Original Notice.

     Preproposal statement of inquiry was filed as WSR 00-05-097.

     Title of Rule and Other Identifying Information: Chapter 246-323 WAC, Residential treatment facilities for psychiatrically impaired children and youth; chapter 246-325 WAC, Adult residential rehabilitation centers and private adult treatment homes; and chapter 246-326 WAC, Alcoholism treatment facilities.

     The proposed rules create new chapter 246-337 WAC.

     Hearing Location(s): Department of Health, 310 Israel Road S.E., Conference Room 152, Tumwater, WA 98501, on June 7, 2005, at 1:00 p.m.

     Date of Intended Adoption: June 10, 2005.

     Submit Written Comments to: Allen Spaulding, 310 Israel Road, P.O. Box 47852, Tumwater, WA 98504-7852, or http://www3.doh.wa.gov/policyreview/, fax (360) 236-2901, by June 7, 2005.

     Assistance for Persons with Disabilities: Contact Allen Spaulding by June 3, 2005, TTY (800) 833-6388 or (360) 236-2929.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rules develop chapter 246-337 WAC with a core set of requirements that address all facility service categories, plus program specific requirements, that are flexible to meet the changing needs of the adult and child populations receiving treatment in community based residential treatment facilities for chemical dependency and mental illness.

     The proposal repeals existing chapters 246-323, 246-325, and 246-326 WAC.

     Reasons Supporting Proposal: The proposed rules combine like requirements into one core chapter to establish consistency amount the different service categories, remove any unnecessary requirements and increase clarity.

     Statutory Authority for Adoption: Chapter 71.12 RCW.

     Statute Being Implemented: Chapter 71.12 RCW.

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

     Name of Proponent: Department of Health, governmental.

     Name of Agency Personnel Responsible for Drafting and Implementation: Barbara Runyon, 310 Israel Road, Tumwater, WA 98504-7852, (360) 236-2937; Enforcement: Gary Bennett, 310 Israel Road, Tumwater, WA 98504-7852, (360) 236-2902.

     A small business economic impact statement has been prepared under chapter 19.85 RCW.

     Rule-making Requirements of the Regulatory Fairness Act (chapter 19.85 RCW): The Regulatory Fairness Act, RCW 19.85.030 requires the department to conduct a small business economic impact statement (SBEIS) for proposed rules that have more than minor impact on small businesses. As defined in RCW 19.85.020 a small business is "any business entity, including a sole proprietorship, corporation, partnership, or other legal entity, that is owned and operated independently from all other businesses, that has the purpose of making a profit, and that has fifty or fewer employees."

     1. Briefly describe the proposed rule: The proposed rule outlines the minimum public health and safety standards for the licensure and operations of an RTF in Washington state.

     Minor Changes:

•	Condense and clarify wording, grammar, structure, and formatting.
•	Clarify requirements for licensing, reporting, documentation, and compliance.
•	Remove issues unrelated to public health.
•	Update terminology to reflect current usage and populations served.

     Changes Easing Requirements:

•	Reflect the current building code in describing adequate space as providing at least a three-foot clear path of egress from one side of each bed or mattress in case of fire.
•	Allow licensees to wash and sanitize laundry in accordance with the washer manufacturer's recommendations and detergent and sanitizer instructions.
•	Allow the use of domestic type dishwashers for facilities with sixteen or fewer residents.
•	Establish consistency among the requirements for facilities providing residential treatment services when possible.
•	Establish eight service categories that may be provided under one RTF license.
•	Allow the issuance of a single RTF license to a campus of two or more buildings.

     Changes Imposing Additional Requirements:

•	Require a written basic emergency preparedness plan.
•	Maintain documentation of an on-going training procedure for implementing the emergency preparedness plan.
•	A facility-wide approach to process design and performance measurement (coordinated quality improvement program).

     Other Components of the Rule:

•	DOH process in case of facility deficiencies.

     2. Is an SBEIS required for this rule? Yes.

     3. Which industries are affected by this rule? In preparing this SBEIS, the Department of Health used the following SIC codes:

SIC Industry Code and Title	No. of Businesses		No. of Employees		Average No. of Employees For Smallest Businesses		Average No. of Employees for 10% of Largest Businesses
8059 Nursing and personal care, not elsewhere classified 8361 Residential Care 8052 Intermediate Care Facilities	110 1534 29		4081 20252 1651		35.2 8.0 22.3		159.5 97.4 146.6

     4. What are the costs of complying with this rule for small businesses (those with fifty or fewer employees) and for the largest 10% of businesses affected? The following tables show cost impacts of the proposed rules vary for small and large RTF's. The last column in Table 2 shows the "ratio" of costs per employee for small versus large facilities. A ratio of less than one indicates that no disproportionate economic burden would exist for the indicated industry; a ratio greater than one indicates that a disproportionate burden would exist for the industry. As is evident from these calculations, disproportionate burdens appear to exist for all industries, but to a varying degree. Although a disproportionate burden exists for RTF, the absolute economic burden and cost per employee are low.

Table 1
Significant WAC Rules with New Fiscal Impact

WAC	Annual Cost for Typical Small Business	Annual Cost for Typical Large Business
246-337-045(5) Coordinated quality improvement	$600	$1200
246-337-050(3) Age appropriate CPR training	$100	$200
246-337-070 Emergency disaster plan	$1280	$1280
246-337-070(4) Three day emergency food supply	$576	$1440
TOTAL	$2556	$4120

Table 2
Small Business Economic Impact Analysis

SIC	Costs for Typical Small Business		Costs for Typical Large Business		Average Number of Employees for Small Business		Average Number of Employees for Large Business		Costs Per Employees for Typical Small Business		Cost Per Employees for Typical Large Business		Cost Per Employee Ratio (Small/Large)
8059	$2556		$4120		35.2		159.5		$72.60		$25.80		2.8
8361	$2556		$4120		8.0		97.4		$319.50		$42.30		7.6
5052	$2556		$4120		22.3		146.6		$114.60		$28.10		4.1

     5. Does the rule impose a disproportionate impact on small businesses? Yes. As the ratios in the last column of Table 2 show, the rule imposes a disproportionate impact on small businesses.

     6. If the rule imposes a disproportionate impact on small businesses, what efforts were taken to reduce that impact (why is it not "legal and feasible" to do so) by:

     (a) Reducing, modifying, or eliminating substantive regulatory requirements? The department implemented the following changes and/or techniques in effort to reduce impacts throughout the proposed WAC chapter:

•	Reflect the current building code in describing adequate space as providing at least a three-foot clear path of egress from one side of each bed or mattress in case of fire.
•	Allow licensees to wash and sanitize laundry in accordance with the washer manufacturer's recommendations and detergent and sanitizer instructions.
•	Allow the use of domestic type dishwashers for facilities with sixteen or fewer residents.
•	Establish consistency among the requirements for facilities providing residential treatment services when possible.
•	Establish eight service categories that may be provided under one RTF license.
•	Allow the issuance of a single RTF license to a campus of two or more buildings.
•	Condense and clarify wording, grammar, structure, and formatting.
•	Clarify requirements for licensing, reporting, documentation, and compliance.
•	Remove issues unrelated to public health.
•	Update terminology to reflect current usage and populations served.

     (b) Simplifying, reducing, or eliminating record keeping and reporting requirements? The department eliminated duplicative standards by collaborating with DSHS Mental Health Division and the Division of Alcohol and Substance Abuse to improve accuracy, compatibility, consistent interpretation and nonduplication by agencies.

     (c) Reducing the frequency of inspections? The frequency of inspections is not addressed in the proposed rules.

     (d) Delaying compliance timetables? Although the department plans to offer statewide training on the proposed rules, no compliance delay is scheduled for its implementation.

     (e) Reducing or modifying fine schedules for noncompliance? Fine schedules for noncompliance are not addressed in the proposed rules.

     (f) Any other mitigation techniques? WAC 246-337-020 retroactivity allows RTF's that are currently licensed and operating on the date of adoption of the proposed chapter to continue without change to physical plant, except as is specifically covered in the chapter, or as deemed necessary for the general safety and welfare of the occupants and public by either the local building official, licensing regulators, or state fire marshal.

     7. How are small businesses involved in the development of this rule? Department staff worked closely with constituents, small businesses and the public to minimize the burden of this rule. The department notified all licensees and stakeholders when it first started developing the rule. Interested parties were invited to participate in a stakeholders workgroup including participants from small and large businesses. Four stakeholder workgroup meetings were held in Kent, Washington. The department also sought comment on draft language throughout the rule development process.

     A copy of the statement may be obtained by contacting Allen Spaulding, Department of Health, Facilities and Services Licensing, 310 Israel Road, Tumwater, WA 98504-7852, phone (360) 236-2929, fax (360) 236-2901, e-mail al.spaulding@doh.wa.gov.

     A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Allen Spaulding, Department of Health, Facilities and Services Licensing, 310 Israel Road, Tumwater, WA 98504-7852, phone (360) 236-2929, fax (360) 236-2901, e-mail al.spaulding@doh.wa.gov.

Bill White

for Mary C. Selecky

Secretary

OTS-6706.4

     (2) Additionally, these rules apply to residential treatment facilities licensed by the department of health under chapter 71.12 RCW and certified by the department of social and health services under chapter 71.05 RCW (Mental illness), chapter 70.96A RCW (Treatment for alcoholism, intoxication and drug addiction), and chapter 71.34 RCW (Mental health services for minors).

     (3) These rules are intended to supplement other applicable federal, state and local laws, rules and ordinances. If any provision of this chapter is more restrictive than local codes and ordinances this chapter shall prevail over any less restrictive provision.

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     (1) "Administrator" means an individual person responsible for managing the day-to-day operations of the RTF.

     (2) "Adult" means an individual age eighteen years or older.

     (3) "Approved" means approved by the department, unless otherwise specified.

     (4) "Authorized" means mandated or permitted, in writing, by the administrator to perform an act that is within a health care provider's lawful scope of practice, or that was lawfully delegated to the health care provider or to the unlicensed staff member.

     (5) "Bathroom" means a room containing at least one bathtub or shower.

     (6) "Chemical dependency" means alcoholism, drug addiction, or dependence on alcohol and one or more other psychoactive chemicals, as the context requires.

     (7) "Chemical dependency RTF" means all or part of an RTF certified by DSHS under chapter 70.69A RCW, that provides twenty-four hour evaluation, stabilization and treatment services for persons with chemical dependency within one or more of the following service categories:

     (a) "Acute detoxification" as defined in chapter 388-805 WAC;

     (b) "Subacute detoxification" as defined in chapter 388-805 WAC;

     (c) "Intensive inpatient services" as defined in chapter 388-805 WAC;

     (d) "Long-term treatment services" as defined in chapter 388-805 WAC;

     (e) "Recovery house services" as defined in chapter 388-805 WAC.

     (8) "Child" or "minor" means an individual under the age of eighteen.

     (9) "Communicable disease" means a disease caused by an infectious agent that can be transmitted from one person, animal, or object to another individual by direct or indirect means including transmission via an intermediate host or vector, food, water or air.

     (10) "Confidential" means information that may not be disclosed except under specific conditions permitted or mandated by law or legal agreement between the parties concerned.

     (11) "Construction" means:

     (a) The erection of a facility;

     (b) An addition, modification, alteration or change of an approved use to an existing facility; or

     (c) The conversion of an existing facility or portion of a facility for use as a RTF.

     (12) "DASA" means division of alcohol and substance abuse, within DSHS.

     (13) "Department" means the Washington state department of health.

     (14) "DSHS" means the Washington state department of social and health services.

     (15) "Emergency health care" means services provided consistent with the health care needs of the resident for an acute illness, injury, or unexpected clinical event as determined by an authorized health care provider.

     (16) "Facility" means a building or portion of a building.

     (17) "First aid" means care for a condition that requires immediate assistance from an individual trained and certified in first-aid procedures.

     (18) "Hand hygiene" means handwashing, antiseptic hand wash, or antiseptic hand or surgical hand antisepsis.

     (19) "Health" means a state of complete physical and mental well-being and not merely the absence of disease or infirmity.

     (20) "Health assessment" means a systematic examination of the person's body conducted by an authorized health care provider.

     (21) "Health care" means any care, service, or procedure provided by a health care provider to diagnose, treat, or maintain a resident's physical or mental condition, or that affects the structure or function of the human body.

     (22) "Health care provider" means an individual who is licensed, registered or certified under Title 18 RCW to provide health care within a particular profession's statutorily authorized scope of practice.

     (23) "Health care screen" means the process approved by an authorized health care provider to determine the health care needs of a resident.

     (24) "Licensee" means the person, corporation, association, organization, county, municipality, public hospital district, or other legal entity, including any lawful successors thereto to whom the department issues a RTF license.

     (25) "Medication" means a legend drug prescribed for a resident by an authorized health care provider, or nonprescription drugs, also called "over-the-counter medications," that can be purchased by the general public without a prescription.

     (26) "Medication administration" means the direct application of a medication or device by ingestion, inhalation, injection, or any other means, whether self-administered by a resident, or administered by a parent or guardian (for a minor), or an authorized health care provider.

     (27) "Medication self-administration" or "self-medication administration" means a process by which each resident obtains his/her container of medication from a supervised and secure storage area, removes the dose needed and ingests or applies the medication as directed on the label while being observed by staff.

     (28) "Medication error" includes any failure to administer or receive a medication according to an authorized health care provider's order, or according to the manufacturer's directions for nonprescription drugs.

     (29) "Medication protocol" means a specific group of orders to be used for specific symptoms for specific residents and authorized by a health care provider.

     (30) "Mental health RTF" means all or part of a RTF providing twenty-four hour evaluation, stabilization and treatment services for persons with a mental disorder and certified by DSHS under chapters 71.05 or 71.34 RCW, within one or more of the following service categories:

     (a) "Adult residential treatment" as defined in chapter 388-865 WAC;

     (b) "Inpatient evaluation and treatment" as defined in chapter 388-865 WAC;

     (c) "Child long-term inpatient treatment" as defined in chapter 388-865 WAC.

     (31) "Parent" means:

     (a) A biological or adoptive parent who has legal custody of the child, including either parent if custody is shared under joint custody agreement; or

     (b) An individual or agency judicially appointed as legal guardian or custodian of the child.

     (32) "Resident" means an individual (adult or child) admitted to the RTF licensed under this chapter.

     (33) "Residential treatment facility" or "RTF" means a facility for purposes of evaluation and treatment or evaluation and referral of any individual with a chemical dependency or mental disorder.

     (34) "Restraint" means a continuum of methods used to prevent or limit free body movement.

     (35) "Room" means a space set apart by floor to ceiling partitions on all sides with all openings provided with doors or windows.

     (36) "Seclusion" means the involuntary confinement of a resident alone in a room or area from which the resident is physically prevented from leaving.

     (37) "Sink" means a properly trapped plumbing fixture, capable of holding water, with approved potable hot and cold running water under pressure.

     (38) "Survey" means an inspection or investigation conducted by the department to evaluate and monitor a licensee's compliance with chapter 71.12 RCW and this chapter.

     (39) "Toilet room" means a room containing a water closet (toilet).

     (40) "WISHA" means the state of Washington Industrial Safety and Health Act, chapter 49.17 RCW, administered by the Washington state department of labor and industries.

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     (a) A completed application on form(s) provided by the department, signed by the owner or legal designee, including:

     (i) The identity of each officer and director, or their equivalent, of the licensee;

     (ii) Disclosure statements and criminal history background checks obtained within three months of the application date for the administrator in accordance with chapter 43.43 RCW;

     (iii) The license fee specified in WAC 246-337-990; and

     (iv) A reduced floor plan on 8-1/2 x 11 size paper that shows each room within the facility in a manner that is easily seen and understood.

     (b) Evidence of applicant's compliance with chapter 71.12 RCW and this chapter including:

     (i) The department approved construction documents and functional program plan;

     (ii) Documentation of application for certification by DSHS under chapter 71.05 RCW (Mental illness), chapter 70.96A RCW (Treatment for alcoholism, intoxication and drug addiction), or chapter 71.34 RCW (Mental health services for minors);

     (iii) Approval of the chief of the Washington state patrol, through the director of fire protection, as required by RCW 71.12.485 and chapter 212-12 WAC;

     (iv) Compliance with all applicable federal, state and local laws, rules, and codes; and

     (v) Completion of an initial on-site survey.

     (c) Other information as required by the department.

     (2) If the applicant has met all requirements for licensure set forth in subsection (1) of this section, the department shall issue a RTF license (listing the service categories). An RTF license is effective for one year from the date it is issued.

     (3) Renewal: At least thirty days before the expiration date of the current license, the licensee must submit to the department:

     (a) A completed application on form(s) provided by the department;

     (b) Disclosure statements and criminal history background checks obtained within three months of the renewal date for the administrator in accordance with chapter 43.43 RCW;

     (c) The fee specified in WAC 246-337-990;

     (d) Documentation satisfactory to the department of licensee's compliance with chapter 71.12 RCW and this chapter, including the following:

     (i) Compliance with rules adopted by the chief of the Washington state patrol, through the director of fire protection, as required by RCW 71.12.485 and chapter 212-12 WAC;

     (ii) Compliance with all applicable federal, state and local laws, and rules; and

     (e) Other information as required by the department.

     (4) At least sixty days prior to changing any of the license service categories, number of resident beds, location or use of rooms as listed on the licensed room list, or the physical structure of the RTF, the licensee must:

     (a) Notify the department in writing of the intended change;

     (b) Request the department to determine the need for review by the department's construction review services; and

     (c) If the change involves an approved increase in beds, the licensee must pay a fee under WAC 246-337-990;

     (5) At least sixty days prior to selling, leasing, renting or otherwise transferring control of a license, that results in a change of the Uniform Business Identifier Number (UBI #), the licensee must submit to the department:

     (a) The full name and address of the current licensee and prospective licensee;

     (b) The name and address of the licensed RTF and the name under which the RTF will operate;

     (c) Date of the proposed change;

     (d) Plans for preserving resident records, consistent with WAC 246-337-095; and

     (e) Other information required by the department.

     (6) A prospective new RTF owner shall apply for licensure by complying with subsection (1) of this section.

     (7) A RTF license is not transferable.

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     (1) Chemical dependency acute detoxification;

     (2) Chemical dependency subacute detoxification;

     (3) Chemical dependency intensive inpatient;

     (4) Chemical dependency long-term treatment;

     (5) Chemical dependency recovery house;

     (6) Mental health adult residential treatment (includes crisis services for twenty-four hours or more);

     (7) Mental health inpatient evaluation and treatment;

     (8) Mental health child long-term inpatient treatment.

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     (a) Comply with chapter 71.12 RCW and this chapter;

     (b) Maintain and post in a conspicuous place on the premises:

     (i) A current RTF license; and

     (ii) The name, address and telephone number of the department, appropriate resident advocacy groups, and description of ombudsman services;

     (c) Provide services limited to each service category that appears on the RTF license;

     (d) Maintain the occupancy level at or below the licensed resident bed capacity of the RTF;

     (e) Cooperate with the department during on-site surveys;

     (f) Respond to a statement of deficiencies by submitting to the department:

     (i) Within ten working days of receipt, a written plan of correction for each deficiency cited that includes a target date and is subject to approval by the department; and

     (ii) A written progress report attesting to the final completion of the correction of deficiencies identified in the plan of correction.

     (2) The department shall:

     (a) Issue or renew a license when the applicant or licensee meets the requirements in chapter 71.12 RCW and this chapter;

     (b) List, in writing, the service category(ies) the RTF is licensed to provide under this chapter;

     (c) Verify compliance with RCW 71.12.485 and chapter 212-12 WAC administered by the Washington state patrol fire marshal fire protection service;

     (d) Verify compliance with applicable state and local codes;

     (3) The department may issue a single RTF license to include two or more RTF (campus), if the applicant or licensee:

     (a) Meets the licensure requirements of chapter 71.12 RCW and this chapter; and

     (b) Operates the multiple RTF as a single integrated system with:

     (i) Governance by a single authority or body over all buildings;

     (ii) All services provided by an integrated staff; and

     (4) Conduct on-site surveys. After completing a survey, the department may:

     (a) Give the administrator a written statement of deficiencies identifying failure to meet specific requirements of chapter 71.12 RCW and this chapter observed during an on-site survey;

     (b) Obtain, review, and approve written plan of correction with dates to be completed;

     (c) Review the progress report attesting to correction of deficiencies;

     (d) Conduct a follow up on-site assessment at the discretion of the department;

     (e) Document, during an initial survey or as needed, a department-approved room list identifying resident rooms, the dimensions and calculated square footage of each room, the number of approved resident beds, and other information related to the licensed resident bed capacity. This list will be kept as part of the RTF licensure file.

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     (a) The specific section, or sections, of rules for which the exemption is requested;

     (b) An explanation of the circumstances involved;

     (c) A proposed alternative that would ensure the safety and health of residents meeting the intent of the rule; and

     (d) Any supporting research or other documentation.

     (2) After review and consideration, the department may grant an exemption if the exemption does not:

     (a) Negate the purpose and intent of these rules;

     (b) Place the safety or health of the residents in the RTF in jeopardy;

     (c) Reduce any fire and life safety or infection control laws or rules; or

     (d) Adversely affect the structural integrity of a facility.

     (3) The department will send a copy of the exemption decision to the licensee, and shall maintain the exemption as part of the current RTF file. The licensee shall maintain the documented exemption decision on file in the RTF.

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     (a) Been denied a license to operate a health care, child care, group care or personal care facility in this state or elsewhere, had the license suspended or revoked, or been found civilly liable or criminally convicted of operating the facility without a license;

     (b) Committed, aided or abetted an illegal act in connection with the operation of any RTF or the provision of health care or residential services;

     (c) Abandoned, abused, neglected, assaulted, or demonstrated indifference to the welfare and well-being of a resident;

     (d) Failed to take immediate corrective action in any instance of assault, abuse, neglect, or indifference to the welfare of a resident;

     (e) Retaliated against a staff member, resident or other individual for reporting suspected abuse or other alleged improprieties;

     (f) Failed to comply with any of the provisions of chapter 71.12 RCW or this chapter; or

     (g) Failed to meet DSHS certification standards under chapters 71.05, 70.96A and 71.34 RCW.

     (2) An applicant or licensee may contest a disciplinary decision or action of the department under RCW 43.70.115, chapters 34.05 RCW and 246-10 WAC.

     (3) The department may summarily suspend a license pending a proceeding for revocation or other action if the department determines a deficiency is an imminent threat to a resident's health, safety, or welfare.

     (4) In addition to any other rights allowed under applicable law, the department may address violations by an applicant or a licensee of chapter 71.12 RCW or this chapter by:

     (a) Offering a plan of correction if the department determines that identified deficiencies are not major, broadly systemic, or of a recurring nature. Under this chapter, a "plan of correction" is a proposal devised by the applicant or licensee and approved by the department, that includes specific corrective actions that must be taken to correct identified deficiencies and a time frame in which to complete them. Implementation is required within the approved time frame, and is subject to verification by the department;

     (b) Offering a directed plan of correction if the department determines that identified deficiencies are broadly systemic, recurring, or of a significant threat to public health and safety. Under this chapter, a "directed plan of correction" is a plan of correction based on a statement of deficiencies, and includes specific corrective actions that must be taken and a time frame in which to complete them. Under this chapter, a "statement of deficiencies" is a survey or investigation report completed by the department identifying one or more deficiencies. The final content of the directed plan of correction will be reached during meetings between the department and the licensee, following an initial statement of general requirements by the department. Timelines will be reduced to the minimum necessary, even prior to formalization of the directed plan of correction, to redress problems;

     (c) Initiating administrative action, under chapter 34.05 RCW, RCW 43.70.115 and chapter 246-10 WAC, either as the department's primary alternative, or in the event the department requires corrective action under (a) or (b) of this subsection, and the applicant or licensee fails to correct identified deficiencies to the department's satisfaction within the approved time frame; and/or

     (d) Taking administrative action initiated under chapter 34.05 RCW:

     (i) An administrative action may result in a hearing before a presiding officer and the issuance of formal findings and a directed order;

     (ii) The administrative action and any resulting order constitute formal action under the provisions of chapter 34.05 RCW.

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     (2) The licensee or applicant must submit a written functional program, in accordance with RCW 71.12.470, outlining the service categories and types of residents to be served and how the needs of the residents will be met including, but not limited to:

     (a) Program goals;

     (b) Staffing and health care to be provided;

     (c) Infection control;

     (d) Security and safety;

     (e) Seclusion and restraint;

     (f) Laundry;

     (g) Food and nutrition; and

     (h) Medication.

     (3) The licensee or applicant must submit accurate, timely, and complete construction documents that comply with all governing rules.

     (4) Construction documents must include:

     (a) Drawings prepared, stamped, and signed by an architect licensed by the state of Washington under chapter 18.08 RCW. The services of a consulting engineer licensed by the state of Washington may be used for the various branches of the work, if appropriate; and

     (b) Drawings with coordinated architectural, mechanical, and electrical work drawn to scale showing complete details for construction, including:

     (i) Site plan(s) showing streets, driveways, parking, vehicle and pedestrian circulation, utility line locations, and location of existing and new buildings;

     (ii) Dimensioned floor plan(s) with the function of each room and fixed/required equipment designated;

     (iii) Elevations, sections, and construction details;

     (iv) Schedule of floor, wall, and ceiling finishes;

     (v) Schedules of doors and windows - sizes and type, and door finish hardware;

     (vi) Mechanical systems - plumbing and heating/venting/air conditioning; and

     (vii) Electrical systems, including lighting, power, and communication/notification systems;

     (c) Specifications that describe with specificity the workmanship and finishes; and

     (d) Shop drawings and related equipment specifications for:

     (i) An automatic fire sprinkler system when required by other codes; and

     (ii) An automatic fire alarm system when required by other codes.

     (5) A license may not be issued for a new RTF, a new facility within an RTF, or changes in resident bed capacity or licensed service category(ies) for a currently licensed RTF, without written approval from the department's construction review services unit and residential care services program.

     (6) The applicant or licensee must:

     (a) Comply with the standards as adopted by the Washington state building code council;

     (b) Assure conformance to the approved plans during construction;

     (c) Submit addenda, change orders, construction change directives or any other deviation from the approved plans prior to their installation;

     (d) Provide a written construction project completion notice to the department indicating:

     (i) The completion date; and

     (ii) The actual construction cost;

     (e) Make adequate provisions for the health, safety, and comfort of residents during construction projects.

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     (1) Adopting, periodically reviewing, and updating as necessary, policies that:

     (a) Govern the organization and functions of the RTF including:

     (i) A brief narrative explaining the scope of services provided;

     (ii) An organization chart specifying the governing body, staff positions, and number of full- or part-time persons for each position; and

     (iii) A policy addressing that sufficient resources such as personnel, facilities, equipment, and supplies are provided to meet the needs of the population served;

     (b) Provide a process for communication and conflict resolution for both staff and residents; and

     (c) Provide clear lines of authority for both management and operation of the RTF.

     (2) Establishing procedures for selecting and periodically evaluating a qualified administrator to assure that he or she carries out the goals and policies of the governing body. The administrator must:

     (a) Be qualified through appropriate knowledge, experience and capabilities to supervise and administer the services properly;

     (b) Be available, or assure that a designated alternate who has similar qualifications is available, one hundred percent of the time, either in person, by telephone or electronic pager (or similar electronic means), to carry out the goals, objectives and standards of the governing body.

     (3) Establishing written policies and procedures that implement all applicable rules, which are routinely reviewed by the administrator and the governing body to ensure they are kept current, made known to staff, made available at all times to all staff, and are complied with within the RTF.

     (4) Establishing a personnel system that assures:

     (a) Personnel records of all employees and volunteers contain written job descriptions consistent with staff responsibilities and standards for professional licensing;

     (b) Staff are assigned, oriented, trained, supervised, monitored, and evaluated;

     (c) Staff who provide direct resident care, direct treatment, or manage the safety of a resident are competent by training, experience and capability;

     (d) Contractors have current contracts on file clearly stating the responsibilities of the contractor;

     (e) Staff with unsupervised access to residents complies with WAC 246-337-055.

     (5) Establishing a RTF-wide approach to a coordinated quality improvement program for resident care services under chapter 71.12 RCW and equivalent to the provisions outlined in chapter 246-50 WAC.

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     (1) A sufficient number of personnel must be present on a twenty-four hour per day basis to meet the health care needs of the residents served; managing emergency situations; crisis intervention, implementation of health care plans; and required monitoring activities.

     (2) Personnel trained, authorized and credentialed (where applicable) to carry out assigned job responsibilities consistent with scopes of practice, resident population characteristics and the resident's individual plan of care/treatment;

     (3) The presence of at least one individual trained in basic first aid and age appropriate cardiopulmonary resuscitation twenty-four hours per day.

     (4) Written documentation to verify credentials, training, and performance evaluations for each staff member including, but not limited to:

     (a) Employment application/hire date;

     (b) Verification of education, experience and training;

     (c) Current job description;

     (d) Criminal disclosure statement and results of a Washington state patrol background inquiry;

     (e) HIV/AIDS training or verification;

     (f) Current license/certification/registration (if applicable);

     (g) Current basic first aid and age appropriate cardiopulmonary resuscitation training (if applicable);

     (h) Current food and beverage service worker permit (if applicable);

     (i) Current driver's license (if applicable);

     (j) Tuberculosis screening (refer to WAC 246-337-060);

     (k) Performance evaluation(s);

     (l) Staff using restraint and seclusion procedures must receive initial and ongoing education and training in the proper and safe use of seclusion and/or restraints;

     (m) Initial orientation and ongoing training to address the safety and health care needs of the population served.

     (5) If independent contractors, consultants, students, volunteers and trainees are providing direct on-site residential care, the licensee must ensure their compliance with this section.

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     (1) Implementing and maintaining an infection control program by assignment of responsibility for infection control and monitoring to a specified staff member.

     (2) Maintaining an infection control program that includes adoption and implementation of written policies and procedures for:

     (a) Meeting the standards as outlined in the most recent edition of the department's Human Immune Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) Curriculum Manual, including;

     (i) Hand hygiene;

     (ii) Disinfection;

     (iii) Standard/universal precautions;

     (b) Residents with poor hygiene;

     (c) Control of bloodborne pathogens in accordance with WISHA, chapter 296-823 WAC;

     (d) Control of tuberculosis consistent with WISHA, department guidelines, and chapter 246-170 WAC;

     (e) Exclusion of staff from work who have a communicable disease in an infectious stage; and

     (f) Environmental management and housekeeping functions.

     (3) Ensuring that staff report notifiable conditions and cooperate with public health authorities to facilitate investigation of a case, suspected case, or outbreak of a notifiable condition, consistent with chapter 246-101 WAC.

     (4) Providing the equipment necessary to implement the RTF infection control policies and procedures.

     (5) Complying with chapter 246-100 WAC "Communicable and certain other diseases."

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     (1) Coordination of interagency and intra-agency services, if any, to meet and provide for resident health care needs.

     (2) The provision of health care services.

     (3) The provision for transportation for residents in accordance with Washington state laws and rules governing transportation.

     (4) Smoking policies and procedures in compliance with applicable Washington state laws and rules.

     (5) Security to protect residents, visitors, staff and property including, but not limited to:

     (a) Controlling access to and egress (elopement and evacuation) from the RTF; and

     (b) Investigating, and recording all security incidents.

     (6) Reporting to the department serious or undesirable resident outcomes including, but not limited to, death, suicide, or major disruption of services through internal or external emergency events.

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     (a) Be specific to the RTF, and each building that comprises the RTF;

     (b) Be communicated to the residents and staff;

     (c) Be coordinated with local emergency plans;

     (d) Address actions the licensee will take if residents cannot return to the facility;

     (e) Be posted or readily available to all staff and residents; and

     (f) Require emergency phone numbers to be adjacent to appropriate phones.

     (2) The emergency plan must identify:

     (a) Who is responsible for each aspect of the plan;

     (b) Procedures for accounting for all residents and staff during and after the emergency;

     (c) How the premises will be evacuated, if necessary, and the meeting location after evacuation;

     (d) How to address care of residents with special needs during and after an emergency;

     (e) Provisions for emergency medications, food, water, clothing, shelter, heat and power;

     (f) How family members will be contacted; and

     (g) Transportation arrangements if necessary.

     (3) The licensee must evaluate the effectiveness of the emergency plan, including:

     (a) Review at least annually and revise as needed;

     (b) Conduct and document, at least annually, emergency drills for residents and staff; and

     (c) Debrief and evaluate the plan after each emergency incident or drill.

     (4) Supplies and first-aid equipment must be:

     (a) In a designated location;

     (b) Readily available to staff during all hours of operation including during transportation of residents;

     (c) Sufficient in type and quantity according to staff and residents' needs; and

     (d) Sufficient to maintain a three-day emergency supply of dry or canned food and water for all staff and residents.

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     (1) Inform each resident in an understandable manner, his or her personal representative, designee or parent, of all rights, treatment methods, and rules applicable to the proposed health care of a particular resident.

     (2) Document that each resident received a written copy of his or her rights on or before admission.

     (3) Address use of emergency interventions such as use of youth behavior management guidelines, restraint and/or seclusion, the use of special treatment interventions, restriction of rights and parameters of confidentiality.

     (4) Allow residents, their personal representatives, and parents, to review resident files in accordance with chapter 70.02 RCW.

     (5) Ensure that each resident is treated in a manner that respects individual identity, human dignity and fosters constructive self-esteem by ensuring each resident has the right to:

     (a) Be free of abuse, including being deprived of food, clothes or other basic necessities;

     (b) Be free of restraint and/or seclusion, except as provided in WAC 246-337-110;

     (c) Participate or abstain from social and religious activities;

     (d) Participate in planning his or her own health care and treatment that considers their own medical and/or mental health advance directives;

     (e) Refuse to perform services for the benefit of the RTF unless agreed to by the resident, as a part of the individual health care plan and in accordance with applicable law;

     (f) Inform each resident of the cost of treatment;

     (g) Inform each resident in writing of the department contact information, including telephone number and mailing address;

     (h) Inform each resident that the resident may file a complaint with the department regarding the RTF's noncompliance with any part of this chapter, without interference, discrimination or reprisal. The resident may choose whether to notify the RTF of the complaint;

     (i) Promote a healthy, safe, clean and comfortable environment;

     (j) Protect each resident from invasion of privacy: Provided that reasonable means may be used to detect or prevent items that may be harmful or injurious to the resident or others, from being possessed or used on the premises.

     (6) Protect the confidentiality of treatment and personal information when communicating with individuals not associated or listed in the resident individual's treatment plan or confidentiality disclosure form.

     (7) Comply with reporting requirements of suspected incidents of child or adult abuse and neglect in accordance with chapters 26.44 and 74.34 RCW.

     (8) Account for each resident's assets, including allowance, earnings from federal or state sources and expenditures.

     (9) Assist each resident, upon request, in sending written communications of the fact of the resident's commitment in the RTF to friends, relatives, or other persons.

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     (a) Admission, transfer, discharge and referral process.

     (b) Addressing how the licensee provides or makes provision for health care services.

     (c) Addressing the action of RTF personnel when medical emergencies or a threat to life arises when a physician or authorized health care provider is not present including:

     (i) Having current policies and procedures signed by a physician or authorized health care provider, reviewed as needed and at least biennially;

     (ii) How resident medical and related data shall be transmitted in the event of a transfer;

     (iii) Need for the notification of legal guardian or next of kin, the department or other regulatory agencies in the event of a serious change in the resident's condition, transfer of a resident to another facility, elopement, death, or when unusual circumstances occur; and

     (iv) When to consult with internal or external resource agencies or persons e.g., poison control, fire department and police.

     (d) Addressing how the RTF must provide for each resident's need for personal care items and durable medical equipment.

     (e) Addressing provisions for transfer and appropriate prenatal and postnatal care services for pregnant residents.

     (f) Addressing how a licensee providing twenty-four hours per day nursing service functions provides systems for supervision, assessment and delegation in accordance with applicable statute and rules including chapter 18.79 RCW, Nursing care.

     (g) Addressing how a RTF providing health care for chemical dependency will ensure resident health and safety in accordance with chapters 70.96A RCW and 308-805 WAC.

     (h) Addressing how a licensee providing acute detoxification services must ensure resident health and safety including:

     (i) A licensed nurse must be on-site when a resident is receiving acute detoxification services;

     (ii) Registered nurse responsible for supervising resident care nursing services shall be on-site at least four hours per week and available on-call to the licensed practical nurse; and

     (iii) Policies and procedures for acute detoxification services approved by an authorized health care provider.

     (i) Addressing how licensees providing subacute detoxification services must ensure resident health and safety, including:

     (i) Implementing policies and procedures establishing agreements with authorized health care providers or hospitals that includes:

     (A) Criteria for determining the degree of medical stability of a potential resident in a subacute detoxification facility;

     (B) Monitoring the resident after being admitted;

     (C) Reporting abnormal symptoms according to established criteria;

     (D) Criteria requiring immediate transfer to a hospital; and

     (E) Resident discharge or transfer criteria;

     (ii) Monitoring of residents by a staff including observing a resident for signs and symptoms of illness or trauma; and

     (iii) Observing the resident to self-administer his or her own medication as prescribed by the resident's health care provider.

     (2) Delivery of resident care services: The licensee must ensure the provision of or for that resident care services to meet the health care needs of the resident including:

     (a) Admission is limited to residents for whom a facility is qualified by staff, services, equipment, building design and occupancy to give safe care.

     (b) A health care screen of each resident that is to be conducted upon admission and updated as changes occur or when additional health care needs are identified.

     (c) A completed comprehensive health assessment and medical history that is to be conducted by a health care provider following admission to an RTF, unless a current comprehensive health assessment or review was performed and is available upon admission to an RTF providing mental health or acute detoxification services.

     (d) A health assessment by a health care provider, any time a resident exhibits signs and symptoms of an injury, illness or abnormality for which medical diagnosis and treatment are indicated.

     (e) Access to and availability of authorized health care providers to develop and implement the resident plan of care.

     (f) Sufficient numbers of trained personnel who are available to provide health care according to the resident's health care plan.

     (g) Provision for or access by referral to health care for residents admitted to the RTF including, but not limited to:

     (i) Assisting residents in following all prescribed treatments, modified diets, activities or activity limitations.

     (ii) Assisting residents to keep health care appointments.

     (iii) Medication administration or observing the resident self-administer his or her own medication as prescribed by the resident's authorized health care provider.

     (iv) Incorporating resident's health care needs and behavioral needs into the resident's overall health care plan;

     (v) Emergency health care.

     (h) Provision for twenty-four hours per day nursing service functions to include availability by phone; when the RTF provides mental health inpatient evaluation and treatment, mental health adult residential treatment, mental health child long-term inpatient treatment, and/or chemical dependency acute detoxification.

     (i) Provision is made either on the premises, through a contract laboratory or through a health care provider for service(s) required by the resident.

     (j) Storing and labeling each resident's personal care items separately preventing contamination and access by other residents.

     (3) Documentation: The licensee must ensure documentation of health care received or provided in the resident's health care record.

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     (1) Operate or arrange for child care licensed by DSHS under chapter 388-295 WAC, Minimum licensing requirements for child day care centers, chapter 388-151 WAC, School-age child care center minimum licensing requirements, chapter 388-155 WAC, Minimum licensing requirements for family child day care homes which the children will attend during treatment hours of the parent;

     (2) Allow an infant under one month of age to be cared for by the staff of the RTF to supplement care by the mother;

     (3) Allow the parent to be responsible for the care of his/her own child during the hours the parent is not in treatment, with the following conditions:

     (a) The parent's management of the child is subject to the policies and procedures of the RTF;

     (b) A parent may designate another resident to care for a child, if the designation is in writing and includes:

     (i) A specified time period;

     (ii) Any special instructions; and

     (iii) Is signed by the parent, designee and staff member who approves of the designation;

     (4) Establish policies and procedures addressing the chronological and developmental needs of the children to be accepted;

     (5) Obtain a health history for each child following admission;

     (6) Develop with the parent a plan of care for each child that addresses the child's health care needs including medications.

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     (1) The licensee shall provide:

     (a) Food and dietary services managed by a person knowledgeable in food services, and, when needed, consultative services provided by a registered dietician;

     (b) Food and water daily, supplying at least one hundred percent of the current nationally recommended dietary allowance for meals and snacks, adjusted for:

     (i) Age, gender, development, activities and health conditions; and

     (ii) Reasonable accommodations for cultural and religious preferences.

     (2) The licensee shall provide at least three meals at regular intervals without more than fourteen hours between the last meal of the day and the first meal of the next day.

     (3) If modified food plans are needed for residents receiving detoxification services or who have other nutritional needs, the licensee must:

     (a) Provide modified diets, nutrient supplements and concentrates to residents as prescribed by an authorized health care provider;

     (b) Limit modified meal content or frequency to no more than forty-eight hours without an authorized health care provider's orders; and

     (c) Notify staff of any resident with food allergies or other medical conditions, symptoms of allergic reactions to watch for, and emergency measures to take if they occur.

     (4) The licensee must allow sufficient time for residents to consume meals.

     (5) The licensee must designate at least one individual having a current food and beverage service worker's permit to monitor and oversee food handling at the RTF; and require that all residents who do not have food and beverage worker permits, but have been medically screened and cleared to work in the kitchen, be oriented and supervised by staff with current food and beverage worker permits at all times when working in the kitchen.

     (6) Menus must be dated, available and conspicuously posted one week or more in advance. The licensee must:

     (a) Keep records of all food served, and substitutions;

     (b) Retain menu records of food served for at least three months.

     (7) All food must be prepared on-site unless the licensee has a signed contract or agreement with a food establishment.

     (8) Each licensee must keep on file:

     (a) A description of how food will be handled, prepared and stored; and

     (b) A written plan of action should food be in an unacceptable condition.

     (9) Staff must follow manufacturer's instructions in operating kitchen equipment.

     (10) A licensed RTF with sixteen or fewer residents may use domestic or home-type kitchen appliances.

     (11) An RTF with more than sixteen residents must use commercial appliances.

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     (1) Develop and implement procedures for maintaining current health care records as required by chapter 70.02 RCW and RCW 71.05.390 or by applicable laws.

     (2) Make health care records accessible for review by appropriate direct care staff, the resident and the department in accordance with applicable law.

     (3) Ensure health care records are legibly written or retrievable by electronic means.

     (4) Document medical information on the licensee's standardized forms.

     (5) Record health care information by the health care provider or direct care staff with resident contact to include typed or legible handwriting in blue or black ink, verified by signature or unique identifier, title, date and time.

     (6) Maintain the confidentiality and security of health care records in accordance with applicable law.

     (7) Maintain health care records in chronological order in their entirety or chronological by sections.

     (8) Keep health care records current with all documents filed according to the licensee's written timeline policy.

     (9) Inclusion of the following, at a minimum, in each record:

     (a) Resident's name, age, sex, marital status, date of admission, voluntary or other commitment, name of physician, diagnosis, date of discharge, previous address and phone number, if any;

     (b) Resident's receipt of notification of resident's rights and responsibilities, if applicable;

     (c) Resident's consent for health care provided by the RTF;

     (d) A copy of any authorizations, advance directives, powers of attorney, letters of guardianship, or other similar documentation provided by the resident;

     (e) Original reports, where available or, if not available, durable, legible copies of original reports on all tests, procedures, and examinations performed on the resident;

     (f) Health assessments;

     (g) Health care plan, including the names, relationship to the resident and addresses of those individuals the resident states with whom the RTF may freely communicate regarding the health care of the resident without violating the resident's right to confidentiality or privacy of health care information;

     (h) Dated and signed (or initialed) notes describing health care provided for each contact with the resident pertinent to the resident's health care plan including, but not limited to:

     (i) Physical and psychosocial history;

     (ii) Medication administration, medical/nursing services, and treatment provided, resident's response to treatment and any adverse reactions and resolution of medical issues;

     (iii) Use of restraint or seclusion consistent with WAC 246-337-110;

     (iv) Instructions or teaching provided to resident in connection with his or her health care; and

     (v) Discharge summary, including:

     (A) Concise review of resident's physical and mental history, as applicable;

     (B) Condition upon discharge;

     (C) Recommendations for services, follow-up or continuing care; and

     (D) Date and time of discharge.

     (10) Retaining the health care records at least six years beyond resident's discharge or death date, whichever occurs sooner, and at least six years beyond the age of eighteen.

     (11) Destroying the health care records in accordance with applicable law and in a manner that preserves confidentiality.

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     (1) The health care plan must be prepared by one or more staff involved in the resident's care with participation by the resident and by either his or her legal representative or parent when minors are involved;

     (2) An initial or provisional health care plan addressing the health care needs of the resident on admission to a RTF;

     (3) A discharge (aftercare) health care plan if the resident will require less than a fourteen-day treatment, if appropriate; and

     (4) A comprehensive health care plan developed by participants providing health care to the resident addressing and including, but not limited to:

     (a) Health care needs;

     (b) Implementation, modification and review of health care needs documented in the health care plan and health care record;

     (c) Needs of a mother and child during pregnancy and after delivery, if applicable;

     (d) Work assignments given to residents as part of their health care plan, if applicable; and

     (e) Discharge health care needs.

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     (1) Ensuring policies and procedures and medication protocols are developed, approved, reviewed and implemented by licensed health care providers, administration and pharmacist (as needed). The policies and procedures must be consistent with the rules of the department and the department's board of Pharmacy and address all aspects of medication administration, including the following:

     (a) Timely procurement;

     (b) Medication administration;

     (c) Prescribing;

     (d) Proper storage conditions addressing security, safety, sanitation, temperature, light, moisture and ventilation;

     (e) Use of nonprescription drugs:

     (i) List of drugs available;

     (ii) Parameters of use;

     (f) Receipt;

     (g) Proper labeling;

     (h) Disposal;

     (i) Medication brought into RTF by a resident;

     (j) Accountability;

     (k) Starter supply of psychotropic, detoxification and emergency drugs not for a specific resident;

     (l) Emergency allergy response kit of prepackaged medications and supplies for the treatment of anaphylactic shock; and

     (m) Medications for short term authorized absence (pass) from the RTF, where applicable.

     (2) Establishing and maintaining of an organized system that ensures accuracy in receiving, transcribing and implementing policies and procedures for medication administration, including ensuring residents receive the correct medication, dosage, route, time, and reason.

     (3) Documentation of all medications administered or self-administered, including the following data:

     (a) Name and dosage of medication;

     (b) Start/stop date;

     (c) Time;

     (d) Route;

     (e) Staff or resident initials indicating medication was administered, self-administered or issued;

     (f) Notation if medication was refused, held, wasted or not administered or self-administered;

     (g) Allergies;

     (h) Resident response to medication when given as necessary or as needed (PRN);

     (i) Medical staff notification of errors, adverse effects, side effects; and

     (j) Within established parameters for nonprescription drugs.

     (4) Ensuring written orders are signed by an authorized health care provider with prescriptive authority for all legend drugs and vaccines. Verbal orders for legend drugs and vaccines must be signed by the prescriber as soon as possible, but no later than seven days after the verbal order.

     (5) Ensuring use of nonprescription drugs that are self-administered are:

     (a) Within parameters established for nonprescription drugs; and

     (b) According to established list.

     (6) Having a current established drug reference resource available for use by RTF staff.

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     (1) The licensee may use seclusion or restraint only in emergency situations needed to ensure the physical safety of the individual resident or other residents or staff of the facility, and when less restrictive measures have been found to be ineffective to protect the resident or others from harm.

     (2) Seclusion and restraint procedures must be implemented in the least restrictive manner possible in accordance with a written modification to the resident's health care plan and discontinued when the behaviors that necessitated the restraint or seclusion are no longer in evidence.

     (3) "Whenever needed" or "as needed" (PRN) orders for use of seclusion or restraint are prohibited.

     (4) A physician or other authorized health care provider must authorize use of the restraint or seclusion within one hour of initiating the restraint or seclusion.

     (5) Each order of restraint or seclusion is limited in length of time to:

     (a) Adults: Four hours;

     (b) Children and adolescents ages nine to seventeen: Two hours; and

     (c) Children under nine years of age: One hour.

     (6) A physician or an authorized health care provider, authorized by the licensee, may only renew the original order in accordance with these limits for up to a total of twenty-four hours.

     (7) A licensed physician must examine the resident, before the restraint or seclusion exceeds more than twenty-four hours. This procedure must be repeated for each subsequent twenty-four hour period of restraint or seclusion.

     (8) Within one hour of initiation of restraint or seclusion, an authorized health care provider must conduct a face-to-face assessment of the physical and psychological well-being of the resident.

     (9) The resident's clinical record must include the following documentation should restraint or seclusion be used:

     (a) Order for the restraint or seclusion including name of the physician or authorized health care provider authorizing restraint or seclusion;

     (b) Date/time order obtained;

     (c) The specific intervention ordered including length of time and behavior that would terminate the intervention;

     (d) Time restraint or seclusion began and ended;

     (e) Time and results of one hour assessment;

     (f) Resident behavior prior to initiation of restraint or seclusion;

     (g) Any injuries sustained during the restraint or seclusion; and

     (h) Post intervention debriefing with resident to discuss precipitating factors leading to the need for intervention.

     (10) Safety health checks must be conducted and documented at a minimum of every fifteen minutes, to include:

     (a) Behavior;

     (b) Food/nutrition offered;

     (c) Toileting; and

     (d) Physical condition.

     (11) Staff shall continuously observe and monitor residents in seclusion or restraint by an assigned staff member (face-to-face) or by staff using both video and audio equipment.

     (12) Staff involved in the restraint or seclusion will debrief and address effectiveness and safety issues.

     (13) The licensee must ensure that restraint and seclusion is carried out in a safe environment. This room must:

     (a) Be designed to minimize potential for stimulation, escape, hiding, injury, or death;

     (b) Have a maximum capacity of one resident;

     (c) Have a door that opens outward;

     (d) Have a staff-controlled, lockable, adjoining toilet room;

     (e) Have a minimum of three feet of clear space on three sides of the bed; and

     (f) Have negative pressure with an independent exhaust system with the exhaust fan at the discharge end of the system.

     (14) Restraint equipment must be clean and in good repair.

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     (1) Sanitary disposal and collection of garbage and refuse, by including:

     (a) Use of noncombustible waste containers in resident rooms and common use areas;

     (b) Containers constructed of nonabsorbent material, which are water-tight, covered, and adequate to store garbage and refuse generated by the RTF;

     (c) A storage area location convenient for resident and staff use;

     (d) An area and containers that are cleaned and maintained to prevent:

     (i) Entrance of insects, rodents, birds, or other pests;

     (ii) Odors; and

     (iii) Other nuisances.

     (2) Management of biohazardous and nonmedical waste in accordance with applicable federal, state and local rules, including the use of appropriate containers and collection and disposal services if infectious wastes are generated.

     (3) A locked housekeeping room on each level of the RTF that is equipped with:

     (a) A utility sink or equivalent means of obtaining and disposing of mop water separate from food preparation and service areas; and

     (b) Storage for cleaning supplies and wet mops which is mechanically ventilated to the outside according to standards adopted by the state building code council, chapter 51-13 WAC.

     (4) Adequate storage space for:

     (a) Clean and soiled equipment and linens;

     (b) Lockable, shelved storage impervious to moisture, for cleaning supplies, disinfectants and poisonous compounds; and

     (c) Separate, locked storage for flammable materials or other fire and safety hazards.

     (5) A safe and cleanable area is designated for pouring stock chemicals and cleaning supplies into separate, properly labeled containers if stock chemicals are used.

     (6) An effective pest control program so that the RTF is free of pests such as rodents and insects.

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     (1) Each RTF shall be located on a site which is:

     (a) Free of standing water; and

     (b) Accessible by emergency vehicles on at least one street, road or driveway usable under all weather conditions and free of major potholes or obstructions.

     (2) Develop and implement systems for routine preventative maintenance, including:

     (a) Heating ventilation and air conditioning, plumbing and electrical equipment;

     (b) Certification and calibration of biomedical and therapeutic equipment; and

     (c) Documentation of all maintenance.

     (3) Rooms shall be provided for dining, multipurpose, counseling, therapy and social activities, including:

     (a) At least forty square feet per resident for the total combined area which is utilized for dining, social, educational, recreational activities and group therapies;

     (b) A ceiling height of at least seven and one-half feet over the required floor area throughout the RTF;

     (c) At least one private area for visitation of residents and guests;

     (d) Therapy rooms for individual and group counseling that maintain visual and auditory confidentiality in the ratio of at least one room per twelve residents; and

     (e) A medical examination room, when there is routine physical examination of residents within the RTF. The examination room must be equipped with:

     (i) An exam table with at least three feet of space on two sides and end of the table for staff access;

     (ii) An examination light;

     (iii) Storage units for medical supplies and equipment;

     (iv) A handwashing sink;

     (f) Dining room(s) or area(s) are large enough to accommodate all residents at a single sitting or in no more than three shifts. If the space is used for more than one purpose, that space must be designed to accommodate each of the activities without unreasonable interference with one another.

     (4) Equip stairways with more than one riser and ramps with slopes greater than one in twenty with handrails on both sides. Ends of handrails are designed in a manner that eliminates a hooking hazard.

     (5) School facilities, excluding child care, serving residents on the same grounds as the RTF must meet all requirements for health and safety and comply with chapter 246-366 WAC, Primary and secondary schools.

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     (1) Provision for a minimum of one toilet (water closet) and handwashing sink for every eight residents, or fraction thereof. Urinals may count for up to one-third of the required toilets in a male-only toilet room.

     (2) A toilet and handwashing sink in, or immediately accessible to each bathroom.

     (3) A minimum of one bathing fixture for every eight residents.

     (4) Rooms containing more than one water closet or more than one bathing area must:

     (a) Be designated for use by one gender, unless it is a toilet specifically designated for children under the age of six years;

     (b) Provide for privacy during toileting, bathing, and dressing through the use of doors or dividers;

     (5) Each toilet room and bathroom must be equipped with:

     (a) Water resistant, smooth, easily cleanable, slip-resistant bathtubs, showers, and floor surfaces;

     (b) Washable walls to the height of splash or spray;

     (c) Washable cabinets and counter tops;

     (d) Plumbing fixtures designed for easy cleaning;

     (e) Clean, nonabsorbent toilet seats free of cracks;

     (f) Grab bars installed at each water closet and bathing fixture;

     (g) Shatter resistant mirrors when appropriate;

     (h) Adequate lighting for general illumination;

     (i) One or more handwashing sink with soap and single use or disposable towels with a mounted paper towel dispenser, unless a blower or equivalent hand-drying device is provided;

     (j) Toilet tissue with a reachable mounted tissue dispenser by each toilet.

     (6) Reasonable access to bath and toilet rooms must be provided by:

     (a) Locating a toilet room and bathing facilities on the same floor or level as the sleeping room of the resident; and

     (b) Providing access without passage through any food preparation area or from one bedroom through another bedroom.

     (7) If a toilet room or bathing facility adjoins a bedroom, the bathing facility is restricted to use by those residents residing in the adjoining bedrooms.

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     (1) Maintaining tempered water between one hundred and one hundred twenty degrees Fahrenheit in resident areas.

     (2) Maintaining the plumbing systems free of cross connections.

     (3) Assuring all sewage and waste water drain into a public sewer system in compliance with applicable laws and rules, or meet the requirements of chapters 246-272 and 173-240 WAC, and local laws and rules.

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     (2) Direct evaporative coolers may not be used for cooling. In existing facilities, no new or replacement evaporative coolers may be used after adoption of these rules. Facilities currently using direct evaporative coolers (swamp coolers or similar equipment) shall follow manufacturer's instructions and develop and implement a written preventive maintenance program.

     (3) All areas of the building must be ventilated to prevent excessive odors and moisture. The ventilation system must be in compliance with chapter 51-13 WAC. Facilities licensed prior to July 1991 may continue to use windows for ventilating toilet rooms, bathrooms, and janitor rooms if the windows are equipped with sixteen gauge mesh screens.

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     (1) Light fixtures are protected against light bulb breakage by using appropriately fitted shields, bulbs, or tubes manufactured with shatter resistant materials in all areas occupied by residents, including common areas, and in medication and food preparation areas.

     (2) Each room or area occupied by children under age five or residents with unsafe behaviors must have tamper resistant electrical outlets.

     (3) Each electrical outlet within six feet of a sink or wet area must be of the ground fault interrupter type or be controlled by a ground fault circuit interrupter.

     (4) Provide emergency lighting on each floor.

     (5) Provide operable exterior lighting with solar or battery backup at the exit and entry doors.

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     (1) The licensee must provide laundry and linen services on the premises, or by commercial laundry.

     (2) The licensee must handle, clean, and store linen according to acceptable methods of infection control. The licensee must:

     (a) Provide separate areas for handling clean laundry and soiled laundry;

     (b) Ensure clean laundry is not processed in, and does not pass through, areas where soiled laundry is handled;

     (c) Ensure areas where clean laundry is stored are not exposed to contamination from other sources;

     (d) Ensure all staff wears appropriate personal protective equipment and uses appropriate infection control practices when handling laundry;

     (e) Ensure that damp textiles or fabrics are not left in machines for longer than twelve hours;

     (f) Ensure that gross soil is removed before washing and proper washing and drying procedures are used; and

     (g) Ensure that contaminated textiles and fabrics are handled with minimum agitation to avoid contamination of air, surfaces and persons.

     (3) The licensee must use and maintain laundry equipment according to manufacturers' instructions.

     (4) The licensee must use washing machines that have a continuous supply of hot water with a temperature of one hundred forty degrees Fahrenheit, or that automatically dispense a chemical sanitizer and detergent or wash additives as specified by the manufacturer, whenever the licensee washes:

     (a) Licensee's laundry;

     (b) Licensee's laundry is combined with resident's laundry into a single load; or

     (c) More than one resident's laundry is combined into a single load.

     (5) The licensee or a resident washing an individual resident's personal laundry, separate from other laundry, may wash the laundry at temperatures below one hundred forty degrees Fahrenheit provided chemicals suitable for low temperature washing at proper use concentration and according to the cleaning instructions of the textile, fabric or clothing are used.

     (6) The licensee must ventilate laundry rooms and areas to the exterior including areas or rooms where soiled laundry is held for processing by off-site commercial laundry services.

     (7) The licensee must locate laundry equipment in rooms other than those used for open food storage, food preparation or food service.

     (8) If the licensee provides a laundry area where residents may do their personal laundry, the laundry area must be arranged to reduce the chances of soiled laundry contaminating clean laundry and equipped with:

     (a) A utility sink;

     (b) A table or counter for folding clean laundry;

     (c) At least one washing machine and one clothes dryer; and

     (d) Mechanical ventilation to the exterior.

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     (1) Sleeping rooms designed to provide at least a three-foot clear access aisle from the entry door, along at least one side of each bed, and in front of all storage equipment.

     (2) If a bunk bed is used, a minimum access aisle of five feet shall be provided along at least one side of the bunk bed.

     (3) Room identification and resident capacity per sleeping room consistent with the approved room list and evacuation floor plan.

     (4) Direct access to a hallway, living room, lounge, the outside, or other common use area without going through a laundry or utility area, a bath or toilet room, or another resident's bedroom.

     (5) Each sleeping room having one or more outside windows that:

     (a) Is easily opened if necessary for fire exit or ventilation;

     (b) Is marked with a solid color or barriers to prevent residents from accidentally walking into them if clear glass windows or doors extend to the floor;

     (c) Has adjustable curtains, shades, blinds, or equivalent installed at the windows for visual privacy; and

     (d) Is shatterproof, screened, or of the security type as determined by the resident needs.

     (6) Sleeping rooms equipped with:

     (a) One or more noncombustible waste containers;

     (b) An individual towel and washcloth rack or an equivalent method to provide clean towels and washcloths;

     (c) Storage facilities for storing a reasonable quantity of clothing and, when requested by the resident, storage in a lockable drawer, cupboard, locker, or other secure space somewhere in the building;

     (d) Furniture appropriate for the age and physical condition of each resident, must be provided, including:

     (i) A chair, which may be used in either the bedroom or a group room interchangeably;

     (ii) A bed of appropriate size equipped with:

     (A) A mattress that is clean, in good repair, and fits the frame;

     (B) One or more pillows that are clean, and in good repair for each resident over two and one-half years;

     (C) Bedding that includes a tight-fitting sheet or cover for the sleeping surface, and a clean blanket or suitable cover; and

     (D) Bedding that is in good repair, changed weekly or more often as necessary to maintain cleanliness;

     (iii) A bed thirty-six or more inches wide for adults and appropriate size for children, spaced thirty-six inches apart;

     (iv) A single level nonstacking crib, infant bed, bassinet or playpen for children twenty-four months and younger meeting chapter 70.111 RCW, and including:

     (A) Sleep equipment having secure latching devices; and

     (B) A mattress that is:

     (I) Snug-fitting to prevent the infant from becoming entrapped between the mattress and crib side rails;

     (II) Waterproof and easily sanitized; and

     (III) Free of crib bumpers, stuffed toys or pillows;

     (v) A youth bed or regular bed for children twenty-five months and older;

     (vi) If bunk beds are used, children six years of age or less are prohibited from utilizing the upper bunk.

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FEE TYPE	AMOUNT
Administrative processing/ initial application fee	$150.00
License bed fee (per bed)	$136.10
Annual renewal fee (per bed)	$136.10
Late fee (per bed)	$25.00 (up to $500.00)
Follow-up compliance survey fee or a complete on-site survey fee resulting from a substantiated complaint	$1000.00

     If a written request is submitted for withdrawal after the department has begun the licensure review process, but before licensure, the department may refund any portion of the fees not consumed by departmental action taken prior to the request for withdrawal.

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OTS-6710.1

REPEALER
     The following chapter of the Washington Administrative Code is repealed:

WAC 246-323-010	Definitions.
WAC 246-323-020	Licensure.
WAC 246-323-022	Criminal history, disclosure, and background inquiries.
WAC 246-323-030	Administration.
WAC 246-323-040	HIV/AIDS education and training.
WAC 246-323-050	Client care services.
WAC 246-323-060	Pharmaceutical services.
WAC 246-323-070	Infection control.
WAC 246-323-080	Clinical records.
WAC 246-323-090	Physical environment.
WAC 246-323-990	Fees.

OTS-6711.1

REPEALER
     The following chapter of the Washington Administrative Code is repealed:

WAC 246-325-010	Definitions.
WAC 246-325-012	Licensure -- Adult residential rehabilitation centers and private adult treatment homes.
WAC 246-325-015	Licensure -- Private adult treatment home.
WAC 246-325-020	Administration -- Adult residential rehabilitation center.
WAC 246-325-022	Criminal history, disclosure, and background inquiries.
WAC 246-325-025	HIV/AIDS education and training.
WAC 246-325-030	Resident care services in adult residential rehabilitation centers or private adult treatment homes.
WAC 246-325-035	General resident safety and care -- Policies, procedures, practices.
WAC 246-325-040	Pharmaceutical services in adult residential rehabilitation centers.
WAC 246-325-045	Food storage -- Preparation -- Service.
WAC 246-325-050	Infection control in adult residential rehabilitation centers.
WAC 246-325-060	Clinical records.
WAC 246-325-070	Physical environment in adult residential rehabilitation centers.
WAC 246-325-100	Resident care services in private adult treatment homes.
WAC 246-325-120	Physical environment requirements for private adult treatment homes.
WAC 246-325-990	Fees.

OTS-6712.1

REPEALER
     The following chapter of the Washington Administrative Code is repealed:

WAC 246-326-010	Definitions.
WAC 246-326-020	Licensure.
WAC 246-326-030	Administrative management.
WAC 246-326-035	HIV/AIDS education and training.
WAC 246-326-040	Patient care and services -- General.
WAC 246-326-050	Health and medical care services -- All facilities.
WAC 246-326-060	Medication responsibility -- Administration of medications and treatments.
WAC 246-326-070	Maintenance and housekeeping -- Laundry.
WAC 246-326-080	Site and grounds.
WAC 246-326-090	Physical plant and equipment.
WAC 246-326-100	Special additional requirements for facilities providing alcoholism detoxification service.
WAC 246-326-990	Fees.

© Washington State Code Reviser's Office