SECTION
WAC 388-148-1140
Must my child-placing agency retain the records of adopted children?

Your child-placing agency must retain a record of each child you place in permanent custody. This record must contain all available identifying legal, medical, and social information and must be kept confidential, as required by chapter 26.33 RCW.

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NEW SECTION
WAC 388-148-1145
What happens to the adopted children's records if my agency closes?

If your agency closes, you must make arrangements for the permanent retention of the adopted children's records. You must inform DSHS, children's administration state adoption program manager about the closure of the agency and where the files will be kept (for example, by another adoption agency or Washington state archival files).

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REPEALER

     The following sections of the Washington Administrative Code are repealed:
WAC 388-73-010 Authority.
WAC 388-73-012 Definitions.
WAC 388-73-014 Persons and organizations subject to licensing.
WAC 388-73-016 Exceptions to rules.
WAC 388-73-018 Persons and organizations not subject to licensing.
WAC 388-73-019 Effect of local ordinances.
WAC 388-73-01950 Fire standards.
WAC 388-73-020 Certification of juvenile detention facility and exempt agency.
WAC 388-73-022 Application or reapplication for license or certification -- Investigation.
WAC 388-73-024 Licenses for homes supervised by licensed agency.
WAC 388-73-026 Licensing of employees.
WAC 388-73-028 Limitations on licenses and dual licensure.
WAC 388-73-030 General qualifications of licensee, adoptive applicant, and persons on the premises.
WAC 388-73-032 Age of licensee.
WAC 388-73-034 Posting of license.
WAC 388-73-036 Licensure -- Denial, suspension, or revocation.
WAC 388-73-038 Licensed capacity.
WAC 388-73-040 Discrimination prohibited.
WAC 388-73-042 Religious activities.
WAC 388-73-044 Special requirements regarding American Indians.
WAC 388-73-046 Discipline.
WAC 388-73-048 Corporal punishment.
WAC 388-73-050 Abuse, neglect, exploitation.
WAC 388-73-052 Interstate placement of children.
WAC 388-73-054 Client records and information -- All agencies.
WAC 388-73-056 Reporting of illness, death, injury, epidemic, child abuse, or unauthorized absence -- All facilities.
WAC 388-73-057 Reporting of circumstantial changes.
WAC 388-73-058 Earnings, allowances, personal belongings.
WAC 388-73-060 Work assignments.
WAC 388-73-062 Transportation.
WAC 388-73-064 Clothing.
WAC 388-73-066 Personal hygiene.
WAC 388-73-068 Personnel policies.
WAC 388-73-069 Consumption of alcoholic beverages.
WAC 388-73-070 Training.
WAC 388-73-072 Education and vocational instruction.
WAC 388-73-074 Social service staff.
WAC 388-73-076 Social study -- Treatment plans.
WAC 388-73-077 Multidisciplinary care plan for severely and multiply-handicapped children.
WAC 388-73-078 Clerical, accounting and administrative services.
WAC 388-73-080 Support and maintenance staff.
WAC 388-73-100 Site and telephone.
WAC 388-73-101 Wheeled baby walkers.
WAC 388-73-102 Equipment, safety, and maintenance.
WAC 388-73-103 Water safety.
WAC 388-73-104 Firearms.
WAC 388-73-106 Storage.
WAC 388-73-108 Bedrooms.
WAC 388-73-110 Special care room.
WAC 388-73-112 Kitchen facilities.
WAC 388-73-114 Housekeeping sink.
WAC 388-73-116 Laundry.
WAC 388-73-118 Toilets, handwashing sinks, and bathing facilities.
WAC 388-73-120 Lighting.
WAC 388-73-122 Pest control.
WAC 388-73-124 Sewage and liquid wastes.
WAC 388-73-126 Water supply.
WAC 388-73-128 Temperature.
WAC 388-73-130 Ventilation.
WAC 388-73-132 Health care plan.
WAC 388-73-134 First aid.
WAC 388-73-136 Medications controlled by licensee.
WAC 388-73-138 Self-administration of medications.
WAC 388-73-140 Health history, physical examinations, immunizations.
WAC 388-73-142 Infection control, communicable disease.
WAC 388-73-143 HIV/AIDS education and training.
WAC 388-73-144 Nutrition.
WAC 388-73-146 Care of younger or severely and multiply-handicapped children.
WAC 388-73-200 Child-placing agency.
WAC 388-73-202 Required personnel.
WAC 388-73-204 Office space.
WAC 388-73-206 Out-of-country, out-of-state agencies.
WAC 388-73-208 Medical care.
WAC 388-73-210 Foster care licensees.
WAC 388-73-212 Foster care placements.
WAC 388-73-213 Certification to provide adoption services.
WAC 388-73-214 Adoption procedures.
WAC 388-73-216 Adoptive placements.
WAC 388-73-300 Foster family homes.
WAC 388-73-302 Orientation and training.
WAC 388-73-304 Capacity.
WAC 388-73-306 Foster parents -- Employment.
WAC 388-73-308 Absence from home.
WAC 388-73-310 Fire safety.
WAC 388-73-312 Family foster homes -- Services to person under care.
WAC 388-73-351 Staffed residential homes for children or expectant mothers.
WAC 388-73-353 Agency affiliation.
WAC 388-73-355 Function of staffed residential home for children or expectant mothers.
WAC 388-73-357 Capacity.
WAC 388-73-361 Required positions.
WAC 388-73-363 Nursing services.
WAC 388-73-365 Required rooms, areas, and equipment.
WAC 388-73-367 Staffed residential homes for children or expectant mothers--Services to person under care.
WAC 388-73-369 Fire safety--Staffed residential child care home for children or expectant mothers.
WAC 388-73-371 Location of care.
WAC 388-73-373 Occupancy separations.
WAC 388-73-375 Exits.
WAC 388-73-377 Windows.
WAC 388-73-379 Sprinklers.
WAC 388-73-381 Accessibility of exits.
WAC 388-73-383 Single station smoke detectors.
WAC 388-73-385 Fire extinguishers.
WAC 388-73-387 Fire prevention.
WAC 388-73-389 Sprinkler system maintenance.
WAC 388-73-391 Fire evacuation plan.
WAC 388-73-393 Fire evacuation drill.
WAC 388-73-395 Staff fire safety training.
WAC 388-73-500 Day treatment center.
WAC 388-73-502 Function of day treatment program.
WAC 388-73-504 Personnel.
WAC 388-73-506 Ratio of counselor and teaching staff to children.
WAC 388-73-508 Program.
WAC 388-73-510 Ill children.
WAC 388-73-512 Play areas.
WAC 388-73-600 Group care facilities.
WAC 388-73-602 Function of group care facility.
WAC 388-73-604 Daily activity program.
WAC 388-73-606 Required positions.
WAC 388-73-610 Required rooms, areas, and equipment -- Group care facilities.
WAC 388-73-700 Maternity services.
WAC 388-73-702 Types of maternity services.
WAC 388-73-704 Daily activities program.
WAC 388-73-706 Eligibility for service -- Required services.
WAC 388-73-708 Required personnel.
WAC 388-73-710 Services provided.
WAC 388-73-712 Health education.
WAC 388-73-714 Family life education.
WAC 388-73-718 Child care.
WAC 388-73-720 Medical service.
WAC 388-73-722 Required rooms, areas, equipment.
WAC 388-73-800 Crisis residential centers.
WAC 388-73-802 Limitations on number of facilities.
WAC 388-73-803 Crisis residential center--Admission.
WAC 388-73-804 Hours of operation.
WAC 388-73-805 Crisis residential center administrator requirements--Multidisciplinary teams.
WAC 388-73-810 Group crisis residential centers.
WAC 388-73-815 Group crisis residential centers -- Staffing.
WAC 388-73-820 Family crisis residential centers.
WAC 388-73-821 Behavior management--Secure crisis residential centers.
WAC 388-73-822 Secure crisis residential centers--Staff training.
WAC 388-73-823 Secure crisis residential centers--Program requirements.
WAC 388-73-825 Secure crisis residential center--Physical facility.
WAC 388-73-900 Facilities for severely and multiply-handicapped children.
WAC 388-73-901 Multidisciplinary care plan for severely and multiply-handicapped children.
WAC 388-73-902 Services provided.
WAC 388-73-904 Therapy room.

Washington State Code Reviser's Office