Original Notice.

Preproposal statement of inquiry was filed as WSR 98-09-092.

Title of Rule: Chapter 388-820 WAC, Community residential services and supports (formerly chapter 275-26 WAC).

Purpose: The purpose of the chapter is establish standards for DSHS to provide, or contract to provide, individualized community residential services to eligible clients. This chapter impacts group homes and support living agencies. These are for-profit, nonprofit, and governmental organizations.

Statutory Authority for Adoption: RCW 71A.12.030.

Statute Being Implemented: RCW 71A.12.010 through 71A.12.080.

Summary: Specific requirements are being set out for DDD certified and contracted residential services providers to support people with developmental disabilities in specific residential settings.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Saif Hakim, DSHA/DDD, Mailstop 45310, Olympia, WA 98504, (360) 902-0263.

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

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

Explanation of Rule, its Purpose, and Anticipated Effects: This chapter sets specific requirements for DDD certified and contracted residential services providers to support people with developmental disabilities in specific residential settings. The rules will assure that health and safety needs are met for clients who are authorized to receive this support. It assists clients to live in the least restrictive environment.

Proposal Changes the Following Existing Rules: Some rules in this chapter have been added to enhance the support needs and ensure choice for people with developmental disabilities.

The proposed major changes to the chapter are adding the required age of the eligible client (18 years of age); adding requirements for service providers when they plan to serve nonclients in the same household as clients; clarifying that vendors have dispute rights only for certification disagreements and nurse delegation civil fines; adding a process that vendors must go through if they disagree with certification decisions; defining the individual service plan and identifying people responsible to design and monitor the plan; and adding a new rule to address how a provider handles client's funds and mandating an individual financial plan that the provider develops with the client.

No small business economic impact statement has been prepared under chapter 19.85 RCW. DDD has analyzed these proposed rule amendments and concludes that no new costs will be imposed on the small businesses affected by them. The preparation of a comprehensive SBEIS is not required.

RCW 34.05.328 applies to this rule adoption. These rules do meet the definition of a "significant legislative rule" in RCW 34.05.328 and a cost benefit analysis has been prepared. To obtain a copy contact Kelly Cooper, DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, (360) 664-6094, or e-mail coopekd@dshs.wa.gov.

Hearing Location: Blake Office Building East, 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on May 22, 2001, at 10:00 a.m.; and at the DDD Region 1 Office, 1611 West Indiana Avenue, Spokane, WA 99205, on May 23, 2001, at 11:00 a.m.

Assistance for Persons with Disabilities: Contact Kelly Cooper, DSHS Rules Coordinator, by May 17, 2001, phone (360) 664-6094, TTY (360) 664-6178, e-mail coopeKD@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by May 23, 2001.

Date of Intended Adoption: No sooner than May 24, 2001.

April 13, 2001

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

OTS-4768.1

PURPOSE
AMENDATORY SECTION(Amending WSR 99-19-104, filed 9/20/99, effective 9/20/99)

WAC 388-820-010   ((Definitions.)) What is the purpose of this chapter?   (((1) "Agency" means the department-certified entity providing residential instruction and support services to clients.

(2) "Certification" means the determination of satisfactory compliance with the rules and regulations outlined as referenced under this chapter.

(3) "Client" means a person the division determines under RCW 71A.16.040 and WAC 275-27-026 eligible for division-funded services.

(4) "Client/provider account" means an account in the name of one client where the client or client's provider has the authority to make deposits or withdrawals. The banking laws under RCW 30.22.040 refer to this as an "agency account."

(5) "Client services" means instruction and support activities promoting the following client-centered benefits:

(a) Health and safety:

(i) Needing and using health services;

(ii) Dealing with illness and injury and first aid procedures;

(iii) Learning about basic nutrition;

(iv) Maintaining good health;

(v) Obtaining mental health services when needed;

(vi) Learning about human sexuality;

(vii) Being aware of fire evacuation plans;

(viii) Knowing emergency procedures, including how to use 911 or a local emergency number;

(ix) Being aware of burglary protection strategies; and

(x) Learning self-protection.

(b) Personal power and choice:

(i) Securing housing and furnishings reflecting personal preferences, life style, and financial means;

(ii) Expressing opinions and making decisions;

(iii) Learning and exercising rights and responsibilities;

(iv) Improving communication skills;

(v) Participating in various activities, including new experiences;

(vi) Exercising a voter's rights;

(vii) Learning about available protection and advocacy services; and

(viii) Making career choices.

(c) Positive recognition by self and others:

(i) Creating positive self-esteem and feelings of self-worth;

(ii) Choosing valued social roles; and

(iii) Having choices influencing valued perception of self and others.

(d) Integration in the physical and social life of the community:

(i) Residing in areas convenient to shopping, banking, eating, worshiping, learning, making friends, and otherwise participating in community life;

(ii) Assisting people to use available transportation;

(iii) Meeting new people and participating with other members of the community in shared activities; and

(iv) Accessing educational and vocational opportunities.

(e) Positive relationships:

(i) Establishing, maintaining, expanding, and improving relationships by providing personal interaction opportunities with people;

(ii) Involving the client's family, guardian, or representative in planning and decision making which affect the client;

(iii) Resolving disagreements among clients or among clients and family, friends, neighbors, and co-workers;

(iv) Coping with the loss of a significant relationship, such as the death of a friend or family member, end of a relationship, loss of a job, or change of staff.

(f) Competence and self-reliance:

(i) Learning and using skills useful to the client, such as meal planning, grocery shopping, meal preparation, cleaning laundry, using household appliances, money management and budgeting, and use of leisure time in settings where the skills are needed;

(ii) Identifying situations in which the client needs or desires assistance from others;

(iii) Accomplishing tasks requiring the assistance of staff or others; and

(iv) Acquiring and using adaptive devices and equipment.

(6) "Department" means the department of social and health services of the state of Washington.

(7) "Depositor," when utilized in determining the rights of persons to funds in an account, means a person who owns the funds.

(8) "Division" means the division of developmental disabilities of the department of social and health services.

(9) "Exemption" means the department's approval of a written request for an exception to a rule in this chapter.

(10) "Facility based" means a residence which is owned, leased, or rented by an entity other than the client.

(11) "Frequency" means how often a designated event has occurred.

(12) "Group home" means a residence licensed by the applicable state authority and operated by an agency certified by the division of developmental disabilities.

(13) "Group training home" means a residence meeting the definition of RCW 71A.22.020(2) and which is operated by an agency certified by the division of developmental disabilities as defined under RCW 71A.22.040.

(14) "Imprest fund" means a petty cash fund which has a pre-established limit. The total of the cash in the fund and receipts from withdrawals from the fund equal the pre-established limit.

(15) "Individual account" means one account in the name of one client primarily managed by a provider.

(16) "Individual client cash" means one client's cash controlled by the provider.

(17) "Instruction" means goal-oriented teaching addressing skill acquisition and skill enhancement.

(18) "Nonfacility based" means the client owns, leases, sub-leases, or rents a residence although others, except the department, may guarantee the client's credit.

(19) "Nursing assistant" means a nursing assistant-registered under chapter 18.88A RCW, or a nursing assistant-certified under chapter 18.88A RCW.

(20) "Provider" means the agency or individual with which the department contracts for providing client instruction and support services.

(21) "Reprisal" means any negative action taken as retaliation against an employee. A rebuttable presumption is raised that reprisal has occurred if a negative action occurs within a year of a refusal to delegate or accept delegation. Occurring as a result of a lawful employee action, "reprisal" includes, but is not limited to:

(a) Harassment;

(b) Firing;

(c) Demotion; or

(d) Disciplinary action.

(22) "Residence" means the place or home where a client resides.

(23) "Residential service" means work or duties performed by the provider to meet clients' daily living needs and enhance clients' lives.

(24) "Secretary" means the secretary of social and health services or the secretary's designee.

(25) "Severity" means the seriousness of the occurrence as determined by the:

(a) Actual or potential negative outcomes for residents; or

(b) Extent to which the resident's physical, mental, or psychosocial well-being is compromised or threatened.

(26) "Support" means:

(a) Assistance to a client in performance of necessary functions or tasks; or

(b) The performance of a task on behalf of a client, that is, someone else does the client's task.

(27) "Trust account" means an account containing two or more clients' funds where the provider has the authority to make deposits or withdrawals.)) (1) This chapter establishes standards for the department of social and health services (DSHS) to provide, or contract to provide, individualized community residential services to clients who:

(a) Are eligible to receive services by the division of developmental disabilities (DDD); and

(b) Receive support from certified service providers.

(2) Service providers support eligible clients to enable them to:

(a) Enjoy all rights and privileges under the Constitution and laws of the United States and the state of Washington; and

(b) Participate in community life and have control of their environment to the greatest extent possible.

(3) The authority for this chapter is Title 71A RCW.

[99-19-104, recodified as 388-820-010, filed 9/20/99, effective 9/20/99. Statutory Authority: Chapters 18.88A and 71A.12 RCW. 96-10-076 (Order 3978), 275-26-010, filed 5/1/96, effective 6/1/96. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-010, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), 275-26-010, filed 2/9/83.]

(b) If the agency contests the department's decision, the agency may request an administrative review conference as described under WAC 275-26-022.)) "Agency" means an entity interested in becoming a service provider that offers residential instruction and support services to clients.

"Certification" means the determination by DSHS that an agency or service provider has satisfactorily complied with the requirements outlined in this chapter and in the department contract.

"Client" means a person who:

Has a developmental disability;

Is eligible under RCW 71A.10.020; and

Is authorized by DDD to receive residential services outlined in this chapter. (For eligibility criteria, see chapter 388-825 WAC.)

"Client services" means instruction and support activities that benefit clients, as specified under WAC 388-820-450 through 388-820-510.

"Community alternatives program (CAP)" means a Title XIX Medicaid waiver program that serves a specific number of individuals. This waiver is for particular home- and community-based services not covered under the Medicaid state plan. (See WAC 388-825-170 for more details.)

"Community protection services" (Community Protection Intensive Supported Living Services, or CP-ISLS) means intensive supported living services provided to clients who meet the criteria of "Individual with Community Protection Issues."

"DDD" refers to the division of developmental disabilities at DSHS.

"DSHS" refers to the department of social and health services of Washington state.

"Exceptions" means DSHS' approval of a written request for an exception to a rule in this chapter. (There are no exceptions to RCWs.)

"Group home" means residential services provided in a dwelling that is:

Owned, leased, or rented by an entity other than the client;

Licensed by the applicable state authority; and

Operated by a provider.

(See WAC 388-820-090 for further details.)

"Group training home" means a certified nonprofit residential facility that provides full-time care, treatment, training, and maintenance for clients, as defined under RCW 71A.22.020(2).

"IFP" refers to individual financial plan. (See WAC 388-820-620.)

"IISP" refers to the individual instruction and support plan for clients. (See WAC 388-820-560 through 388-820-580.)

"Individual with community protection issues" means:

The person has been convicted of or charged with a crime of sexual violence as defined in chapter 71.09 RCW, including, but not limited to, rape, statutory rape, rape of a child, and child molestation;

The person has been convicted of or charged with acts directed towards strangers or individuals with whom a relationship has been established or promoted for the primary purpose of victimization;

The person has been convicted of or charged with a sexually violent offense and/or predatory act, and may constitute a future danger;

The person has not been convicted and/or charged, but has a history of stalking, sexually violent, predatory, and/or opportunistic behavior which demonstrates a likelihood to commit a sexually violent and/or predatory act based on current behaviors that may escalate to violence;

The person has committed one or more violent crimes, such as murder, attempted murder, arson, first degree assault, kidnapping, or use of a weapon to commit a crime.

"Instruction" means goal-oriented teaching that is designed for acquiring and enhancing skills.

"ISP" refers to the individual service plan for clients. (See WAC 388-820-520 through 388-820-550.)

"Nursing assistant" means a person who is registered or certified by department of health under chapter 18.88A RCW. A nursing assistant performs certain nursing care tasks that are delegated by a registered nurse for a specific client in authorized settings. (See chapter 246-841 WAC for more details.)

"Reprisal" means any negative action taken as retaliation against an employee.

"Residential service" means client services offered by certified service providers.

"Secretary" means the secretary of the department of social and health services or the secretary's designee.

"Service provider" means an agency certified by and contracted with DDD to provide residential services to clients.

"Severity" means the seriousness of an incident. This is determined by the extent to which a client's physical, mental, or psychosocial well-being is or may be compromised or threatened.

"Support" means assistance as requested or needed by a client, based on their abilities, needs, and goals.

"Supported living" means residential services provided to clients living in their own homes, which are owned, rented, or leased by the clients or their legal representatives. (See WAC 388-820-080 for more details.)

"Trust account" means a bank account containing two or more clients' funds where the service provider has the authority to make deposits and withdrawals.

[99-19-104, recodified as 388-820-020, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-020, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 86-08-003 (Order 2349), 275-26-020, filed 3/20/86; 83-05-017 (Order 1945), 275-26-020, filed 2/9/83.]

(b) The proceeding shall be governed by the Administrative Procedure Act (chapter 34.05 RCW), RCW 43.20A.205, this chapter, and chapter 388-08 WAC. If any provision in this chapter conflicts with chapter 388-08 WAC, the provision in this chapter governs.)) Residential service is supports provided to eligible clients by service providers to enable clients to live in their community. These may include:

(1) Supported living services;

(2) Group home services; or

(3) Services provided in the group training home.

Residential services must follow the requirements outlined in this chapter.

[99-19-104, recodified as 388-820-030, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-022, filed 8/9/91, effective 9/9/91. Statutory Authority: RCW 34.05.220 (1)(a) and 71.12.030 [71A.12.030]. 90-04-074 (Order 2997), 275-26-022, filed 2/5/90, effective 3/1/90. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), 275-26-022, filed 2/9/83.]

[99-19-104, recodified as 388-820-040, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-050, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), 275-26-050, filed 2/9/83.]

(7) Clients shall not be routinely involved in the instruction and support of other clients.)) Residential services may be offered by service providers in:

(1) The client's own home;

(2) Group homes; or

(3) The group training home.

[99-19-104, recodified as 388-820-050, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-060, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), 275-26-060, filed 2/9/83.]

(5) The agency shall document orientation, review, and training activities.)) Clients who are at least eighteen years old and authorized by DDD may receive residential services.

[99-19-104, recodified as 388-820-060, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-070, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), 275-26-070, filed 2/9/83.]

(e) Revise the individual instruction and support plan (IISP) as benefits are achieved.)) (1) When clients receive more than forty hours of residential services per month, the service provider must ensure that the following physical and safety requirements are met for the client:

(a) A safe and healthy environment;

(b) Accessible telephone equipment;

(c) An evacuation plan developed and practiced with the client;

(d) An entrance and/or exit that does not rely solely upon windows, ladders, folding stairs, or trap doors;

(e) A safe storage area for flammable and combustible materials;

(f) Unblocked exits;

(g) A working smoke detector, with a light-alarm for clients with hearing impairments, located close to sleeping rooms;

(h) A flashlight or a nonelectrical light source in working condition; and

(i) Basic first-aid supplies.

(2) These physical and safety requirements are also offered to clients who receive forty hours or less of residential services per month. If clients choose not to participate in meeting these requirements, service providers must document these situations according to WAC 388-820-100.

(3) The service provider must ensure that documentation is kept, showing that physical safety requirements are met. The client may independently document that these requirements are met as long as the client's IISP shows this involvement.

(4) Residential services must be located in a residential neighborhood within reasonable distance of necessary resources, unless a client chooses to live in a remote area. Resources include stores, banks, laundromats, churches, job opportunities, and other public services.

(a) Exception: Group homes certified prior to 1983 do not need to follow this requirement.

(b) Exception: Clients who receive community protection services do not need to follow this requirement.

[99-19-104, recodified as 388-820-070, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-072, filed 8/9/91, effective 9/9/91.]

(5) The agency shall post and keep posted in a conspicuous place or places where notices to employees are customarily posted, the toll free telephone number established by aging and adult services administration for receiving complaints regarding delegation of specific nursing tasks to nursing assistants.)) (1) Supported living services are instruction and supports offered by service providers to clients who live in or are establishing their own homes. Homes must be owned, rented, or leased by the clients or their legal representatives.

(2) Clients who receive supported living services are responsible for paying for their daily living expenses, such as rent, utilities, and food, using their personal financial resources.

(3) The level of support is based on each client's instruction and support needs. Support may range from one hour per month to twenty-four hours per day of staff support per client.

[99-19-104, recodified as 388-820-080, filed 9/20/99, effective 9/20/99. Statutory Authority: Chapters 18.88A and 71A.12 RCW. 96-10-076 (Order 3978), 275-26-074, filed 5/1/96, effective 6/1/96.]

(d) Nothing in this rule shall be construed to require the department to impose a fine if a determination is made that no unlawful delegation occurred.)) (1) Group homes are residences that are licensed as either a boarding home or an adult family home by aging and adult services administration in DSHS, under chapters 388-78A and 388-76 WAC, respectively.

(2) The service provider must ensure that group homes comply with all applicable licensing regulations.

(3) Group homes provide residential services to two or more clients.

(4) Clients who live in group homes pay costs of room and board from their own financial resources. (See WAC 388-820-120 for additional information.)

[99-19-104, recodified as 388-820-090, filed 9/20/99, effective 9/20/99. Statutory Authority: Chapters 18.88A and 71A.12 RCW. 96-10-076 (Order 3978), 275-26-076, filed 5/1/96, effective 6/1/96.]

(b) Properly insured for its usage.)) (1) A service provider must document a client's refusal to participate in:

(a) Physical and safety requirements, as outlined in WAC 388-820-070(2); and

(b) Health services under WAC 388-820-690.

(2) Documentation must include the following:

(a) A description of events relating to the client's refusal to participate in these services;

(b) A plan to inform the client of the benefits of these services;

(c) A description of the service provider's efforts to give the services to the client; and

(d) Any health or safety concerns that the refusal may pose.

[99-19-104, recodified as 388-820-100, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-087, filed 8/9/91, effective 9/9/91.]

[99-19-104, recodified as 388-820-110, filed 9/20/99, effective 9/20/99. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), 275-26-097, filed 2/9/83.]

(2) The provider shall submit the department-required billing documents.))

For all service providers

(1) DSHS must pay for residential services provided to clients under department contract at the contracted rate.

(2) DSHS must require a client to share the cost of services when mandated by federal or state statute or regulation.

(3) The service provider must inform DSHS when the client requires additional supports.

(a) The service provider must submit a written request with justification for additional service hours.

(b) DSHS may approve and provide payment for additional expenses or services.

(c) The service provider must retain a copy of department approval.

For group home services

(4) For a client who is receiving group home services and support:

(a) The client must pay for cost of care or services from earnings or other financial resources. Clients receiving SSI are responsible only for the cost of room and board.

(b) DSHS may pay for these services only after a client has used his or her own financial resources.

(c) When a client's guardian or legal representative controls the client's income, estate, or trust fund, they must reimburse the service provider as described in WAC 388-820-120.

For supported living services

(5) A client receiving supported living services must pay for housing, utilities, food, clothing, and other personal and incidental expenses from earnings and other financial resources.

[99-19-104, recodified as 388-820-120, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-107, filed 8/9/91, effective 9/9/91.]

(14) The provider shall not release client funds to a person other than the client or the client's guardian or legal representative without the written consent of the client or the secretary.)) (1) DSHS may enter into a contractual agreement to reimburse the service provider for costs incurred to establish services. The costs must be based on a budget negotiated with DSHS.

(2) DSHS may reimburse service providers for client costs of establishing a residence.

(3) For reimbursement, the service provider must submit the billing documents required by DSHS.

[99-19-104, recodified as 388-820-130, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-115, filed 8/9/91, effective 9/9/91.]

(1) Initial certification;

(2) Regular certification; and

(3) Provisional certification.

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(2) An interested agency must apply to DDD to be certified.

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(1) An agency's completed application must be submitted to the regional DDD office for initial certification in that region. The application must include:

(a) A letter of intent;

(b) A mission statement;

(c) A statement of assurance stating that the service provider will not discriminate against a client or employee (see WAC 388-820-280);

(d) Verification of financial stability;

(e) A budget forecast;

(f) A staff-coverage schedule;

(g) A staff in-service training plan;

(h) The agency's policies and procedures;

(i) Relevant experience and qualifications of the agency;

(j) A minimum of two professional references;

(k) A copy of the license if applying for a group home;

(l) The administrator's resume; and

(m) A list of the agency board of directors and affiliations, if applicable.

(2) DSHS must provide the county with a copy of the agency's application.

(3) The county may submit written recommendations about the application to DSHS within thirty calendar days after receiving the application. DSHS reviews the county's recommendations.

(4) An agency must comply within one hundred and eighty days of the certification's effective date with:

(a) Relevant federal, state, and local laws and ordinances; and

(b) Department-established requirements.

(5) DDD notifies the agency in writing that all documentation has been received and approves or denies initial certification.

[]

(1) Under initial certification, agencies that receive a contract with DDD become service providers. Once a contract is in place, a service provider is approved for receiving client referrals and serving clients in a particular region for up to one hundred and eighty days. Service providers must have a separate contract for each region where they receive referrals and serve clients.

(2) If DDD does not contract with an agency, initial certification will be valid for up to a year for that agency.

[]

[]

(2) The county may submit recommendations about a service provider to DSHS.

(3) After determining that a service provider has complied with requirements, DSHS may approve a service provider for regular certification.

(a) This certification allows a service provider to continue to receive referrals and provide instruction and support to clients.

(b) Regular certification may be granted to service providers for up to two years.

(4) Regular certification may be extended for a period up to one hundred and eighty days.

[]

(2) DSHS may review a client's records and activities at any time to see if the service provider continues to address the clients' needs for instruction and support activities.

(3) DSHS may conduct additional evaluations or audits of any service provider at its discretion.

[]

(2) Ways to gather information for evaluation must include:

(a) Review of records;

(b) Interview of clients, legal representatives, and others with the client's consent; and

(c) Observation of staff and client interactions.

(3) Information may also be gathered by conducting:

(a) Interviews with other entities contracted with DSHS; and

(b) Interviews with DSHS staff.

(4) The state-contracted evaluators conduct meetings with the service provider and DDD to discuss their preliminary findings and request additional information and clarification.

(5) Evaluators conduct an exit conference to present the evaluation report to the service providers and DSHS.

(a) The evaluation report will include the service provider's operation history.

(b) If the service provider has not complied with certification requirements or with its contract with DSHS, the evaluator will note the findings in the report.

(c) The report must specify the corrective action plan. The corrective action plan and specific time frames are negotiated between the service provider and DSHS.

(d) At the conclusion of the exit conference, the service provider may request a copy of part or all of the draft report from the evaluator.

(e) The service provider may also submit a letter requesting a draft copy of the report to DDD headquarters within fourteen days of the exit conference.

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(a) The exit conference; or

(b) Receipt of the draft of the evaluation report.

(2) After receiving the service provider's documentation, DDD must send written notification of its decision to the service provider within fourteen calendar days.

(3) The service provider's documentation and DDD's decision must become part of the final evaluation report.

(4) DDD must file a report of the evaluation results and send a copy to the service provider. At this time, the evaluation report is considered to be a public document.

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(2) Provisional certification may not exceed one hundred eighty days.

(3) At the end of provisional certification:

(a) If the service provider has complied with certification requirements, DSHS may approve the service provider for regular certification.

(b) If the service provider has not complied with certification requirements, DSHS must revoke the service provider's certification and terminate the contract.

[]

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(1) Overseeing all aspects of staff development, such as recruitment and staff training;

(2) Preparing and maintaining policies and procedures related to client services, personnel, and financial records; and

(3) Securely storing client, personnel, and financial records.

[]

(1) Service providers must have these written statements approved by DDD:

(a) A mission statement;

(b) Program description and admission criteria;

(c) An organizational chart and description showing all supervisory relationships; and

(d) Definition of staff roles and responsibilities, including the person designated to act in the absence of the administrator.

(2) Service providers must also have these policies and procedures approved by DDD:

(a) Background checks, as required under chapter 388-146 WAC;

(b) Client confidentiality and release of information;

(c) Client rights, which must include information on how to report suspected abuse, neglect, exploitation, and mistreatment;

(d) Client grievance procedures;

(e) Protection of client's financial interests, including management of client accounts, if applicable;

(f) Medication management, administration, and assistance;

(g) Plans for responding to missing persons; client emergencies, including access to medical, mental health, and law enforcement resources; and natural or other disasters;

(h) Notification of client's guardian and/or relatives in case of emergency; and

(i) Methods used for soliciting client input and feedback on services and support received.

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(2) Personnel policies and procedures must be available to all employees.

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(a) Race;

(b) Color;

(c) Creed;

(d) Religion;

(e) National origin;

(f) Age;

(g) Gender;

(h) Presence of any sensory, mental, or physical disability, including HIV/AIDS conditions;

(i) Use of a trained dog guide or service animal by a person with a disability;

(j) Marital status;

(k) Disabled status or Vietnam Era veteran status;

(l) Sexual orientation; and

(m) Any other reasons prohibited by law.

(2) Exception: An employer may deny employment to a person if the decision is based upon a bona fide occupational qualification. (See chapter 49.60 RCW.)

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(2) Clients must have immediate access to staff, or the means to contact staff, at all times: Twenty-four hours a day, seven days a week.

(3) A service provider must provide adequate staff within contracted funds to administer the program and meet the needs of the clients.

(4) A service provider must have other staff available, as specified by the service provider's contract with DSHS.

(5) Each group home must maintain staffing that complies with:

(a) Boarding home or adult family home licensing requirements under chapter 388-78A or 388-76 WAC, respectively; and

(b) Contract requirements with the division of developmental disabilities.

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(2) An FBI check is required when an employee or volunteer has resided in the state for less than three years.

(3) Exception: The department may give a provisional background clearance of one hundred twenty days when an FBI check is required.

(4) Clearances must be obtained for each service provider where the staff person works or volunteers.

(5) Clearances must be renewed as specified by DSHS.

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(1) Exhibit job-related competency and the ability to make independent judgments;

(2) Have a high school diploma or GED equivalent, unless the employees were hired before 1983;

(3) Be at least eighteen years of age when employed as a direct care staff, or at least twenty-one years of age when employed as an administrator; and

(4) Treat a client with dignity and consideration, respecting the client's civil and human rights at all times.

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(1) Before the employee works alone with clients, the service provider must explain the following to the employee:

(a) The current instruction and support plan for the employee's clients;

(b) Emergency procedures for clients;

(c) The DSHS-approved policy on abuse and neglect; and

(d) Client confidentiality.

(2) Within the first four weeks of employing a staff person, the service provider must provide training that includes:

(a) The service provider's mission statement;

(b) Policies and procedures; and

(c) On-the-job training.

(3) Additional training within the first six months must include:

(a) First aid/CPR;

(b) Bloodborne pathogens with HIV/AIDS information; and

(c) Client services.

(4) Each employee must keep first aid/CPR certification and bloodborne pathogens training current.

(5) The service provider must document orientation and training activities.

(6) Group homes must also meet the training requirements mandated by the licensing requirements specified by DSHS.

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(2) If the service provider is a nonprofit organization, administrators must be evaluated annually by their supervisor or by the organization's governing board.

(3) If the service provider is a for-profit organization, owners are not required to have performance reviews.

(4) If the service provider is a governmental agency, administrators are evaluated by their supervisor.

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(2) The staff-coverage schedules must be approved at the following times:

(a) Before certification review takes place;

(b) When household configuration changes affect funding; and

(c) When additional staffing is requested.

(3) Staff-coverage schedules may be requested by DDD at any time.

(4) Each service provider must retain copies of the approved staff-coverage schedules.

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(2) On the effective date of a change of ownership, DSHS must terminate the department's certification and contract with the previous service provider.

(3) DSHS must withhold final payment to the previous service provider until that service provider submits and DSHS accepts all reports and required documents.

(4) DSHS is under no obligation to contract with the new owner entity.

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(1) A client stops receiving residential services and supports from a service provider;

(2) A service provider transfers ownership; or

(3) The client chooses a different service provider.

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(a) DSHS, the client, and/or legal representative upon their request to the service provider; and

(b) The county developmental disabilities board with DDD approval, as allowed under RCW 71A.14.070.

(2) Any other transfer or inspection of records must be authorized by a release of information form that:

(a) Specifically gives information about the transfer or inspection; and

(b) Is signed by the client or guardian.

(3) A signed release of information is valid for up to one year.

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(2) After a client's participation with a service provider ends, the client's records must be kept by the service provider for at least six years.

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(1) The client's name, address, and Social Security number.

(2) The name, address, and telephone number of the client's relative, guardian or legal representative.

(3) Copies of legal guardianship papers, if any.

(4) Client health records, including:

(a) The name, address, and telephone number of the client's physician, dentist, mental health service provider, and any other health care service provider;

(b) Health care service providers' instructions about health care needed, including appointment dates and date of next appointment if appropriate;

(c) Written documentation that the health care service providers' instructions have been followed; and

(d) A record of major health events and surgeries when known.

(5) A copy of the client's individual service plan (ISP).

(6) The client's individual instruction and support plan (IISP), including:

(a) Instruction and support activities for each client as a basis for review and evaluation of client's progress;

(b) Semiannual review of the IISP;

(c) Consultation with other service providers and other interested persons;

(d) IISP revisions and changes; and

(e) Other activities relevant to the client that the client wants included.

(7) Progress notes and incident reports on clients.

(8) The client's financial records for funds managed by the service provider, including:

(a) Receipts, ledgers and records of the client's financial transactions; and

(b) Client's related bankbooks, checkbooks, bank registers, tax records and bank statements.

(9) Burial plans and wills.

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(1) A list of items with a value of at least twenty-five dollars that the client owns when moving into the program;

(2) A list of personal possessions with a value of seventy-five dollars or more per item once the client is receiving services;

(3) Description and identifying numbers, if any, of the property;

(4) The date the client purchased the items after moving into the program;

(5) The date and reason for addition or removal from the record; and

(6) The signature of the staff or client making the entry.

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(2) Entries must be made at the time of or immediately following the occurrence of the event recorded, in legible writing, and dated and signed by the person making the entry.

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(1) Notify the client's guardian or legal representative as soon as possible;

(2) Immediately report to DSHS about a serious incident or emergency, as specified in the contract; and

(3) Submit a written incident report to DSHS, as required by law or policy.

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(2) Reports must be made to one of two different areas at DSHS:

(a) Service providers giving supportive living services must report to adult protective services (APS); and

(b) Service providers giving services through group homes must report to residential care services (RCS).

(3) Reports must be made to law enforcement agencies, when appropriate.

(4) Service providers must have DSHS-approved policies and procedures that specify reporting requirements for client abuse, neglect, exploitation, or mistreatment.

(5) Each administrator, owner, staff person, and volunteer must sign this policy about reporting requirements. The service provider must place the signed policy in the personnel file for staff or volunteers.

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(1) Health and safety;

(2) Personal power and choice;

(3) Competence and self-reliance;

(4) Positive recognition by self and others;

(5) Positive relationships; and

(6) Integration in the physical and social life of the community.

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(1) Know when they need health services;

(2) Maintain good health;

(3) Learn about basic nutrition;

(4) Learn about human sexuality;

(5) Use health services, including mental health services;

(6) Manage and/or self-administer their medications;

(7) Deal with illness and injury;

(8) Apply first-aid procedures;

(9) Learn self-protection;

(10) Become aware of fire evacuation plans and burglary protection strategies; and

(11) Know emergency procedures, such as using 911 or a local emergency number.

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(1) Secure housing and furnishings that reflect personal preferences, life style, and financial means;

(2) Express personal opinions and make decisions;

(3) Learn and exercise rights and responsibilities;

(4) Improve communication skills;

(5) Participate in a variety of activities of their choice, including new experiences;

(6) Exercise voter rights;

(7) Learn about and participate in self-advocacy and protection services; and

(8) Make career choices.

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(1) Develop and achieve their goals;

(2) Learn and use daily living skills, such as meal planning and preparation, grocery shopping, doing laundry, using household appliances, managing money, and using leisure time;

(3) Identify situations where the client needs or desires assistance from others;

(4) Complete or participate in all tasks within their abilities; and

(5) Acquire and use adaptive devices and equipment, as needed.

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(1) Create positive self-esteem and feelings of self-worth;

(2) Choose valued social roles;

(3) Make choices that enhance their positive recognition by community members; and

(4) Present themselves in ways that are typical of other people in their community.

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(1) Improve their communication skills;

(2) Experience opportunities to meet and interact with other people;

(3) Initiate, build and sustain relationships;

(4) Involve the client's guardian, chosen family members or representative in planning and making decisions that affect the client;

(5) Resolve disagreements with peers, family, friends, staff, neighbors, and coworkers; and

(6) Cope with the loss of a significant relationship, such as the death of a friend or family member, the end of a relationship, the loss of a job, or a change of staff.

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(1) Use community resources such as grocery store, bank, and social organizations;

(2) Use available transportation;

(3) Access educational and vocational opportunities; and

(4) Participate on boards, committees, or other positions of influence or status.

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(2) The case resource manager must also involve the client's guardian or legal representative and the service provider.

(3) In creating a client's individual service plan (ISP), under RCW 71A.18.010 and WAC 388-825-050, the client and DDD case resource manager may involve:

(a) Department staff; and

(b) Other interested persons invited by the client.

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(2) In addition, an ISP meeting must be held with the client at least every two years, under RCW 71A.18.010. The meeting must be held in the client's home unless requested otherwise by the client.

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(2) The IISP must be based on the goals of the individual service plan (ISP), reflect the client's preferences, and have the client's agreement.

(3) The IISP identifies activities and opportunities that promote one or more of the following client services:

(a) Health and safety;

(b) Personal power and choice;

(c) Positive recognition by self and others;

(d) Integration in the physical and social life of the community;

(e) Positive relationships; and

(f) Competence and self-reliance.

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(2) The client may involve other interested individuals in developing the IISP.

(3) The service provider must facilitate the individual instruction and support plan (IISP) in a manner that:

(a) Is respectful and inclusive of the client;

(b) Is appropriate to the age of the client or is preferred by the client;

(c) Takes place or occurs in community settings; and

(d) Results in opportunities for clients to experience positive change and personal growth.

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(2) In overseeing each client's IISP, the service provider must:

(a) Consult with other service providers serving the client and other interested persons, as needed, to coordinate the IISP;

(b) Revise the IISP as goals are achieved, or as requested by the client; and

(c) Review and update the plan at least every six months.

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(a) Obtaining written consent from the client, the client's guardian or legal representative; or

(b) Becoming the designated payee by the source of the client's unearned income.

Note:

An example is a client receiving unearned income from the Social Security Administration.

(2) A client's funds are considered to be managed by a service provider when the service provider:

(a) Has signing authority and may disperse a client's funds; and/or

(b) May limit access to client funds by not allowing funds to be expended.

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Note:

In this situation, service providers are not necessarily considered managers of the client's funds.

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(2) The IFP must be reviewed at least annually by the service provider and client.

(3) A copy of the IFP must be sent to:

(a) The guardian and/or legal representative; and

(b) The client's DDD case resource manager upon request.

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(1) The part of the client's funds and income that will be managed by the service provider;

(2) The part of client funds and income that will be managed by the client or legal representative;

(3) The type of accounts used;

(4) A budget process;

(5) Asset management, such as personal property, burial plan, retirement funds, stock, and vehicles;

(6) Cash management;

(7) Money management instruction and/or support;

(8) An explanation of which purchases require receipts; and

(9) Contingency plan for "spend down" if needed. An example of "spend down" is the lump sum amount given from the Social Security Administration.

(10) A signature of the client and the client's guardian, if any.

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(a) Separately track each client's money even when several clients reside together;

(b) Keep the client's account current by maintaining a running balance;

(c) Reconcile the client's account to the bank statement on a monthly basis;

(d) Make deposits to the client's account within one week of receiving the client's money;

(e) Prevent the client's account from being overdrawn;

(f) Ensure that individual cash funds do not exceed seventy-five dollars per person unless specified differently in the individual's financial plan; and

(g) Retain receipts for purchases of over twenty-five dollars.

(2) When a client's service provider receives a check made out to the client, the service provider assisting the client must either:

(a) Get the client's signature and designation "for deposit only," and deposit the check in the client's account; or

(b) Get the client's "x" mark in the presence of another witness, cosign the check with the designation "for deposit only," and deposit the check in the client's account.

(3) If the check for a client is made out to a payee other than the client, the payee signs the check.

(4) Clients may never sign a blank check.

(5) When clients use checks for purchases, they must sign checks at the time of purchase unless specified differently in their individual financial plan.

(6) The service provider must document the names of any staff who assist a client with financial transactions.

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(1) Documentation for bank and cash accounts must include monthly reconciliation of bank and cash accounts that are verified and initialed by a second party who did not make or assist in the transaction.

(2) Other documentation that a service provider must keep for client financial transactions include:

(a) Monthly bank statements and reconciliation;

(b) Checkbook registers and bankbooks;

(c) Deposit receipts;

(d) Receipts for purchases over twenty-five dollars, or as specified in the financial plan;

(e) Any itemized subsidiary ledgers showing deposits, withdrawals, and interest payments to individual clients; and

(f) A control journal for trust accounts.

(3) Other documentation that a service provider must keep for client cash transactions include:

(a) A detailed ledger signed by the person who withdrew any of the client's money;

(b) Monthly reconciliation to the cash amount;

(c) Detailed accounting of the money received on behalf of the client, such as cash received from writing checks over the purchase amount, and a list of where the money was spent; and

(d) Receipts for purchases over twenty-five dollars where service provider staff withdrew the money.

(4) Service providers must notify DSHS when the client:

(a) Receives services under a CAP (community alternative program) waiver; and

(b) Has an account that reaches three hundred dollars less than the maximum amount allowed by federal or state law.

Note:

CAP-waiver is defined under WAC 388-825-170.

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(1) When a client transfers from one service provider to another, the previous service provider must transfer client funds within thirty days. To transfer funds, the previous service provider must:

(a) Give the client, the client's guardian, and/or the legal representative a written accounting of all known client funds;

(b) When applicable, give the new service provider a written accounting of all transferred client funds;

(c) Obtain a written receipt from the client, client's guardian and/or legal representative for all transferred funds; and

(d) When applicable, obtain the new service provider's written receipt for the transferred funds.

(2) When a client becomes incapacitated or a client's whereabouts are unknown, the client's service provider must transfer the client's funds within one hundred and eighty days to the client's legal guardian, to DSHS, or to the requesting governmental entity.

(3) When a client dies, the service provider must transfer the client's funds within ninety days to:

(a) The client's guardian;

(b) The legal representative;

(c) The requesting governmental entity; or

(d) DSHS if the client does not have a legal heir.

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(2) The client's service provider must not:

(a) Charge a client interest for money loaned; or

(b) Borrow funds from the client.

(3) A service provider must retain a signed loan agreement with the client and clearly document:

(a) The original amount of the loan;

(b) Payback schedules; and

(c) The balance owed.

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(1) A service provider or staff has stolen, misplaced, or mismanaged client funds.

(2) There are service charges incurred on a trust account that the service provider operates for a client.

(3) A client performs work for the service provider.

(a) The service provider must pay the client at least the current minimum wage.

(b) Clients who work for a service provider must be paid according to federal and state law requirements.

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(2) For clients who receive an average of thirty hours or more of service per month, the service provider must:

(a) Maintain health records;

(b) Assist the client in arranging appointments with health professionals;

(c) Monitor medical treatment prescribed by health professionals;

(d) Communicate directly with health professionals when needed; and

(e) Ensure that the client receives an annual physical and dental examination unless the appropriate medical professional gives a written exception.

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(2) A service provider must document all denials from:

(a) DSHS' medical assistance administration; and/or

(b) Private insurance companies or other carriers of primary medical insurance.

(3) The written documentation must be given to the client's DDD case resource manager and kept in the client's files.

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(a) Emergency medical care;

(b) Medical appointments; and

(c) Therapies.

(2) Within available resources, the service provider must provide necessary assistance with transportation to and from:

(a) Work, school or other publicly funded services;

(b) Leisure or recreation activities;

(c) Client-requested activities; and

(d) ISP- or IISP-related activities.

(3) A vehicle that the service provider uses to transport clients must be:

(a) In safe operating condition; and

(b) Properly insured for its usage.

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(2) One nursing assistant must not transfer delegated authority to perform nursing care tasks to another nursing assistant.

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(a) Be registered or certified as a nursing assistant (NAR or NAC, respectively);

(b) Complete nurse delegation core training approved by DSHS and receive a certificate; and

(c) Receive client-specific training from the delegating registered nurse.

(2) In addition, registered nursing assistants must complete thirty-two hours of staff training required by WAC 388-820-330 before doing nursing care tasks. Certified nursing assistants may perform delegated tasks before completing the required thirty-two hours of staff training.

(3) After the staff member completes the required training, the service provider must keep:

(a) Written instructions provided by the delegating registered nurse; and

(b) A copy of the registration or certification for each employee.

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(2) Under RCW 7.70.065, if a client is unable to give consent or is incapacitated, certain people are authorized to provide consent for a client's receiving health care. These people must be one of the following in this priority order:

(a) The legal guardian, if any;

(b) An individual who holds a durable power of attorney for health care decisions;

(c) The client's spouse;

(d) The client's children who are at least eighteen years of age;

(e) The client's parents; and

(f) The client's adult siblings.

(3) Proof of consent must be kept in the client's files.

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(1) The service provider must post the toll-free telephone number, established by DSHS' aging and adult services administration, for complaints about the delegation of nursing tasks to nursing assistants. The telephone number must be posted in a conspicuous place for employees.

(2) The nursing assistant:

(a) May consent or refuse to consent to perform a delegated nursing care task; and

(b) Must not receive employer reprisal for refusing to accept the delegation of a nursing care task if the refusal is based on client safety issues.

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(2) When assessing civil fines, DSHS must consider:

(a) Severity of occurrence;

(b) Frequency of occurrence; and

(c) Other relevant factors relating to the occurrence.

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(2) The DSHS technical assistance program must include:

(a) Technical assistance visits where DSHS informs the service provider of violation of law or service provider rules;

(b) Information about how to get technical assistance;

(c) Printed information;

(d) Information and assistance by phone;

(e) Training meetings;

(f) Other appropriate methods to provide technical assistance; and

(g) A list of organizations that provide technical assistance.

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(a) Notify the service provider in writing about the concerns;

(b) Give the service provider an opportunity to explain circumstances or present additional information that may clarify concerns; and

(c) Request the service provider to provide additional information, if necessary.

(2) DSHS must inform the service provider in writing about the outcome of findings and any required actions.

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(1) The service provider has previously been found out of compliance for the same statute or rule; or

(2) The service provider's violation is likely to place a person in danger of death or bodily harm.

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(1) State the amount and reasons for the fine and the applicable law under which the fine is imposed; and

(2) Inform the service provider of the right to request a hearing.

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(2) Exception: If a service provider requests a hearing under chapter 34.05 RCW and RCW 43.20A.215, DSHS must stop the fine while waiting for a final decision on the matter.

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(2) No service provider may discriminate or retaliate in any manner against a person who makes a complaint or has cooperated in the complaint investigation.

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(2) Within twenty-eight days of receiving the decision, the service provider must file a written application for a hearing, showing proof of receipt with the Board of Appeals, P.O. Box 42489, Olympia, WA 98504-2489. The application must include:

(a) The grounds for contesting the department decision; and

(b) A copy of the contested department decision.

(3) Hearings are governed by chapter 34.05 RCW and RCW 43.20A.215, and chapter 388-02 WAC. If any provision in this section conflicts with chapter 388-02 WAC, the provision in this section governs.

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(2) Within this twenty-eight day period, the agency or service provider must request in writing that the DDD director or designee review the decision. The agency or service provider must:

(a) Sign the request;

(b) Identify the challenged decision and the date it was made;

(c) State specifically the issues and regulations involved and the grounds for the service provider's disagreement; and

(d) Include with the request copies of any supporting documentation for the service provider's position.

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(2) Exception: The agency or service provider and DSHS may agree in writing to a specific later date for the conference.

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(2) Exception: If either the department, or the agency or service provider requests in writing that the conference be held in person, the conference may not be conducted by telephone.

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(2) The agency or service provider must bring to the conference, or give to DSHS before the conference, any supporting documentation for the service provider's position.

(3) The parties must clarify and attempt to resolve the issues at the conference.

(4) If additional documentation is needed to resolve issues, a second session of the conference must be scheduled. The second conference must be scheduled no later than twenty-eight days after the initial session unless both parties agree in writing to a specific later date.

(5) The director of the division of developmental disabilities must give a written decision to the service provider after the end of the conference.

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(1) The service provider must submit a written request for an exception to the DDD regional administrator of the region where the contract is held.

(2) DSHS must evaluate requests for exceptions, considering the quality of the services, supervision, and the health and safety of the clients.

(3) The DDD director or designee must approve or deny the request in writing within sixty calendar days after receiving the request from the service provider.

(4) Any exception granted must be in line with the legislative intent of Title 71A RCW.

(5) Service providers must retain a copy of each DSHS-approved exception.

(6) Service providers do not have hearing rights when they receive a denial from DSHS for an exception to the rules in this chapter.

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Washington State Code Reviser's Office