WSR 18-01-046

PROPOSED RULES

DEPARTMENT OF HEALTH

[Filed December 12, 2017, 12:35 p.m.]

Original Notice.

Preproposal statement of inquiry was filed as WSR 12-22-029.

Title of Rule and Other Identifying Information: Chapter 246-337 WAC, Residential treatment facility, the department of health (department) is proposing to amend the residential treatment facility (RTF) licensing regulations by restructuring, streamlining and updating rule language throughout the chapter. The proposal also clarifies language regarding restraint and seclusion, medication management, and resident care services.

Hearing Location(s): On January 24, 2018, at 1:00 p.m., at the Department of Health, Town Center 2, Room 145, 111 Israel Road, Tumwater, WA 98501.

Date of Intended Adoption: February 1, 2018.

Submit Written Comments to: Jeff Wise, Department of Health, P.O. Box 47850, Olympia, WA 98504-7850, email https://fortress.wa.gov/doh/policyreview, fax 360-236-3201, by January 24, 2018.

Assistance for Persons with Disabilities: Contact Jeff Wise, phone 360-236-4987, fax 360-236-3201, TTY 360-833-6388 or 711, email jeff.wise@doh.wa.gov, by January 10, 2018.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rule language reorganizes and clarifies existing requirements for licensees and the department surveyors and investigators. The proposal also amends language regarding restraint and seclusion, medication management, and resident care services, and would set minimum construction standards that are scalable based on the type of the patients and services provided in each facility.

Reasons Supporting Proposal: The proposed rules are needed to support new behavioral health care models, create consistent standards with other state regulated facilities, increase safety in the built environment, and provide clear language that is understood by licensees and regulators. Proposed rule language supports facilities in providing integrated care and streamline regulation for licensees and the department.

Statutory Authority for Adoption: RCW 71.12.670.

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: Julie Tomaro, 101 Israel Road S.E., Tumwater, WA 98501, 360-236-3540; Implementation and Enforcement: Nancy Tyson, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-4796.

A school district fiscal impact statement is not required under RCW 28A.305.135.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Jeff Wise, Department of Health, P.O. Box 47850, Olympia, WA 98504-7850, phone 360-236-4987, fax 360-236-3201, TTY 360-833-6388 or 711, email jeff.wise@doh.wa.gov.

This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:

Is exempt under RCW 19.85.025(3) as the rules are adopting or incorporating by reference without material change federal statutes or regulations, Washington state statutes, rules of other Washington state agencies, shoreline master programs other than those programs governing shorelines of statewide significance, or, as referenced by Washington state law, national consensus codes that generally establish industry standards, if the material adopted or incorporated regulates the same subject matter and conduct as the adopting or incorporating rule; and rules only correct typographical errors, make address or name changes, or clarify language of a rule without changing its effect.

Explanation of exemptions: See cost-benefit analysis, which may be obtained from the department of health.

The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The department used a minor cost threshold of one percent of the average annual payroll of one hundred thirty-three residential treatment facilities in Washington state, which is $6,623. The proposal would require a handwashing sink in medication rooms, and clarified that certain facilities must have a restraint or seclusion room, depending on the services provided. Most facilities requiring such a room already have one in place. The construction costs for such a room and for a sink in medication rooms was determined to be approximately $24,000. Because these are construction costs, the department amortized them over a period of ten years, which is $2,400 per year, on average. When amortized, the annual cost does not exceed the minor cost threshold. There are also possible administrative costs to update policies and procedures which the department estimates to be not more than $650.

December 11, 2017

John Wiesman, DrPH, MPH

Secretary

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-001 Scope and purpose.

(1) This chapter implements chapter 71.12 RCW and sets the minimum health and safety standards for licensure and operations of twenty-four hour private, county or municipal residential treatment facilities (RTF) providing health care services to persons with mental disorders or substance ((abuse)) use disorders.

(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.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-005 Definitions.

((For the purpose of this chapter, the following words and phrases have the following meanings)) The definitions in this section apply throughout this chapter unless the context clearly indicates otherwise:

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

(2) "Adult" means an individual ((age)) eighteen years of age 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))) (4) "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 70.96A 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;

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

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

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

(((9))) (6) "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))) (7) "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))) (8) "Construction" means:

(a) The erection of a facility;

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

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

(13))) (9) "Co-occurring services" means services certified by DSHS-DBHR that combine mental health services and substance use disorder services under a single RTF license.

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

(((14))) (11) "DSHS-DBHR" means the division of behavioral health and recovery within 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))) (12) "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)), or multiple buildings under a single RTF license.

(((20))) (13) "Health assessment" means a systematic physical examination of the person's body conducted by an ((authorized health care provider)) allopathic physician, osteopathic physician, naturopathic physician, allopathic physician's assistant, osteopathic physician's assistant, advanced registered nurse practitioner, registered nurse, or licensed practical nurse who is licensed under Title 18 RCW and operating within their scope of practice.

(((21))) (14) "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))) (15) "Health care prescriber" or "prescriber" means an allopathic physician, osteopathic physician, naturopathic physician, allopathic physician's assistant, osteopathic physician's assistant, or advanced registered nurse practitioner licensed under Title 18 RCW operating within their scope of practice who by law can prescribe drugs in Washington state.

(16) "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))) (17) "Health care screen" means ((the process)) a systematic interview or use of a questionnaire approved by ((an authorized)) a health care ((provider)) prescriber to determine the health history and care needs of a resident.

(((24))) (18) "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))) (19) "Medication" means a legend drug prescribed for a resident by an authorized health care ((provider, or)) prescriber. Medication also means nonprescription drugs, also called "over-the-counter medications," that can be purchased by the general public without a prescription.

(((26))) (20) "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))) (21) "Medication administration error" means a resident failing to receive the correct medication, medication at the correct time, the correct dose, or medication by the correct route.

(22) "Mental health ((RTF)) services" 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;

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

(31))) services certified by DSHS-DBHR under chapter 388-865 or 388-877A WAC to evaluate, stabilize, or treat one or more residents for a mental disorder.

(23) "Parent((")) or guardian" 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))) (24) "Resident" means an individual (((adult or child))) admitted to ((the)) a RTF licensed under this chapter.

(((33))) (25) "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))) in which twenty-four hour on-site care is provided for the evaluation, stabilization, or treatment of residents for substance use, mental health, or co-occurring disorders.

(26) "Restraint" means any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a resident to move his or her arms, legs, body or head freely; or a drug or medication when used as a restriction to manage the resident's behavior or restrict the resident's freedom of movement and is not a standard treatment or dosage for the resident's condition. Restraint does not include momentary periods of minimal physical restriction by direct person-to-person contact, without the aid of mechanical or chemical restraint, accomplished with limited force and designed to:

(a) Prevent a resident from completing an act that would result in potential bodily harm to the resident or others or to damage property;

(b) Remove a disruptive resident who is unwilling to leave the area voluntarily; or

(27) "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))) (28) "Substance use disorder services" means services certified by DSHS-DBHR under chapter 388-877B WAC to evaluate, stabilize, or treat one or more residents for alcoholism, drug addiction, or dependence on alcohol and one or more other psychoactive chemicals, as the context requires.

(29) "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))) (30) "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.))

Reviser's note: The typographical errors in the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-010 ((Initial licensure and renewal process.)) Licensing.

An applicant may not open or operate a RTF until all requirements for licensure set forth in this section are met and the department has issued an initial, renewed, or amended RTF license listing the service type(s) approved to be provided in the RTF.

(1) Initial((:)) licensure. An applicant for an initial RTF license must submit to the department((, sixty days or more before starting)):

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

(iii))) WAC 246-337-055;

(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))

(d) Policies and procedures in 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))) for review and approval by the department;

(e) A completed construction review application and fee, and functional program plan according to WAC 246-337-040;

(f) Written 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.

(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)) (g) Documentation of completion of an initial on-site survey; and

(h) Other information as required by the department.

(((3))) (2) License renewal((:)). At least thirty calendar 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 the previous three months of the ((renewal)) application date for the administrator in accordance with ((chapter 43.43 RCW)) WAC 246-337-055;

(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)) Written approval from 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; and

(e) Other information as required by the department.

(3) License amendment. Prior to changing any of the ((license)) service ((categories)) type(s) provided in the facility, number of resident beds, location or use of rooms ((as listed on the licensed room list, or)), the physical structure of the ((RTF,)) facility, or a change in the administrator, the licensee must submit to the department:

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

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

(5) At least sixty days)) A completed application on form(s) provided by the department;

(d) A request to the department to determine the need for review by the department's construction review services and Washington state fire marshal;

(e) If changing service type, policies and procedures in compliance with chapter 71.12 RCW and this chapter for review and approval by the department; and

(f) If changing administrators, disclosure statements and criminal history background checks obtained within the previous three months of the application date for the administrator in accordance with WAC 246-337-055.

(4) Change of ownership. Prior to selling, leasing, renting or otherwise transferring control of a ((license,)) RTF that results in a change of the state 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;

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

(e) Other information as required by the department.

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

(7))) (5) A RTF license is not transferable.

(6) The licensee shall:

(a) Maintain and post a current RTF license in a conspicuous place on the premises;

(b) Provide services limited to each department approved service type; and

(7) Prior to issuing, renewing, or amending a license, the department shall:

(a) Review and approve the licensing application;

(b) Review and approve RTF policies and procedures according to this chapter, as applicable;

(d) Obtain written verification of compliance with RCW 71.12.485 and chapter 212-12 WAC administered by the Washington state patrol fire marshal fire protection service, as applicable; and

(e) Determine whether the applicant or licensee meets the requirements in chapter 71.12 RCW and this chapter.

(8) The department may issue a single RTF license to include two or more buildings on the same campus if the applicant or licensee:

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

(b) Operates the multiple buildings as a single integrated system with governance by a single authority or body over all staff and buildings.

(9) For the purposes of this section, "campus" means an area where all of the RTF's buildings are located on contiguous properties undivided by:

(a) Public streets, not including alleyways used primarily for delivery services or parking; or

(b) Other land that is not owned and maintained by the owners of the property on which the facility is located.

Reviser's note: The typographical errors in the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-015 Service ((categories)) types.

A licensee ((may)) must provide ((services under a single RTF license for)) one or more of the following types of services ((categories)) in the RTF:

(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;

(9) Mental health child inpatient evaluation and treatment.)) Mental health services;

(2) Substance use disorder services; or

(3) Co-occurring services.

NEW SECTION

WAC 246-337-021 On-site surveys, complaint investigations, and enforcement.

(1) To determine compliance with chapter 71.12 RCW and this chapter, the department may:

(a) Conduct unannounced on-site surveys upon initial licensure and annually thereafter, and as needed; and

(b) Investigate complaints alleging noncompliance with chapter 71.12 RCW and this chapter.

(2) The licensee shall assist the department during on-site surveys and investigations in a cooperative manner.

(3) Notice of correction.

(a) When the department identifies deficiencies it does not determine to be major, broadly systemic, or of a recurring nature, the department will issue the administrator a notice of correction according to RCW 43.05.100.

(b) The "notice of correction" will include:

(i) A description of the condition that is not in compliance and the text of the specific section or subsection of the applicable law or rule;

(ii) A brief statement of what is required to achieve compliance;

(iii) The date by which the department requires compliance to be achieved;

(iv) Notice of the means to contact any technical assistance services provided by the department or other sources of technical assistance; and

(v) Notice of when, where, and to whom a request to extend the time to achieve compliance for good cause may be filed with the department.

(4) Plan of correction.

(a) At the same time the department issues a notice of correction as identified in subsection (3) of this section, the department will provide instructions on how the administrator will complete and submit a plan of correction.

(b) The "plan of correction" must include:

(i) A statement that the administrator:

(A) Has or will correct each cited deficiency; and

(B) Will maintain correction of each cited deficiency.

(ii) A place for the administrator to describe the specific action(s) that must be taken to correct each cited deficiency;

(iii) A place for the administrator to indicate the individual responsible for assuring correction of each deficiency; and

(iv) A place for the administrator to indicate the time frame in which to complete the corrections.

(d) Implementation of the corrective action must be completed within the approved time frame and is subject to verification by the department.

(e) The administrator or the administrator's designee shall:

(i) Complete, sign, date, and submit a written plan of correction to the department within ten business days of receiving a notice of correction; and

(ii) Submit to the department updated plans of correction as needed.

(5) Directed plan of correction.

(a) When the department identifies deficiencies it determines to be broadly systemic, recurring, or of a significant threat to public health and safety, it will issue a directed plan of correction.

(b) The directed plan of correction will include:

(i) Direction from the department on the specific corrective action(s) required for the licensee to correct each cited deficiency; and

(ii) The time frames in which the department requires the licensee to complete each cited deficiency.

(c) The department may reduce the time frames in the directed plan of correction to the minimum necessary. Implementation of the directed corrective action(s) must be completed within the approved time frame and is subject to verification by the department.

(6) The department may deny, suspend, modify, or revoke a RTF license under chapters 71.12, 43.70, 34.05 RCW, and 246-10 WAC, if the applicant or licensees have:

(a) Failed to correct any deficiencies within the required time frames as described in subsections (3) through (5) of this section;

(b) Failed to comply with any other provision of chapter 71.12 RCW or this chapter;

(d) 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;

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

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

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

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

(7) 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.

(8) A licensee may contest a department decision or action according to the provision of RCW 43.70.115, chapter 34.05 RCW, and chapter 246-10 WAC.

Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-025 Exemptions ((and)) or alternative means and methods of compliance.

(1) An applicant or licensee may request an exemption or alternative means or methods of compliance from any part of this chapter by submitting a written request to the department((, including)) that includes:

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

(b) An explanation of the circumstances involved;

(d) Any supporting research or other documentation.

(2) After review and consideration, the department may grant ((an)) the request if the exemption ((if the exemption)) or alternative means or methods of compliance 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;

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

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

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-040 ((Review of construction documents and functional program.)) Construction review services requirements.

(1) Prior to beginning any construction or remodeling, the applicant or licensee must submit an application and fee specified in chapter 246-314 WAC, if applicable, to the department and receive written authorization by the department to proceed.

(2) ((The licensee or applicant must submit)) The requirements of chapter 246-337 WAC in effect at the time the application and fee are submitted to the department, and the project number as assigned by the department, apply for the duration of the construction project.

(3) Standards for design and construction. Construction shall comply with:

(a) The state building code as adopted by the state building code council under the authority of chapter 19.27 RCW; and

(b) The requirements in this chapter for new construction.

(4) Preconstruction. The applicant or licensee must request and attend a presubmission conference with the department for projects with a construction value of two hundred fifty thousand dollars or more. The presubmission conference shall be scheduled to occur at the end of the design development phase or the beginning of the construction documentation phase of the project.

(5) Construction document review. The applicant or licensee must submit accurate and complete construction documents for proposed new construction to the department for review within ten days of submission to the local authorities. The construction documents must include:

(a) A written functional program, in accordance with RCW 71.12.470, outlining the ((service categories and)) types of services provided, types of residents to be served, and how the needs of the residents will be met including((, but not limited to)) a narrative description of:

(((a))) (i) Program goals;

(((b))) (ii) Staffing and health care to be provided consistent with WAC 246-337-080;

(((c))) (iii) Infection control consistent with WAC 246-337-060;

(((d) Security and safety;

(e) Seclusion and restraint)) (iv) Safety and security consistent with WAC 246-337-065;

(v) Restraint and seclusion consistent with WAC 246-337-110;

(((f))) (vi) Laundry consistent with WAC 246-337-112;

(((g))) (vii) Food and nutrition consistent with WAC 246-337-111; ((and

(h))) (viii) 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))) consistent with WAC 246-337-105; and

(ix) Housekeeping.

(b) Drawings prepared, stamped, and signed by an architect or engineer 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)))

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

(d)))

(e) 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))) (f) An interim life safety measures plan to ensure the health and safety of occupants during construction and renovation; and

(g) An infection control risk assessment indicating appropriate infection control measures, keeping the surrounding area free of dust and fumes, and ensuring rooms or areas are well ventilated, unoccupied, and unavailable for use until free of volatile fumes and odors.

(6) Resubmittals. The licensee shall respond in writing when the department requests additional or corrected construction documents.

(7) Construction. The licensee or applicant shall comply with the following requirements during the construction phase:

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

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

(((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.)) (c) Allow any necessary inspections for the verification of compliance with the construction documents, addenda, and modifications.

(8) Project closeout. The licensee or applicant shall not use any new or remodeled areas until:

(a) The department has approved construction documents;

(b) The local jurisdictions have completed all required inspections and approvals, when applicable or given approval to occupy; and

(i) A copy of the local jurisdiction's approval for occupancy;

(ii) The completion date;

(iii) The actual construction cost; and

(iv) Additional information as required by the department.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-045 Governance and administration.

The licensee must establish a governing body with responsibility for operating and maintaining the RTF. The governing body must provide organizational guidance and oversight to ensure that resources support and staff provides safe and adequate resident care including, but not limited to:

(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)) the provision of 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))

(d) Implement the requirements of this chapter and ensure they are:

(i) Kept current;

(ii) Made known to staff and available at all times; and

(iii) Complied with by staff.

(2) Establishing a job description and procedures for selecting and periodically evaluating a qualified administrator to ((assure that he or she carries)) carry 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)); and

(b) Be available at all times either in person, by telephone or similar electronic means, or ((assure that a designated)) designate an alternate who has similar qualifications and 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)) whose:

(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;)) Contracts for contracted personnel are kept on file, kept current, and signed. Contracts must also clearly state the responsibilities for all contracted personnel; and

(e) Staff, contractors, consultants, students, volunteers, and trainees with unsupervised access to residents ((complies)) comply 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 addressing health and safety.))

NEW SECTION

WAC 246-337-048 Quality improvement program.

The licensee must establish policies and procedures to ensure ongoing maintenance of a coordinated quality improvement program to improve the quality of care provided to residents and to identify and prevent serious or unanticipated resident and facility outcomes. The licensee must:

(1) Establish a written performance improvement plan that is periodically evaluated.

(2) Collect, measure, and assess data on policies and procedures, and outcomes related to resident care and the environment including:

(a) Medication administration errors;

(b) Allegations of abuse;

(d) Suicide;

(e) Injuries which result in serious or unanticipated outcomes;

(f) Restraint or seclusion use;

(g) Resident grievances;

(h) Security incidents; and

(i) Disruption of services through internal or external emergency or disaster event.

(3) Review serious or unanticipated resident or facility outcomes as specified in subsection (2) of this section, in a timely manner.

(4) Implement and document changes or improvements made to prevent future occurrences of any serious or unanticipated resident outcome specified in subsection (2) of this section.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-050 Management of human resources.

(1) The licensee must ensure residents receive ((health care by adequate numbers of)) care from qualified staff authorized and competent to carry out assigned responsibilities((, including:

(1))).

(2) A sufficient number of ((personnel)) staff must be present on a twenty-four hour per day basis to:

(a) Meet the ((health)) care needs of the residents served; ((managing))

(b) Manage emergency situations;

(d) Implement individual service plans; and

(e) Carry out required monitoring activities.

(((2) Personnel)) (3) At least one staff trained in basic first aid and age appropriate cardiopulmonary resuscitation (CPR) must be on-site twenty-four hours per day.

(4) Staff must be trained, authorized, and where applicable credentialed (((where applicable) to carry out)) to perform assigned job responsibilities consistent with scopes of practice, resident population characteristics and the resident's individual service 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))) (5) The licensee must document that staff receive the following training as applicable:

(a) Initial orientation and ongoing training to address the safety and health care needs of the residents served for all staff;

(b) Bloodborne pathogen training inclusive of HIV/AIDS training for staff involved in direct resident care or potential for having contact with blood or body fluids;

(c) If restraint or seclusion is used in the facility, initial and annual training in the proper and safe use of restraint or seclusion for staff required to perform restraint or seclusion procedures inclusive of:

(i) Techniques to identify staff and resident behaviors, events, and environmental factors that may trigger circumstances that require the use of restraint or seclusion;

(ii) The use of nonphysical intervention skills;

(iii) Choosing the least restrictive intervention based on an individualized assessment of the resident's medical or behavioral status or condition;

(iv) The safe application and use of all types of restraint or seclusion used in the RTF, including training in how to recognize and respond to signs of physical and psychological distress;

(v) Clinical identification of specific behavioral changes that indicate that restraint or seclusion is no longer necessary; and

(vi) Monitoring the physical and psychological well-being of the resident who is restrained or secluded including, but not limited to, respiratory and circulatory status, skin integrity, and vital signs; and

(d) Current basic first aid and age appropriate cardiopulmonary resuscitation for staff required to provide first aid or CPR.

(6) The licensee shall have written documentation ((to verify credentials, training, and performance evaluations)) for each staff member including((, but not limited to)):

(a) Employment ((application/hire));

(b) Hire date;

(((b))) (c) Verification of education((,)) and experience ((and training));

(((c))) (d) Current signed job description;

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

(e) HIV/AIDS training or verification)) check, according to WAC 246-337-055, completed within the previous three months of hire date and annually thereafter;

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

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

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

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

(j) Initial and ongoing tuberculosis screening (((refer)) according to the facility risk assessment and tuberculosis written plan according to WAC 246-337-060(())); and

(k) Annual signed 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)).

(7) For the purposes of this section staff includes: Independent contractors, consultants, students, volunteers and trainees ((are)) providing direct ((on-site residential care, the licensee must ensure their compliance with this section)) care.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-055 Personnel criminal history, disclosure, and background inquiries.

The licensee ((must ensure that)) shall screen all prospective staff, independent contractors, consultants, students, volunteers and trainees with unsupervised access to residents ((are screened)) for criminal history disclosure and background requirements using a Washington state patrol background check consistent with RCW 43.43.830 through 43.43.842. All background check reports and signed disclosure statements must be made available to the department upon request.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-060 Infection control.

The licensee must ((ensure each resident's care is provided in an environment)) implement and maintain an infection control program that prevents the transmission of infections and communicable disease among residents, staff, and visitors ((including)) by:

(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)) Developing 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))) (b) Cleaning and disinfection;

(((iii) Standard/universal)) (c) Standard precautions to prevent transmission of bloodborne pathogens in accordance with chapter 296-823 WAC;

(((b))) (d) Resident((s with poor)) hygiene;

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

(d) Control)) (e) Preventing transmission of tuberculosis consistent with ((WISHA, department guidelines,)) the department's Washington State Tuberculosis Services Manual, DOH 343-071 June 2012, and chapter 246-170 WAC;

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

(f)))

(g) Environmental management; and

(h) 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))) (2) Complying with chapters 246-100 and 246-101 WAC.

(3) Providing ((the)) all necessary supplies and equipment ((necessary)) to implement the ((RTF)) infection control ((policies and procedures.

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

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-065 ((Health and)) Safety and security.

The licensee must protect resident ((health and)) safety and security by developing written policies and procedures that are consistent with the requirements of this chapter((,)) and address:

(1) ((Coordination of interagency and intra-agency services, if any, to meet and provide for resident health care needs.)) Management of disorderly residents, visitors, or staff.

(2) ((The provision of health care services.)) The safety of residents during transportation, including:

(a) Disorderly residents;

(b) Minimum qualifications for transport staff; and

(c) Any additional equipment in transport vehicles to ensure safety such as car seats for infants and children, and first-aid kits.

(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))) Smoking, vaping, and tobacco use by residents, visitors, and staff.

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

(a) Controlling all entrances and exits and accounting for 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.)) Conducting resident searches.

(5) Reporting to the department and other appropriate agencies, by the end of the next business day of the incident occurring, serious or undesirable outcomes that occur in the facility including:

(a) Allegations of abuse;

(b) Death;

(d) Injuries resulting in an inpatient hospital stay; and

(e) Disruption of services through internal or external emergency or disaster.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-070 Emergency disaster plan.

(((1))) The licensee must ((ensure resident health and safety by establishing and implementing)) establish and implement an emergency disaster plan designed ((for response)) to respond to internal and external emergency ((safety)) situations.

(1) The emergency disaster plan must:

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

(b) Be communicated to the residents and staff;

(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)) Include emergency phone numbers ((to be adjacent to appropriate phones)).

(2) The emergency disaster plan must identify:

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

(b) ((Procedures for accounting)) A system to account for all residents and staff during and after the emergency;

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

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

(e) Provisions ((for)) of emergency medications, food, water, clothing, shelter, heat and power for critical functions for three days;

(f) How family members will be contacted; and

(g) Arrangements for 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,)) Evacuation routes must be clearly posted in plain sight of residents and staff.

(4) The emergency disaster plan must include an evaluation process that includes:

(a) At least annually, conducting and documenting emergency drills for residents and staff; ((and

(b) A debriefing and ((evaluate)) evaluation of the plan after each emergency incident or drill; and

(((4))) (5) Emergency supplies and first-aid equipment must be:

(a) In a designated ((location)) location(s);

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

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

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-075 Resident rights.

The licensee must establish a process to ensure resident rights are protected in compliance with chapter 71.12 RCW, this chapter, and ((with chapters 70.96A, 71.05, and/or 71.34 RCW, as applicable, depending)) other applicable laws, and are based on the service ((categories that are part of the RTF license)) types provided in the RTF. This process must address((, at a minimum,)) how the RTF will:

(1) In an understandable manner, inform each resident ((in an understandable manner, his or her)) or their personal representative, designee or parent or guardian, of the following:

(a) All rights, treatment methods, and rules applicable to the proposed health care of ((a particular)) the 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));

(b) The estimated cost of treatment;

(d) How to file a complaint with the department without interference, discrimination, reprisal or facility knowledge; and

(e) Use of applicable emergency interventions such as:

(i) Behavior management;

(ii) Restraint or seclusion, if used in the RTF;

(iii) Special treatment intervention such as room or personal searches;

(iv) Restrictions of rights; and

(v) Confidentiality parameters based on terms of admission or confinement.

(2) Treat 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)) or seclusion, except as provided in WAC 246-337-110;

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

(e) Review or have their personal representative, designee, or parent or guardian review the resident's files in accordance with chapter 70.02 RCW;

(f) Refuse to perform services for the benefit of the RTF unless agreed to by the resident, ((as a part of)) documented in the individual ((health care)) service 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)) (g) Have a safe and clean environment; and

(h) Be free 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))) (3) On or before admission, document that each resident, or the resident's personal representative, designee, parent or guardian receives a written copy of the resident's rights that includes all items in subsection (2) of this section.

(4) Protect the confidentiality of:

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

(7)));

(b) Residents when visitors or other nonresidents are in the RTF; and

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

(((9))) (7) 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.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-080 Resident care services.

(((1) Policies and procedures: The licensee must establish and implement policies and procedures that describe how residents are provided care and personal equipment to meet their health care needs including:

(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 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.

(h) 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;

(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, mental health child inpatient evaluation and 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.)) (1) The licensee must establish and implement policies and procedures that:

(a) Describe how the licensee meets the residents' health care needs by satisfying the requirements of this section; and

(b) Are reviewed and approved by a health care prescriber at least biennially.

(2) The licensee must:

(a) Limit admission, transfer, discharge, and referral processes to residents for whom the RTF is qualified by staff, services, equipment, building design and occupancy to give safe care;

(b) Conduct or accept a current health care screening of each resident upon admission including a tuberculosis risk assessment and symptom screening;

(c) Refer residents for health care provided outside of the RTF as needed such as, but not limited to, laboratory, dental, ambulatory care or specialty services as needed;

(d) Assist residents in following all prescribed treatments, modified diets, activities or activity limitations;

(e) Assist residents to keep health care appointments;

(f) Provide access to a health assessment by a health care prescriber any time a resident exhibits signs or symptoms of an injury, illness or abnormality for which a medical diagnosis and treatment are indicated;

(g) Provide access to tuberculosis testing if the resident is high-risk or symptomatic of tuberculosis;

(h) Address serious illness, medical emergencies, or threat to life, to include:

(i) Criteria for determining the degree of medical stability of residents;

(ii) Observing residents for signs and symptoms of illness or trauma;

(iii) Reporting abnormal signs and symptoms according to an established protocol;

(iv) Criteria requiring a resident's immediate transfer to a hospital;

(v) How staff transmits the resident's medical and related data in the event of a transfer;

(vi) How to notify the parent or guardian, personal representative or next of kin in the event of an emergency, threat to life, serious change in the resident's condition, transfer of a resident to another facility, or death; and

(vii) When to consult with internal or external resource agencies or entities such as poison control, fire department or police.

(i) Provide access to emergency and prenatal care for pregnant residents, and postnatal care services for residents and infants; and

(j) Assure provisions of each resident's personal care items and durable medical equipment including storing and labeling each resident's personal care items separately, preventing contamination, and preventing access by other residents.

(3)(a) RTFs performing the following duties must meet the staffing requirements in (b) of this subsection:

(i) Have a health care prescriber initiate or adjust medication that is administered by staff according to the resident's individual service plan;

(ii) Otherwise administer medications to the resident; or

(iii) Use restraint or seclusion.

(b) RTFs performing any duties described in (a) of this subsection must meet the following staffing requirements:

(i) A registered nurse, licensed practical nurse, or prescriber must be available on-site during medication administration or while restraint or seclusion is being used, and otherwise available by phone twenty-four hours per day, seven days per week; and

(ii) A prescriber or registered nurse who is responsible for the supervision of resident care and nursing services must be available on-site at least four hours per calendar week.

(4) RTFs which do not perform any duties described in subsection (3)(a) of this section but have a health care prescriber initiate or adjust medication for residents to self-administer according to the resident's individual service plan must have a registered nurse or licensed practical nurse available at least by phone twenty-four hours per day, seven days per week.

(5) RTFs which meet the conditions in subsection (3) or (4) of this section must:

(a) Perform a health assessment for each resident. A prescriber or licensed nurse operating within their scope of practice shall conduct and complete the assessment following the resident's admission to the RTF unless a health assessment was performed within the past three months and is available to the RTF upon admission; and

(b) Develop and implement the policies and procedures explaining how nursing staff will be utilized including:

(i) Scheduling of hours on-site and availability by phone;

(ii) Supervision, assessment, and training of other staff;

(iii) Delegation to other staff;

(iv) Medication management;

(v) Treatment planning;

(vi) Health screenings;

(vii) Health assessments; and

(viii) If applicable, restraint or seclusion.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-085 Accepting a child with a parent in treatment.

((A chemical dependency facility that accepts)) (1) A RTF providing substance use disorder services and no mental health services may accept a child or children along with a parent in treatment ((must assure child care services are provided for the child and the services of a health care provider who is responsible for developing health care policies, provides consultation and monitors the child's health care. The facility shall:

(1))) as long as the parent is not receiving withdrawal management services.

(2) If the RTF provides withdrawal management, the child must be kept physically and visually separate from residents receiving withdrawal management services.

(3) A RTF that accepts a child with a parent in treatment must operate or arrange for child care which the child will attend during treatment hours of the parent. Child care facilities must be licensed by ((DSHS)) the department of early learning under:

(a) Chapter ((388-295)) 170-295 WAC((, Minimum licensing requirements for child day care centers,));

(b) Chapter ((388-151)) 170-297 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)); or

(4) During the hours the parent is not in treatment((, with)) the RTF must require that the parent be responsible for the child's care under the following conditions:

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

(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((;

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

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

(5) The RTF shall obtain a health history for each child following admission((;

(6))) and, if needed, develop with the parent a plan of care for each child that addresses the child's health care needs, including medications.

Reviser's note: The typographical errors in the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-095 Resident health care records.

The licensee must ensure the RTF meets the following requirements:

(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)) other applicable laws.

(2) Health care records may be integrated into a resident's individual service plan so long as the requirements of this section are met.

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

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

(4) Document ((medical)) health care information ((on the licensee's)) in a standardized ((forms)) manner.

(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)) chronologically by sections.

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

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

(a) Resident's name, ((age)) date of birth, sex, marital status, date of admission, voluntary or other commitment, name of ((physician)) health care prescriber, 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, unless the resident is admitted under an involuntary court order;

(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)) Individual service plan according to WAC 246-337-100;

(g) Individuals whom the resident consents for the RTF to freely communicate with regarding the health care of the resident ((without violating the resident's right to confidentiality or privacy of health care information)) including the individual's name, relationship to the resident, and address;

(h) Dated and signed (((or initialed))) notes describing all health care provided for each contact with the resident pertinent to the resident's ((health care)) individual service 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))) Health screening;

(iii) Health care service and treatment provided, including resident's response to treatment and any adverse reactions and resolution of health care issues and when applicable;

(iv) Medication administration, and medical staff notification of medication administration errors, adverse effects, or side effects;

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

(((iv))) (vi) Staff actions or response to health care needs;

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

(((v))) (viii) Discharge summary, including:

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

(B) Condition upon discharge;

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

(((D))) (E) Date and time of discharge.

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

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

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-100 ((Health care)) Resident's individual service plan.

(1) The licensee must ((ensure that)) develop and implement an individual ((health care)) service plan ((is developed and implemented)) for each resident based on ((health assessment(s) on admission and updated as additional needs are identified during treatment that includes the following:

(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;

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

(e) Discharge health care needs)) the resident's:

(a) Initial health on admission; and

(b) Health assessment(s).

(2) Individual service plans must:

(a) Be prepared by one or more staff involved in the resident's care with participation by the resident and by either his or her personal representative or parent or guardian when minors are involved;

(b) Address the needs of a mother and baby during pregnancy and after delivery, if applicable;

(d) Be updated as additional needs are identified during treatment; and

(e) Include a discharge health care plan.

AMENDATORY SECTION (Amending WSR 15-09-108, filed 4/20/15, effective 5/21/15)

WAC 246-337-105 Medication management.

The licensee is responsible for ((the control and use of all medications within the RTF, including:

(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 pharmacy quality assurance commission and address all aspects of medication administration, including the following:

(a) Timely procurement;

(b) Medication administration;

(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)) implementing policies and procedures for the control and appropriate use of all drugs within the RTF in accordance with all applicable state and federal regulations. The policies and procedures to implement this section must be developed, approved, and reviewed by a health care prescriber and the RTF administrator, and must be consistent with this chapter.

(1) Procurement. Timely procurement of drugs must be achieved in one or more of the following ways:

(a) A pharmacy licensed under chapter 18.64 RCW provides resident specific drugs by prescription order to the RTF;

(b) A prescriber purchases drugs from a licensed wholesaler and is responsible for the drugs;

(c) The RTF is listed as a hospital pharmacy associated clinic under a hospital pharmacy license in accordance with chapter 18.64 RCW and applicable rules adopted by the Washington state pharmacy quality assurance commission;

(d) The RTF holds a health care entity license under chapter 18.64 RCW and purchases drugs consistent with chapter 246-904 WAC; and

(e) The resident brings his or her prescribed medication with them to the RTF.

(2) Storage and security.

(a) Storage of drugs must include limits on access to drugs to those staff authorized to assist, administer, or dispense drugs and addresses security, safety, sanitation, temperature, light, moisture and ventilation, and hand washing facilities. All drugs must be stored in accordance with United States pharmacopoeia standards and designated storage locations are constructed in accordance with WAC 246-337-126.

(b) Automated drug dispensing devices (ADDDs). For the purposes of this section, an ADDD has the same meaning as defined in WAC 246-874-010. ADDDs may be used to store drugs if:

(i) The ADDD is leased or owned by a prescriber who maintains sole responsibility for the drugs;

(ii) The RTF holds a health care entity license under chapter 18.64 RCW and complies with chapters 246-874 and 246-904 WAC; or

(iii) The RTF is operated in connection with a licensed hospital and complies with chapter 246-874 WAC and rules of the pharmacy quality assurance commission governing hospital pharmacy associated clinics.

(3) Inventory of stock drugs. The licensee shall document:

(a) Receipt and disposal of all drugs;

(b) Inventory of legend drugs;

(i) Keep all controlled substance records for a minimum of two years;

(ii) Have two authorized staff verify shift counts of controlled substances when transfer of accountability occurs. If an ADDD is used, staff must follow the policies and procedures developed for the ADDD; and

(iii) Report to the Washington state pharmacy quality assurance commission if the controlled substance counts or inventory indicate disappearances or unaccounted for discrepancies of controlled substances in accordance with WAC 246-873-080 and 246-887-020, and 21 C.F.R. Sec. 1301.76(b).

(4) Prescribing and administering drugs.

(a) An organized system must be established and maintained that ensures accuracy in receiving, transcribing and implementing ((policies and procedures)) orders for medication administration((, including ensuring)) that ensures residents receive the correct medication, dosage, route, time, and reason.

(((3) Documentation of)) (b) An authorized health care prescriber shall sign all written orders for legend drugs, controlled substances and vaccines. Orders, including telephone or verbal orders for legend drugs, controlled substances and vaccines must be signed as soon as possible, but no later than seventy-two hours after the telephone or verbal order has been issued.

(c) If using electronic prescribing, prescribers shall comply with RCW 69.50.312, chapter 246-870 WAC, and 21 C.F.R. Sec. 1311(c).

(d) A prescriber shall approve the use of self-administered nonprescription drugs. Staff shall provide the nonprescription drugs according to prescriber instructions.

(e) A prescriber shall:

(i) Develop an approved list of nonprescription drugs acceptable for residents that includes the parameters of use for each drug; and

(ii) Review and approve the list annually.

(f) The licensee shall address the way(s) medications are administered including:

(i) Staff-administered medication in which licensed staff operating within their scope of practice remove the drug from the container and provide it to the resident for ingestion or otherwise administer the drug to the resident;

(ii) Observed self-administration of medication in which residents obtain their container of medication from a supervised and secure storage area, remove the dose needed, ingest or otherwise take the medication as directed on the label while being observed by staff;

(iii) Independent self-administration of medication in which residents obtain their container of medication from either a supervised and secure storage area or from their personal belongings, remove the dose needed, ingest or otherwise take the medication as directed on the label without being observed by staff; or

(iv) Involuntary antipsychotic medication administration consistent with WAC 388-865-0570.

(g) Medication administration errors, adverse effects, and side effects must be reported and addressed;

(h) The licensee shall develop a policy and procedure for:

(i) The use, receipt, storage and accountability for residents receiving methadone from an outpatient methadone clinic, if applicable; and

(ii) Drugs given to a resident on temporary leave from the RTF.

(5) Documentation. All medications administered ((or)), observed being self-administered, or involuntarily administered must be documented on the medication administration record, including ((the following data)):

(a) Name and dosage of the medication;

(b) ((Start/stop date;)) Parameters of use;

(d) Date the medication order was discontinued;

(e) Time of administration;

(((d))) (f) Route;

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

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

(((g))) (i) Allergies; and

(((h))) (j) 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))."

(6) RTF staff must have available to them a current established drug reference resource.

(7) For the purposes of this section:

(a) Controlled substance has the same meaning as defined in RCW 69.50.101; and

(b) Legend drugs has the same meaning as defined in RCW 69.41.010.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-110 Use of ((seclusion and)) restraint and seclusion.

((Any)) (1) This section only applies to an RTF that ((utilizes)) uses restraint or seclusion ((must ensure that restraint or seclusion is performed in compliance with chapters 70.96A, 71.05, 71.34 RCW, this chapter, and other applicable federal and state laws and rules. Restraint and seclusion must be performed in a manner that is safe, proportionate and appropriate to the severity of the behavior, the resident's)). The licensee shall have policies and procedures addressing the application and use of restraint or seclusion consistent with this chapter.

(2) The following facilities must have a minimum of one seclusion room for seclusion or temporary holding of residents awaiting transfer:

(a) Any RTF certified under chapter 388-865 WAC as an evaluation and treatment facility, competency restoration facility or involuntary crisis triage facility; or

(b) Any RTF certified under chapter 388-877B WAC as a detoxification facility providing secure detoxification services as defined in RCW 70.96B.010.

(3)(a) At admission, the incoming resident must be informed and provided a copy of the RTF's policy regarding the use of restraint or seclusion. An acknowledgment that the information and policy has been received must be obtained in writing from the resident; or

(b) In the case of a minor, the resident's parent(s) or guardian(s) must be informed and provided a copy of the RTF policy and acknowledge in writing that the information has been received.

(4) Restraint or seclusion must be safe, based on:

(a) Assessment of behavior;

(b) Chronological and developmental age((,));

(d) Gender((,));

(e) Physical, medical, and psychiatric condition((,)); and

(f) Personal history.

(((1) The licensee may use seclusion or)) (5) Restraint or seclusion must only be used in emergency situations ((needed)) to ensure the physical safety of the individual resident or other residents or staff of the ((facility)) RTF, 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))) (6) A prescriber must authorize use of the restraint or seclusion.

(7) If the order for restraint or seclusion is verbal, the verbal order must be received by a registered nurse or licensed practical nurse.

(8) "Whenever needed" or "as needed" (((PRN))) orders for use of ((seclusion or)) restraint or seclusion 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))) (9) In emergency situations in which an order cannot be obtained prior to the application of restraint or seclusion, the order must be obtained either during the emergency application of the restraint or seclusion, or immediately after the restraint or seclusion has been applied. Policies and procedures must identify who can initiate the emergency application of restraint or seclusion prior to obtaining an order from a health care prescriber.

(10) Restraint and seclusion cannot be used simultaneously with persons under twenty-one years of age.

(11) Staff shall continuously observe and monitor residents in restraint or seclusion using:

(a) Face-to-face observation and monitoring; or

(b) Both direct sight video and two-way audio communications.

(12) The health care prescriber must:

(a) Limit each order of restraint or seclusion ((is limited in length of time to)) as follows:

(((a))) (i) Adults: Four hours;

(((b))) (ii) Children and adolescents ((ages)) at least nine ((to seventeen)) years old but less than eighteen years old: Two hours; and

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

(6) A physician or an authorized health care provider, authorized by the licensee, may));

(b) Be available to staff for consultation, at least by phone, throughout the period of emergency safety intervention;

(d) Only renew the original order in accordance with ((these)) the limits in (a) of this subsection for up to a total of twenty-four hours. For each subsequent twenty-four hour period of restraint or seclusion, repeat the examination.

(((7) A physician or an authorized health care provider 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)) (13) A health care prescriber or registered nurse must, within one hour of initiation of restraint or seclusion, conduct a face-to-face assessment of the resident including the residents' physical and psychological status, behavior, appropriateness of intervention, and any complications resulting from the intervention of the resident and consult the ordering health care prescriber. If restraint or seclusion is discontinued before the face-to-face assessment is performed, the face-to-face assessment must still be performed.

(14) The following documentation ((should)) must be included in the residents' individual service plan when restraint or seclusion ((be)) is used:

(a) The original and any subsequent order for the restraint or seclusion including name of the ((physician or authorized)) health care ((provider authorizing restraint or seclusion)) prescriber;

(b) ((Date/time)) The date and time the order was obtained;

(d) Time the restraint or seclusion began and ended; and

(e) Time and results of the one hour face-to-face 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)).

(15) During the period a resident is placed in restraint or seclusion, appropriately trained staff must assess the client and document in the individual service plan at a minimum of every fifteen minutes((, to include)):

(a) Resident's behavior and response to the intervention used including the rationale for continued use of the intervention;

(b) Food/nutrition offered;

(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;

(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)) of the resident.

(16) Additional documentation in the individual service plan must include:

(a) Alternative methods attempted or the rationale for not using alternative methods;

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

(d) Post intervention debriefing with the resident to include the names of staff who were present for the debriefing, and any changes to the resident's individual service plan that result from the debriefing; and

(e) In the case of a minor, notification of the parent or guardian including the date and time of notification, and the name of the staff person providing the notification.

(17) Within twenty-four hours after the initiation of the restraint or seclusion, staff and the resident shall have a face-to-face discussion. This discussion must, to the extent possible, include all staff involved in the intervention except when the presence of a particular staff person may jeopardize the well-being of the resident. Other staff and the resident's parent(s) or guardian(s) may participate in the discussion when it is deemed appropriate by the RTF. Discussions must be conducted in a language that is understood by the resident and by the resident's parent(s) or legal guardian(s). The discussion must provide both the resident and the staff the opportunity to discuss the circumstances resulting in the use of restraint or seclusion and strategies to be used by the staff, the resident, or others that could prevent the future use of restraint or seclusion.

(18) Restraint or seclusion must be provided in a safe environment. Every licensee must:

(a) Perform a risk assessment that identifies risks in the physical environment to residents, staff and the public when any level of restraint or seclusion is carried out;

(b) Identify location(s) in the RTF where restraint or seclusion is performed;

(c) Ensure that risks in the physical environment are mitigated as appropriate to the type of restraint or seclusion used and the planned population; and

(d) Ensure that restraint or seclusion rooms are constructed as required in WAC 246-337-127. Previously reviewed and approved seclusion rooms are permitted to comply with the requirements of the rule under which they were constructed.

(19) A seclusion room may be used for multiple purposes but must be equipped to allow immediate use for seclusion purposes.

NEW SECTION

WAC 246-337-111 Food and nutrition services.

Meals must meet resident nutritional needs, and are stored, prepared and served in accordance with chapter 246-215 WAC.

The licensee shall:

(1) Provide food and dietary services managed by a person knowledgeable in food services, and, when needed, consultative services provided by a registered dietician.

(2) Post current food handlers permits in the kitchen.

(3) 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.

(4) Consider age, gender, developmental age, activities and health conditions when developing meals.

(5) Make reasonable accommodations for cultural and religious preferences.

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

(7) Provide modified diets, nutrient supplements and concentrates to residents if prescribed or indicated by an authorized health care prescriber or registered dietician.

(8) Allow sufficient time for residents to consume meals.

(9) Require all staff and residents who perform food preparation for group consumption have a current food and beverage service worker's permit and be medically screened and cleared to perform food preparation. All residents who do not perform food preparation for group consumption but who work in the kitchen do not need a food and beverage worker's permit, but must be oriented and supervised by staff with a current food and beverage worker permit at all times when working in the kitchen.

(10) Date, make available, and conspicuously post menus at least one week in advance.

(11) Keep records of all food served, including substitutions for at least three months.

(12) Prepare food on-site or have food provided by a licensed food establishment under chapter 246-215 WAC, Food and Drug Administration, or United States Department of Agriculture, with which the RTF has a signed contract or agreement and a written plan of action should food be in an unacceptable condition.

(13) Use commercial appliances if the kitchen provides meals for more than sixteen residents. A licensed RTF with sixteen or fewer residents may use domestic or home-type kitchen appliances. Domestic and home-type equipment must meet sanitation requirements of chapter 246-215 WAC.

NEW SECTION

WAC 246-337-112 Laundry services.

The licensee shall:

(1) Provide to residents laundry facilities, equipment, handling and processes for linen and laundered items that are clean and in good repair, adequate to meet the needs of residents, and maintained according to the manufacturer's instructions;

(2) Provide laundry and linen services on the premises, or by commercial laundry;

(3) Handle, clean, and store linen according to acceptable methods of infection control including preventing contamination from other sources;

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

(5) Require that all staff wear appropriate personal protective equipment and use appropriate infection control practices when handling grossly soiled laundry;

(6) Remove gross soil from laundry before washing and drying;

(7) Handle contaminated textiles and fabrics with minimum agitation to avoid contamination of air, surfaces and persons;

(8) 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. A resident's personal laundry, separate from other laundry, may be washed 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 for the textile, fabric, or clothing are used.

NEW SECTION

WAC 246-337-113 Resident sleeping room accommodations.

In resident rooms used for sleeping, the licensee shall provide furniture appropriate for the age and physical condition of each resident, including:

(1) A bed at least thirty-six or more inches wide for adults and appropriate size for children, spaced at least thirty-six inches apart.

(2) Equipping each bed 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 of age;

(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.

(3) A single level nonstacking crib, infant bed, bassinet or playpen for children twenty-four months of age 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.

(4) A youth bed or regular bed for children twenty-five months of age and older.

(5) If bunk beds are used, prohibit children six years of age or less from using the upper bunk.

NEW SECTION

WAC 246-337-116 Animal management and safety.

The licensee must develop and implement policies and procedures that protect the health and safety of residents when service animals or, if allowed, therapy animals or pets are allowed on the premises. Policies and procedures must address:

(1) Animal immunizations;

(2) Animal behavior;

(3) The handling and cleanup of animal waste; and

(4) Animal health care needs.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-120 Facility((,)) and environment((, and space)) requirements.

(1) The licensee must ((ensure that each RTF)) maintain the facility, exterior grounds, and component parts such as((, but not limited to,)) fences, equipment, outbuildings, and landscape items ((are)) in a manner that is safe, free of hazards, clean, and ((maintained)) in good repair((, including:

(1) Each RTF shall be)).

(2) Each facility must 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)) (3) Polices and procedures must be developed and implemented 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

(((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;

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

(5) ((School facilities,)) Excluding child cares, school facilities 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)).

(6) Access and egress control devices must be utilized to support the policies of the RTF.

NEW SECTION

WAC 246-337-124 Common room requirements.

The RTF shall include rooms for social, educational, and recreational activities, visitation, dining, toileting and bathing, as described in this section.

(1) Common areas. Provide at least forty square feet per resident for the total combined area which is used for dining, social, educational, recreational activities and group therapies.

(2) Visiting room(s). At least one private area for visitation of residents by guests.

(3) Dining room(s). Dining rooms or areas must be 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) Toilet room(s) and bathroom(s). Toilet rooms and bathrooms must be available to residents including:

(a) A minimum of one toilet and handwashing sink for every eight residents. Urinals may count for up to one-third of the required toilets in a male-only toilet room;

(b) A toilet and handwashing sink in, or immediately accessible to each bathroom;

(d) Rooms containing more than one toilet or more than one bathing area must:

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

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

(e) Equipping each toilet room and bathroom with:

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

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

(iii) Washable cabinets and counter tops;

(iv) Plumbing fixtures designed for easy cleaning;

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

(vi) Grab bars installed at each toilet and bathing fixture;

(vii) Shatter resistant mirrors when appropriate;

(viii) Adequate lighting for general illumination;

(ix) 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; and

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

(f) Providing access to bath and toilet rooms by:

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

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

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

NEW SECTION

WAC 246-337-126 Resident care room requirements.

The facility shall include rooms for individual and group therapy, medical examination when there is routine physical examination of residents, and medication storage if applicable, as described in this section.

(1) Therapy room(s). Therapy rooms for individual and group counseling must maintain visual and auditory confidentiality. The facility must have at least one room per twelve residents.

(2) Medical examination room. The examination room must be equipped with:

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

(b) An examination light;

(d) A handwashing sink.

(3) Medication storage. A room shall be provided with:

(a) Lockable storage;

(b) Refrigeration if needed for pharmaceuticals stored;

(d) In new construction, provide a handwashing sink; and

(e) Appropriate lighting.

NEW SECTION

WAC 246-337-127 Restraint or seclusion room requirements.

This section only applies to an RTF that is approved to use restraint or seclusion. In new construction or modification, each restraint or seclusion room must:

(1) Be designed to minimize potential for stimulation, escape, hiding, injury, or death, including:

(a) Walls, ceiling, and floors shall be designed to resist impact forces;

(b) Ceilings shall be monolithic without joints or crevices or shall be a minimum of nine feet high;

(c) All permanent building fixtures and details in the room shall be designed to prevent injury to the residents or staff; and

(d) Electrical switches and receptacles within the room are prohibited or covered to make them inaccessible.

(2) Have a maximum capacity of one resident.

(3) Be located and designed to permit visual and audible observation of the resident by direct or electronic means.

(4) Be designed to facilitate entrance, transfer and containment of resident, including:

(a) Have a door that opens outward into a vestibule or controlled area away from the generally populated areas; and

(b) Have a staff-controlled, lockable, toilet room that adjoins either the treatment room or vestibule.

(5) Provide appropriate space for the level of treatment being provided, including:

(a) Have a minimum of sixty square feet for seclusion;

(b) Have a minimum of eighty square feet if the room is also used for restraining residents; and

(6) Have negative air pressure with all air exhausted to the exterior of the building with the exhaust fan at the discharge end of the system.

NEW SECTION

WAC 246-337-128 Laundry and housekeeping room requirements.

(1) Laundry. RTFs in which on-site laundry services are provided must:

(a) Locate laundry equipment in rooms other than those used for open food storage, food preparation, or food service;

(b) Equip laundry areas with:

(i) A utility sink;

(ii) A table or counter for folding clean laundry; and

(iii) At least one washing machine and one clothes dryer.

(d) Ventilate laundry rooms and areas to the exterior including areas or rooms where holding soiled laundry for processing by off-site commercial laundry services.

(2) Housekeeping. A housekeeping room must be on each level of the RTF and equipped with:

(a) Locking door(s);

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

NEW SECTION

WAC 246-337-129 Resident sleeping room requirements.

(1) The licensee shall provide residents with an accessible, clean, well-maintained room with sufficient space, light, and comfortable furnishings for sleeping and personal activities.

(2) Sleeping rooms must include:

(a) 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;

(b) If a bunk bed is used, a minimum access aisle of five feet along at least one side of the bunk bed;

(d) 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; and

(e) One or more outside windows that:

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

(ii) Is shatterproof, screened, or of the security type as determined by the resident needs; and

(iii) Are marked with a solid color or barrier if clear glass windows or doors extend to the floor.

(3) Sleeping rooms must be 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; and

(c) Secured storage facilities for storing clothing and, when requested by the resident, storage in a lockable drawer, cupboard, locker, or other secure space somewhere in the building.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-130 Water supply, sewage and waste disposal.

The licensee ((must)) shall ensure ((that)):

(1) Water supply and waste disposal in each facility meet the provisions of chapter 246-290 or 246-291 WAC, whichever applies((, including:

(1) Maintaining)).

(2) Tempered water between one hundred and one hundred twenty degrees Fahrenheit in resident areas.

(((2) Maintaining the)) (3) Plumbing systems free of cross connections.

(((3) Assuring all)) (4) 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.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-135 Heating, ventilation and air conditioning.

(((1))) The licensee ((must)) shall ensure ((that all)):

(1) Rooms used by residents are able to maintain interior temperatures between sixty-five degrees Fahrenheit and seventy-eight degrees Fahrenheit year-round.

(2) Direct evaporative coolers ((may not be)) are not 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 ((())such as swamp coolers or similar equipment(())) shall follow manufacturer's instructions and develop and implement a written preventive maintenance program.

(3) Excessive odors and moisture are prevented in 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)) the mechanical code as adopted by the Washington state building code council.

(4) RTFs 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.

AMENDATORY SECTION (Amending WSR 05-15-157, filed 7/20/05, effective 8/20/05)

WAC 246-337-140 Lighting, emergency lighting, and electrical outlets.

The licensee ((must)) shall ensure that lighting, emergency lighting, and electrical outlets are adequate and safe including:

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

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

(3) ((Each)) Use of electrical outlets of the ground fault interrupter type or be controlled by a ground fault circuit interrupter when the outlet is 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.

NEW SECTION

WAC 246-337-146 Cleaning, maintenance and refuse disposal.

The licensee shall maintain the facility, equipment, and furnishings in a safe and sanitary condition, and in good repair through the following requirements:

(1) Provide sanitary disposal and collection of garbage and refuse by:

(a) Use of containers constructed of nonabsorbent material, which are water-tight, covered, and adequate to store garbage and refuse;

(b) Having a storage area location convenient for resident and staff use;

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

(ii) Odors; and

(iii) Other nuisances.

(d) A disposal program for biohazardous and nonmedical waste using appropriate containers and disposal services.

(2) Provide 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

(3) Provide a safe and cleanable area designated for pouring stock chemicals and cleaning supplies into separate, properly labeled containers if stock chemicals are used.

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

REPEALER

The following sections of the Washington Administrative Code are repealed:


WAC 246-337-020	Responsibilities and rights of the licensee and department.
WAC 246-337-035	Procedures to deny, suspend, modify or revoke a license.
WAC 246-337-090	Food and nutrition services.
WAC 246-337-115	Cleaning, maintenance and refuse disposal.
WAC 246-337-125	Toilet rooms and bathrooms.
WAC 246-337-145	Laundry.
WAC 246-337-150	Resident rooms, furnishings and storage.
WAC 246-337-155	Pet management and safety.