Chapter 388-110 WAC
CONTRACTED RESIDENTIAL CARE SERVICES: ASSISTED LIVING SERVICES,
ENHANCED ADULT RESIDENTIAL CARE, AND ADULT RESIDENTIAL CARE
Last Update: 7/11/02
WAC SECTIONS
PART I
ALL CONTRACTED RESIDENTIAL CARE SERVICES
| 388-110-100 |
Transfer and discharge, social leave, and bed
hold. |
PART II
ASSISTED LIVING SERVICES
| 388-110-140 |
Assisted living services facility structural
requirements. |
| 388-110-180 |
Nurse delegation training and
registration. |
| 388-110-190 |
Performance of delegated nursing care
tasks. |
PART III
ENHANCED ADULT RESIDENTIAL CARE
| 388-110-220 |
Enhanced adult residential care service
standards. |
PART IV
ADULT RESIDENTIAL CARE
PART V
REMEDIES FOR ASSISTED LIVING, ENHANCED ADULT
RESIDENTIAL CARE, AND ADULT RESIDENTIAL CARE
| 388-110-270 |
Notice, hearing rights, effective dates relating to imposition
of remedies. |
DISPOSITIONS OF SECTIONS FORMERLY CODIFIED IN THIS CHAPTER
| 388-110-110 |
Caregiver education and training requirements. [Statutory
Authority: RCW 74.39A.010 and 74.39A.020. 97-19-020, § 388-110-110, filed
9/8/97, effective 10/9/97. Statutory Authority: RCW 74.39A.010, 74.39A.020
and 74.39A.080. 96-21-050, § 388-110-110, filed 10/11/96, effective
11/11/96. Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060,
74.39A.080, 74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045
(Order 3979), § 388-110-110, filed 5/8/96, effective
6/8/96.] Repealed by 02-15-065, filed 7/11/02, effective
8/11/02. Statutory Authority: RCW 18.20.090, 70.128.040, 74.39A.050,
34.05.020, 2000 c 121, and 2002 c
233. |
PART I
ALL CONTRACTED RESIDENTIAL CARE
SERVICES
WAC 388-110-005
Authority. The following rules are adopted under RCW 74.39A.010,
74.39A.020, 74.39A.060, 74.39A.070, 74.39A.080, 74.39A.170, and 18.88A.210
through 18.88A.240.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-005, filed 5/8/96, effective 6/8/96.]
WAC 388-110-010 Scope and
applicability. (1) These rules apply only to boarding homes
licensed under chapter 18.20 RCW, or boarding homes located within the
boundaries of a federally recognized Indian reservation and licensed by a tribe,
that contract with the department to provide assisted living services, enhanced
adult residential care, or adult residential care.
(2) Only services provided to or on behalf of the assisted living services,
enhanced adult residential care, or adult residential care resident, and paid
for fully or partially by the department shall be subject to these rules.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-010, filed 5/8/96, effective 6/8/96.]
WAC 388-110-020
Definitions. (1) "Adult residential care" is a package of
services, including personal care services, that the department contracts with a
licensed boarding home to provide in accordance with Parts I and IV of this
chapter.
(2) "Aging in place" means being in a care
environment that can accommodate a resident's progressive disability or changing
needs without relocating. For aging in place to occur, needed services are
adjusted to meet the changing needs of the resident.
(3) "Applicant" means the individual, partnership, corporation or other entity
which has applied for a contract with the department to provide assisted living
services, enhanced adult residential care, or adult residential care to state
funded residents in a licensed boarding home.
(4)
"Assisted living services" is a package of services, including personal care and
limited nursing services, that the department contracts with a licensed boarding
home to provide in accordance with Parts I and II of this chapter. Assisted
living services include housing for the resident in a private apartment-like
unit.
(5) "Boarding home" means the same as the
definition found in RCW 18.20.020(2), or a boarding home located within the
boundaries of a federally recognized Indian reservation and licensed by the
tribe.
(6) "Caregiver" means any person responsible
for providing direct personal care services to a resident and may include but is
not limited to the contractor, employee, volunteer, or
student.
(7) "Case manager" means the department
staff person or designee assigned to negotiate, monitor, and facilitate a
service plan for residents receiving services fully or partially paid for by the
department.
(8) "Contractor" means the individual,
partnership, corporation, or other entity which contracts with the department to
provide assisted living services, enhanced adult residential care, or adult
residential care to state funded residents in a licensed boarding
home.
(9) "Department" means the Washington state
department of social and health services (DSHS).
(10) "Dignity" means the quality or condition of being esteemed and respected in
such a way as to validate the self-worth of the
resident.
(11) "Enhanced adult residential care" is
a package of services, including personal care and limited nursing services,
that the department contracts with a licensed boarding home to provide in
accordance with Parts I and III of this chapter.
(12) "Frail elder or vulnerable adult" means the same as the definition found in
RCW 74.34.020 or 43.43.830.
(13) "Homelike" means an
environment having the qualities of a home, including privacy, comfortable
surroundings, and the opportunity to modify one's living area to suit one's
individual preferences. A homelike environment provides residents with an
opportunity for self-expression, and encourages interaction with the community,
family and friends.
(14) "Independence" means free
from the control of others and being able to assert one's own will, personality
and preferences.
(15) "Individuality" means the
quality of being unique; the aggregate of qualities and characteristics that
distinguishes one from others. Individuality is supported by modifying services
to suit the needs or wishes of a specific
individual.
(16) "Limited nursing services" means
the same as the definition found in WAC 246-316-265.
(17) "Personal care services" means both physical assistance and/or prompting
and supervising the performance of direct personal care tasks as determined by
the resident's needs as defined in WAC 388-15-202(38). Personal care services do
not include assistance with tasks that must be performed by a licensed health
professional.
(18) "Resident" means a person
residing in a boarding home for whom services are paid for, in whole or in part,
by the department under a contract for assisted living services, enhanced adult
residential care, or adult residential care. "Resident" includes former
residents when examining complaints about admissions, re-admissions, transfers
or discharges. For decision-making purposes, the term "resident" includes the
resident's surrogate decision maker in accordance with state law or at the
resident's request.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-020, filed 5/8/96, effective 6/8/96.]
WAC 388-110-030 Contract
application. (1) In order to apply for a contract with the
department to provide assisted living services, enhanced adult residential care,
or adult residential care, an applicant shall:
(a)
Have a valid boarding home license for the facility at which the contracted
services will be provided;
(b) Complete and submit a
contract application on department provided forms at least sixty days before the
requested effective date for the contract; and
(c)
Provide information regarding any facilities the applicant, and any partner,
officer, director, managerial employee, or owner of five percent or more of the
applicant has been affiliated with in the last ten
years.
(2) Within sixty days of the receipt of the
application the department shall approve a contract, refuse to enter into a
contract, or request additional information the department deems relevant from
the applicant. The department may extend the sixty days to allow the applicant
to supply or clarify information requested by the department. The department
shall conduct an on-site review of the contracting facility before issuing a
contract.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-030, filed 5/8/96, effective 6/8/96.]
WAC 388-110-040 Contract
qualifications. (1) The department shall consider separately and
jointly as applicants each person and entity named in the application for a
contract for assisted living services, enhanced adult residential care, or adult
residential care. If the department finds any person or entity unqualified, the
department shall deny the contract.
(2) In making a
determination whether to grant a contract, the department shall
review:
(a) The information in the application;
and
(b) Other documents and information the
department deems relevant, including inspection and complaint investigation
findings for each facility with which the applicant or any partner, officer,
director, managerial employee, or owner of five percent or more of the entity
applicant has been affiliated.
(3) The applicant and
the facility for which a contract is sought shall comply with all requirements
established by chapter 74.39A RCW and this chapter. The department may deny a
contract for noncompliance with any such
requirements.
(4) The department shall deny a
contract if an applicant or any partner, officer, director, managerial employee,
or owner of five percent or more of the entity applicant applying for a contract
has a history of significant noncompliance with federal or state regulations in
providing care or services to frail elders, vulnerable adults or children. The
department shall consider, at a minimum, the following as a history of
significant noncompliance requiring denial of a
contract:
(a) Revocation or suspension of a license
for the care of children, frail elders or vulnerable
adults;
(b) Enjoined from operating a facility for
the care of children, frail elders or vulnerable adults;
or
(c) Termination, cancellation, suspension, or
nonrenewal of a Medicaid or Medicare provider agreement, or any other agreement
with a public agency for the care or treatment of children, frail elders or
vulnerable adults.
(5) The department shall deny,
terminate, or refuse to renew a contract if an applicant or any partner,
officer, director, managerial employee, an owner of fifty percent or more of the
entity applicant, or an owner who exercises control over daily operations has
been:
(a) Convicted of a crime against a person as
defined under RCW 43.43.830 or 43.43.842;
(b)
Convicted of a crime related to financial exploitation as defined under RCW
43.43.830 or 43.43.842;
(c) Found by a court in a
protection proceeding or in a civil damages lawsuit under chapter 74.34 RCW to
have abused, neglected, abandoned or exploited a vulnerable
adult;
(d) Found in any final decision issued by a
disciplinary board to have sexually or physically abused, neglected, or
exploited any minor or vulnerable adult;
(e) Found
in any dependency action under chapter 13.34 RCW to have sexually assaulted,
neglected, exploited, or physically abused any minor;
or
(f) Found by a court in a domestic relations
proceeding under Title 26 RCW to have sexually abused, exploited, or physically
abused any minor.
(6) The department may deny,
terminate, or refuse to renew a contract if an applicant or any partner,
officer, director, managerial employee, an owner of fifty percent or more of the
entity applicant, or an owner who exercises control over daily operations
has:
(a) Obtained or attempted to obtain a license
or contract by fraudulent means or
misrepresentation;
(b) Been convicted of a felony or
a crime against a person if the conviction reasonably relates to the competency
of the person to contract with the department;
(c)
Had sanction, corrective or remedial action taken by federal, state, county, or
municipal health or safety officials related to the care or treatment of
children, frail elders or vulnerable adults;
(d) A
poor credit history;
(e) Engaged in the illegal use
of drugs or the excessive use of alcohol;
(f)
Operated a facility for the care of children or adults without a
license;
(g) Failed to meet financial obligations as
the obligations fell due in the normal course of
business;
(h) Misappropriated property of
residents;
(i) Filed for bankruptcy, reorganization,
or receivership;
(j) Been denied a license or
license renewal to operate a facility that was licensed for the care of
children, frail elders or vulnerable adults;
(k)
Relinquished or returned a license in connection with the operation of any
facility for the care of children, frail elders or vulnerable adults, or did not
seek the renewal of such license, following written notification of the
licensing agency's initiation of denial, suspension, cancellation or revocation
of the license; or
(l) Had resident trust funds or
assets of an entity providing care to children, frail elders or vulnerable
adults seized by the IRS or a state entity for failure to pay income or payroll
taxes.
[Statutory Authority: RCW 74.39A.010, 74.39A.020 and 74.39A.080. 96-21-050, §
388-110-040, filed 10/11/96, effective 11/11/96. Statutory Authority: RCW
74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080, 74.39A.170,
18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), § 388-110-040,
filed 5/8/96, effective 6/8/96.]
WAC
388-110-050 Change of contractor. (1) A change of
contractor occurs when there is a substitution of the individual contractor or
contracting entity ultimately responsible for the daily operational decisions of
the assisted living service, enhanced adult residential care, or adult
residential care, or a substitution of control of such contracting
entity.
(a) Events which constitute a change of
contractor include but are not limited to the
following:
(i) The form of legal organization of the
contractor is changed (e.g., a sole proprietor forms a partnership or
corporation);
(ii) Assisted living services,
enhanced adult residential care, or adult residential care contract rights and
responsibilities are transferred by the initial contractor to another party
regardless of whether ownership of some or all of the real property and/or
personal property assets of the facility are also
transferred;
(iii) If the contractor is a
partnership, any event occurs which dissolves the
partnership;
(iv) If the contractor is a
corporation, and the corporation is dissolved, merges with another corporation
which is the survivor, or consolidates with one or more other corporations to
form a new corporation;
(v) If the contractor is a
corporation and, whether by a single transaction or multiple transactions within
any continuous twenty-four-month period, fifty percent or more of the stock is
transferred to one or more:
(A) New or former
stockholders; or
(B) Present stockholders each
having held less than five percent of the stock before the initial transaction;
or
(vi) Any other event or combination of events
which results in a substitution or substitution of control of the individual
contractor or the contracting entity.
(b) The
contractor does not change when the following, without more,
occur:
(i) A party contracts with the contractor to
manage the assisted living, enhanced adult residential care, or adult
residential care facility as the contractor's agent, i.e., subject to the
contractor's general approval of daily operating and management decisions;
or
(ii) The real property or personal property
assets of the facility contractor change ownership or are leased, or a lease of
the real property or personal property assets is terminated, without a
substitution of individual operator or operating entity and without a
substitution of control of the operating entity.
(2)
When a change of contractor is contemplated, the current contractor shall notify
the department and all residents at least sixty days prior to the proposed date
of transfer. The notice shall be in writing and shall contain the following
information:
(a) Name of the present contractor and
prospective contractor;
(b) Name and address of the
facility being transferred; and
(c) Date of proposed
transfer.
(3) The operation or ownership of an
assisted living services, enhanced adult residential care, or adult residential
care contract shall not be transferred until the new operator has entered into a
contract with the department. The new contractor shall comply with contract
application requirements in WAC 388-110-030.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-050, filed 5/8/96, effective 6/8/96.]
WAC 388-110-060 Resident
rights. (1) The contractor shall comply with all requirements of
chapter 70.129 RCW, Long-term care resident rights. The contractor shall promote
and protect the resident's exercise of all rights granted under that
law.
(2) The contractor shall provide care and
services in compliance with the federal Patient self determination act and with
applicable state statutes related to surrogate and health care decision making,
including chapters 7.70, 70.122, 11.88, 11.92 and 11.94 RCW.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-060, filed 5/8/96, effective 6/8/96.]
WAC 388-110-070 General service
standards. The contractor shall:
(1)
Ensure residents have control over their time, space and lifestyle to the extent
that the health, safety and well-being of other residents is not
disturbed;
(2) Promote the resident's right to
exercise decision making and self-determination to the fullest extent
possible;
(3) Follow the informed consent process as
required in chapter 7.70 RCW, when applicable, in the development of the
negotiated service agreement;
(4) Provide services
for residents in a manner and in an environment that encourages maintenance or
enhancement of each resident's quality of life, and promotes the resident's
privacy, dignity, choice, independence, individuality, and decision-making
ability; and
(5) Provide a safe, clean and
comfortable homelike environment, allowing residents to use their personal
belongings to the extent possible.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-070, filed 5/8/96, effective 6/8/96.]
WAC 388-110-080 Social and recreational
activities. (1) The contractor shall provide social and
recreational activities that provide and promote opportunities for the resident
to participate in ongoing and varied activities based on the resident's choice
and consistent with identified resident needs and functional
ability.
(2) The contractor shall support the
participation of residents and the resident council, if there is one, in the
development of recreational and activity programs that reflect the needs and
choices of the residents.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-080, filed 5/8/96, effective 6/8/96.]
WAC 388-110-090
Administration. The contractor shall:
(1) Maintain substantial compliance with all requirements of chapter 18.20 RCW,
Law for boarding homes and chapter 246-316 WAC, Boarding
homes;
(2) Ensure all facility staff are
knowledgeable about chapter 70.129 RCW, Long-term care resident
rights;
(3) Provide residents, prior to move-in, a
copy of the facility's admission agreement which clearly specifies the range of
services the facility is able to provide to
residents;
(4) Not require a resident to sign any
admission contract or agreement that purports to waive any rights of the
resident;
(5) Develop and implement a grievance
procedure and process which is responsive to resident's
complaints;
(6) Post in a place and manner clearly
visible to residents and visitors the department's toll-free complaint telephone
number;
(7) Comply with all federal and state
statutory and regulatory requirements regarding nondiscrimination in all aspects
of the facility's operation;
(8) Ensure resident
rooms or resident units are not located in a separate unit within a facility
that has exiting doors that restrict egress from the unit, such as, but not
limited to automatic locking and unlocking exiting doors, unless the contractor
is already providing services to residents in such a unit under a contract with
the department for assisted living services, adult residential care, or enhanced
adult residential care on the effective date of this
chapter;
(9) Encourage residents and the resident
council, if there is one, to provide input to the facility about residents'
preferences for food choices, taking into account the cultural and religious
needs of residents;
(10) Ensure all instances of
suspected abuse, neglect, exploitation, or abandonment are reported to the
department, as required in chapter 74.34 RCW, and to the local law enforcement
agency;
(11) Not have any sexual contact with any
resident and shall ensure that facility staff and students not have sexual
contact with any resident;
(12) Notify the
department within five business days when there is a change in the facility
administrator; and
(13) Permit department
representatives to enter the facility without prior notification in order to
monitor the contract requirements under this chapter and to conduct complaint
investigations, including but not limited to observing and interviewing
residents, and accessing resident records.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-090, filed 5/8/96, effective 6/8/96.]
WAC 388-110-100 Transfer and discharge,
social leave, and bed hold. The contractor
shall:
(1) Comply with chapter 70.129 RCW and
chapter 246-316 WAC pertaining to transfer and discharge
(move-out);
(2) Include the department's case
manager in the development of a relocation or discharge (move-out) plan, and
have the case manager approve the plan before any notice required under
subsection (1) of this section is issued to the resident, except in an
emergency;
(3) Note an absence in a resident's
record when a resident will be absent from the facility for more than
seventy-two consecutive hours;
(4) Not be required
to discharge (move-out) and readmit a resident for absences less than thirty-one
consecutive days;
(5) Obtain department approval for
payment for social leave in excess of fifteen consecutive days;
and
(6) Retain a bed or unit for a resident
hospitalized or temporarily placed in a nursing home for up to thirty days when
the resident is likely to return, but if as part of the negotiated service
agreement it is determined prior to the end of the thirty days that the resident
will not return to the facility, the facility may discharge (move-out) the
resident in accordance with subsections (1) and (2) above and release the bed or
unit.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-100, filed 5/8/96, effective 6/8/96.]
WAC 388-110-120 Resident personal
funds. (1) Upon the death of a resident, the facility shall
promptly convey the resident's personal funds held by the facility with a final
accounting of such funds to the department or to the individual or probate
jurisdiction administering the resident's estate no later than forty-five
calendar days after the date of the resident's
death:
(a) When the personal funds of the deceased
resident shall be paid to the state of Washington, those funds and the final
accounting shall be made payable to the secretary, department of social and
health services, and sent to the office of financial recovery, estate recovery
unit, P.O. Box 9501, Olympia, Washington 98507-9501, or such address as may be
directed by the department in the future;
(b) The
check and final accounting accompanying the payment shall contain the name and
social security number of the deceased individual from whose personal funds
account the monies are being paid; and
(c) The
department of social and health services shall establish a release procedure for
use of funds necessary for burial expenses.
(2) In
situations where the resident is absent from the facility for an extended time
without notifying the facility, and the resident's whereabouts is
unknown:
(a) The facility shall make a reasonable
effort to find the missing resident; and
(b) If the
resident cannot be located after ninety days, the facility shall notify the
department of revenue of the existence of "abandoned property," outlined in
chapter 63.29 RCW. The facility shall deliver to the department of revenue the
balance of the resident's personal funds within twenty days following such
notification.
(3) Prior to the change of contractor
of the facility business, the contractor shall:
(a)
Provide each resident with a written accounting of any personal funds held by
the facility;
(b) Provide the new contractor with a
written accounting of all resident funds being transferred;
and
(c) Obtain a written receipt for those funds
from the new operator.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-120, filed 5/8/96, effective 6/8/96.]
PART II
ASSISTED LIVING SERVICES
WAC 388-110-140 Assisted living services
facility structural requirements. (1) In a boarding home with an
assisted living services contract, each resident shall have a private
apartment-like unit with a private bathroom. Each unit shall have at least the
following:
(a) In an existing facility, an
individual unit with a minimum of one hundred eighty square feet including
counters, closets and built-ins, and excluding the bathroom. In a new facility,
an individual unit with a minimum of two hundred twenty square feet including
counters, closets and built-ins, and excluding the
bathroom;
(b) A separate private bathroom, which
includes a sink, toilet, and a shower or bathtub. In a new facility, a minimum
of fifty percent of resident bathrooms shall be wheelchair accessible and have a
roll-in shower;
(c) A lockable entry
door;
(d) A kitchen area equipped, at a minimum,
with a refrigerator, a microwave oven or stovetop, and a counter or table for
food preparation. In a new facility, a kitchen area must also be equipped with a
sink and counter area, and storage space for utensils and supplies;
and
(e) A living area wired for telephone and, where
available in the geographic location, wired for television
service.
(2) In a new facility, the contractor shall
provide a private accessible mailbox in which the resident may receive
mail.
(3) The contractor shall provide homelike
smoke-free common areas with sufficient space for socialization designed to meet
resident needs. Common areas shall be available for resident use at any time
provided such use does not disturb the health or safety of other residents. When
possible, access to outdoor areas shall be made available to all
residents.
(4) The contractor shall provide a space
for residents to meet with family and friends outside the resident's living
unit.
(5)(a) For purposes of this section, a new
facility is:
(i) A new building to be used as a
boarding home or part of a boarding home, for which plans are submitted to the
department of health for construction review, as required by WAC 246-316-070, on
or after the effective date of this chapter; or
(ii)
An addition, modification, or alteration to an existing building, for which
plans are submitted to the department of health for construction review, as
required by WAC 246-316-070, on or after the effective date of this
chapter.
(b) All facilities that are not new
facilities under subsection (5)(a) of this section, are existing facilities. An
existing building, or portion thereof, that is converted to boarding home use
shall be considered an existing facility unless there is an addition,
modification or alteration to the existing building.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-140, filed 5/8/96, effective 6/8/96.]
WAC 388-110-150 Assisted living service
standards. (1) The contractor shall ensure that both the physical
environment and the delivery of assisted living services are designed to enhance
autonomy in ways which reflect personal and social values of dignity, privacy,
independence, individuality, choice and decision-making of residents. The
contractor shall provide the resident services in a manner
which:
(a) Makes the services available in a
homelike environment for residents with a range of needs and
preferences;
(b) Facilitates aging in place by
providing flexible services in an environment that accommodates and supports the
resident's individuality;
(c) Supports managed risk
which includes the resident's right to take responsibility for the risks
associated with decision-making; and
(d) Develops a
formal written, negotiated plan to decrease the probability of a poor outcome
when a resident's decision or preference places the resident or others at risk,
leads to adverse consequences, or conflicts with other residents' rights or
preferences.
(2) Building on the department's
assessment and service plan completed before admission, the contractor shall
complete a negotiated service agreement within thirty days of move-in. The
contractor shall involve the following persons in the negotiation and
renegotiation of the agreement:
(a) The resident to
the greatest extent practicable;
(b) Appropriate
facility staff;
(c) The department's case manager;
and
(d) If the resident chooses, the resident's
family or any other person the resident wants
included.
(3) The contractor shall ensure the
negotiated service agreement:
(a) Includes
recognition of the resident's capabilities and choices, and defines the division
of responsibility in the implementation of services;
(b) Addresses, at a minimum, the following elements: assessed health care needs;
social needs and preferences; personal care tasks; and if applicable, limited
nursing and medication services, including frequency of service and level of
assistance;
(c) Is signed and approved by the
resident, the contractor, and the department case manager;
and
(d) Includes the date the agreement was
approved.
(4) The contractor shall provide the
resident and case manager with a copy of the agreement, and place a copy in the
resident's record.
(5) The contractor shall update
the agreement when there are changes in the services the resident needs and
wants to receive. At a minimum, the contractor shall review and update the
negotiated service agreement semiannually.
(6) The
contractor shall provide personal care services based on the resident's
negotiated service agreement.
(7) The contractor
shall provide the range of services required to meet the increasing or changing
needs of residents as they age in place to the maximum extent permitted by the
boarding home regulations.
(8) The contractor shall
provide or arrange for limited nursing services to meet the needs of residents
who require nursing services, at no additional cost to the
resident.
(9) The contractor shall provide written
policies and procedures that ensure the facility will provide limited nursing
services and will allow additional on-site health care services to the maximum
extent allowed under chapter 246-316 WAC, and if requested, shall assist the
resident to obtain the additional on-site health care
services.
(10) If requested or needed by the
resident, the contractor shall assist the resident to obtain, arrange, and
coordinate services such as: transportation to medical services and recreational
activities; ancillary services for medically related care (e.g., physician,
pharmacist, mental health services, physical or occupational therapy, hospice,
home health care, podiatry); barber/beauty services; and other services
necessary to support and assist the resident in maintaining as much independence
as possible.
(11) The contractor shall make
available and offer at no additional cost to the resident generic personal care
items needed by the resident such as soap, shampoo, toilet paper, toothbrush,
toothpaste, deodorant, sanitary napkins, and disposable razors. This does not
include items covered by medical coupons or preclude residents from choosing to
purchase their own personal care items.
(12) The
contractor shall provide all residents with access to an on-site washing machine
and dryer for resident use.
(13) The contractor
shall make beverages and snacks available to
residents.
(14) The contractor shall develop written
policies and procedures to be followed by staff and shared with residents which
illustrate how employees shall deliver services to residents while ensuring
resident's privacy, dignity, choice, independence, individuality and
decision-making ability.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-150, filed 5/8/96, effective 6/8/96.]
WAC 388-110-170 Education and training
requirements. (1) Any administrator hired after the effective
date of this chapter shall have completed forty hours of training regarding
assisted living services, resident rights, and the social model of services
within the first six months of employment. All administrators shall have ten
hours of continuing education credits per calendar
year.
(2) The contractor shall provide and document
a minimum of five hours of training for all staff regarding assisted living
services, resident rights, the social model of services, and service planning
for residents.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-170, filed 5/8/96, effective 6/8/96.]
WAC 388-110-180 Nurse delegation training
and registration. Before performing any delegated nursing task,
facility staff must:
(1) Be a nursing assistant
certified or registered under chapter 18.88A RCW;
and
(2) Attend and successfully complete department
designated core delegation training.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-180, filed 5/8/96, effective 6/8/96.]
WAC 388-110-190 Performance of delegated
nursing care tasks. (1) Facility staff who have been delegated a
nursing care task in compliance with requirements established by the nursing
care quality assurance commission shall perform the
task:
(a) In compliance with all requirements and
protocols established by the commission in WAC 246-840-910 through246-840-980
;
(b) Only for the specific resident who was the
subject of the delegation; and
(c) Only with the
resident's consent.
(2) The delegated authority to
perform the nursing care task is not transferrable to another nurse
assistant.
(3) Facility staff may consent to perform
a delegated nursing care task, and shall be responsible for their own actions
with regard to the decision to consent to the performance of the delegated task.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-190, filed 5/8/96, effective 6/8/96.]
WAC 388-110-200 Nurse
delegation--Penalties. The department shall impose a civil fine
on any contractor that knowingly performs or knowingly permits an employee to
perform a nursing task except as delegated by a nurse pursuant to chapter 18.79
RCW and chapter 246-840 WAC as follows:
(a) Two
hundred fifty dollars for the first time the department finds an unlawful
delegation;
(b) Five hundred dollars for the second
time the department finds an unlawful delegation;
and
(c) One thousand dollars for the third time or
more the department finds an unlawful delegation.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-200, filed 5/8/96, effective 6/8/96.]
WAC 388-110-210 Client service
eligibility. The contractor shall provide assisted living
services only to persons eligible for COPES level of services under WAC
388-15-202 through388-15-205 and WAC 388-15-600 through 388-15-620 as determined
by the department or the department's designee.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-210, filed 5/8/96, effective 6/8/96.]
PART III
ENHANCED ADULT RESIDENTIAL CARE
WAC 388-110-220 Enhanced adult residential
care service standards. (1) The contractor shall complete a
negotiated service agreement within thirty days of move-in with participation
from the resident and the department's case manager, consistent with the general
service standards set forth in WAC 388-110-070.
(2) The agreement shall include what services shall be provided, who will
provide the services, and when and how the services will be
provided.
(3) The service agreement shall support
the principles of dignity, privacy, choice in decision making, individuality,
and independence.
(4) At a minimum, the contractor
shall review and update the negotiated service agreement semi-annually, give a
copy of the agreement to the resident and case manager, and keep a copy in the
resident's record.
(5) The contractor shall provide
personal care services based on the resident's negotiated service
agreement.
(6) The contractor shall provide or
arrange for limited nursing services to meet the needs of residents who require
nursing services, at no additional cost to the
resident.
(7) The contractor shall allow a maximum
of two residents per room.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-220, filed 5/8/96, effective 6/8/96.]
WAC 388-110-230 Client
eligibility. The contractor shall provide enhanced adult
residential care services only to persons eligible for COPES level of services
under WAC 388-15-202 through388-15-205 and WAC 388-15-600 through 388-15-620 as
determined by the department or the department's designee.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-230, filed 5/8/96, effective 6/8/96.]
PART IV
ADULT RESIDENTIAL CARE
WAC 388-110-240 Adult residential care
service standards. (1) The contractor shall complete a negotiated
service agreement within thirty days of move-in with participation from the
resident and the department's case manager, consistent with the general service
standards set forth in WAC 388-110-070.
(2) The agreement shall include what services shall be provided, who will
provide the services, and when and how the services will be
provided.
(3) The service agreement shall support
the principles of dignity, privacy, choice in decision making, individuality,
and independence.
(4) At a minimum, the contractor
shall review and update the negotiated service agreement semi-annually, give a
copy of the agreement to the resident and case manager, and keep a copy in the
resident's record.
(5) The contractor shall provide
personal care services based on the resident's negotiated service agreement.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-240, filed 5/8/96, effective 6/8/96.]
WAC 388-110-250 Client service
eligibility. The contractor shall provide adult residential care
services only to persons eligible for community-based services under WAC
388-15-562, 388-15-610, or 388-15-830 as determined by the department or the
department's designee.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-250, filed 5/8/96, effective 6/8/96.]
PART V
REMEDIES FOR ASSISTED LIVING, ENHANCED ADULT
RESIDENTIAL CARE, AND ADULT RESIDENTIAL CARE
WAC 388-110-260 Remedies. (1)
The department may take one or more of the actions listed in subsection (3)(a)
of this section in any case in which the department finds that a contractor of
assisted living services, enhanced adult residential care services, or adult
residential care services has:
(a) Failed or refused
to comply with the applicable requirements of chapter 74.39A RCW, of chapter
70.129 RCW or of this chapter;
(b) Operated without
a license or under a revoked license;
(c) Knowingly,
or with reason to know, made a false statement of material fact on his or her
application for a contract or any data attached thereto, or in any matter under
investigation by the department; or
(d) Willfully
prevented or interfered with any inspection or investigation by the
department.
(2)(a) For failure or refusal to comply
with any applicable requirements of chapter 74.39A RCW, of chapter 70.129 RCW or
of this chapter, the department may provide consultation and shall allow the
contractor a reasonable opportunity to correct before imposing remedies under
subsection (3)(a) unless the violations pose a serious risk to residents, are
recurring or have been uncorrected.
(b) When
violations of this chapter pose a serious risk to a resident, are recurring or
have been uncorrected, the department shall impose a remedy or remedies listed
under subsection (3)(a). In determining which remedy or remedies to impose, the
department shall take into account the severity of the impact of the violations
on residents and which remedy or remedies are likely to improve resident
outcomes and satisfaction in a timely manner.
(3)(a)
Actions and remedies the department may impose
include:
(i) Refusal to enter into a
contract;
(ii) Imposition of reasonable conditions
on a contract, such as correction within a specified time, training, and limits
on the type of clients the provider may admit or
serve;
(iii) Imposition of civil penalties of not
more than one hundred dollars per day per violation;
(iv) Suspension, termination, or refusal to renew a contract;
or
(v) Order stop placement of persons under the
contract.
(b) When the department orders stop
placement, the facility shall not admit any person under the contract until the
stop placement order is terminated. The department may approve readmission of a
resident to the facility from a hospital or nursing home during the stop
placement. The department shall terminate the stop placement when the department
determines that:
(i) The violations necessitating
the stop placement have been corrected; and
(ii) The
provider exhibits the capacity to maintain adequate care and
service.
(c) Conditions the department may impose on
a contract include, but are not limited to the
following:
(i) Correction within a specified
time;
(ii) Training related to the violations;
and
(iii) Discharge of any resident when the
department determines discharge is needed to meet that resident's needs or for
the protection of other residents.
(d) When a
contractor fails to pay a fine when due under this chapter, the department may,
in addition to other remedies, withhold an amount equal to the fine plus
interest, if any, from the contract payment.
[Statutory Authority: RCW 74.39A.010, 74.39A.020 and 74.39A.080. 96-21-050, §
388-110-260, filed 10/11/96, effective 11/11/96. Statutory Authority: RCW
74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080, 74.39A.170,
18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), § 388-110-260,
filed 5/8/96, effective 6/8/96.]
WAC
388-110-270 Notice, hearing rights, effective dates relating to
imposition of remedies. (1) Chapter 34.05 RCW applies to
department actions under this chapter and chapter 74.39A RCW, except that orders
of the department imposing contracts suspension, stop placement, or conditions
for continuation of a contract are effective immediately upon notice and shall
continue pending any hearing.
(2) Civil monetary
penalties shall become due twenty eight days after the contractor is served with
a notice of the penalty unless the contractor requests a hearing in compliance
with chapter 34.05 RCW and RCW 43.20A.215. If a hearing is requested, the
penalty becomes due ten days after a final decision in the department's favor is
issued. Interest shall accrue beginning thirty days after the department serves
the contractor with notice of the penalty at a rate of one percent per month in
accordance with RCW 43.20B.695.
(3) A person
contesting any decision by the department to impose a remedy shall within
twenty-eight days of receipt of the decision:
(a)
File a written application for an adjudicative proceeding by a method showing
proof of receipt with the Office of Appeals, PO Box 2465, Olympia, WA 98504;
and
(b) Include in or with the
application:
(i) The grounds for contesting the
department decision; and
(ii) A copy of the
contested department decision.
(4) Administrative
proceedings shall be governed by chapter 34.05 RCW, RCW 43.20A.215, where
applicable, this section, and chapter 388-08 WAC. If any provision in this
section conflicts with chapter 388-08 WAC, the provision in this section
governs.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-270, filed 5/8/96, effective 6/8/96.]
WAC 388-110-280 Dispute
resolution. (1) When a contractor disagrees with the department's
finding of a violation under this chapter, the contractor shall have the right
to have the violation reviewed under the department's dispute resolution
process. Requests for review shall be made to the department within ten days of
receipt of the written finding of a violation.
(2)
When requested by a contractor, the department shall expedite the dispute
resolution process to review violations upon which a department order imposing
contract suspension, stop placement, or a contract condition is
based.
(3) Orders of the department imposing
contracts suspension, stop placement, or conditions for continuation of a
contract are effective immediately upon notice and shall continue pending
dispute resolution.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080,
74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), §
388-110-280, filed 5/8/96, effective 6/8/96.]