AGING AND LONG-TERM SUPPORT ADMINISTRATION
Welcome to the DSHS Boarding Home Administrator Online Training!
This course is offered by the Department of Social and Health Services (DSHS) to assist you in becoming familiar with some of the laws and rules related to boarding homes. It is not intended to be legal advice. It is your responsibility to know the law affecting the operation of a boarding home. You should seek advice from your attorney if you have questions about your legal obligations.
WAC 388-78A-2540(2) requires individuals hired as boarding home administrators after September 1, 2004 to complete this training within thirty days of assuming duties as a boarding home administrator.
- Review information
- Complete practice exercise
- Print and sign certificate, maintain on premises
Introduction and Objectives:
The operation of a boarding home in Washington is regulated by a number of different statutes and administrative rules. This self-paced course is designed to be a helpful resource and provide a quick overview of:
- How statutes are created and how administrative rules are created,
- How to locate references to relevant statutes and administrative rules, and
- Four important statutes and six important administrative rules related to operating a boarding home.
The objectives of this course are, that at its completion, you will be able to:
- Generally describe how a statute (Revised Code of Washington-RCW) is enacted and how an administrative rule (Washington Administrative Code-WAC) is adopted.
- State who is responsible for enacting statutes.
- State who is responsible for adopting administrative rules.
- Locate the Office of the Code Reviser on the Internet.
- Given a specific statutory reference, read the text from the Internet.
- Given a specific rule reference, read the text from the Internet.
- Identify the following RCWs and their general subject:
- Boarding Homes (Licensing)
- Long Term Care Resident Rights
- Criminal History Background Checks
- Abuse of Vulnerable Adults (Reporting Requirements)
- Identify the following WACs and their general subject:
- Boarding Home Licensing Rules
- Residential Long Term Care Services (Training)
- Nurse Delegation
- Medication Assistance
- Food Services
- Contracted Residential Care Services
- Using a computer and internet access and given ten different questions regarding requirements for operating a boarding home, list the correct requirement and cite at least one corresponding statutory/ regulatory reference to at least 8 of 10 questions.
As you proceed through this course, a number of Internet links are provided for you. If you are working from your own computer, you may want to add some of these links to your “Favorites” or “Bookmark” list for future reference.
If you would like these links in a written format, please click here for a printable page:
Useful Internet Links for Boarding Home Administrators
A statute is a law that has been enacted by the legislature. In Washington State, laws start out in the legislature as proposed bills. Learn how a proposed bill becomes a law in at the following link: http://apps.leg.wa.gov/billinfo/
After a bill is enacted, the Secretary of State assigns it a session law chapter number. “Session laws” are a listing of all of the bills in their final form that were passed by the legislature and enacted into law during a single session of the legislature. Each bill represents a separate “chapter” in the session laws. You will find the session laws at the following link: http://apps.leg.wa.gov/billinfo/crossref.aspx?year=2011
The indexes in the session laws first list the chapter, and then the corresponding bill number. If you know the bill number, you will find the corresponding session law chapter number by scrolling down further in the index.
Revised Code of Washington
The Washington State Office of the Code Reviser “codifies” the session law into the Revised Code of Washington (RCW). The terms “statute” and “law” and “RCW” all refer to laws that have been passed by Washington’s legislature. For a complete listing of the Revised Code of Washington, click on: http://apps.leg.wa.gov/rcw/
In addition to passing laws, the legislature has also given various state agencies the authority to write administrative rules, which have legal effects similar to statutes. The legislature has spelled out the procedural requirements for how state agencies may adopt administrative rules in Part 3 of the Administrative Procedures Act, chapter 34.05 RCW (http://apps.leg.wa.gov/rcw/default.aspx?cite=34.05)
Washington State Register
The Washington State Register is the official publication in which notices related to agency rule making are published. For more information about the Washington State Register or to review notices, click on: http://www.leg.wa.gov/CodeReviser/Pages/Washington_State_Register.aspx
Washington Administrative Code
The administrative rules adopted by state agencies are codified into the Washington Administrative Code (WAC). The terms “rule” or “administrative rule” or “WAC” all refer to administrative rules adopted by state agencies according to the Administrative Procedures Act. (Administrative rules have also previously been referred to as “regulations.” However, this term is not commonly used now.) A listing of all of the WACs can be found at the following link: http://apps.leg.wa.gov/wac/
Office of the Code Reviser
The home page for the Office of the Code Reviser not only gives the mission statement for the office, but it also provides links to the Revised Code of Washington, the Washington Administrative Code, the Session Laws, and the Washington State Register in which proposed new rules are published. The home page for the Office of the Code Reviser may be found at: http://slc.leg.wa.gov/default.htm .
In citing a WAC or RCW, the first set of numbers is referred to as the “Title,” the second set is referred to as the “Chapter,” the third set as the “Section,” and the fourth set is known as the “Sub-section.” For example, in citing RCW 18.20.125 (3) or WAC 388-78A-2520 (2), the following would apply:
Applicable statutes and rules
Each of us is subject to multiple federal, state, county, and municipal laws and rules on a daily basis. Depending on our activity or business, we may be more mindful of some laws than we are of others. For example, most of us are aware of traffic laws during our daily commutes to work. However, we may be less mindful of laws regulating public waterways or controlling noxious weeds unless we happen to work in occupations related to these subjects. Nevertheless, these laws apply to each of us if we intend to take actions that may impact public waterways, or own land on which noxious weeds may grow.
In the same way, there are a great number of statutes and rules that may affect the operation of a boarding home. This course is not intended to be a comprehensive review of all the federal, state, county and municipal laws and rules that may apply to your work. For example, this course does not review other laws related to the following relevant subjects including, but not limited to:
- Local zoning and land use
- Americans with Disabilities Act
- Federal Fair Housing Act
- Federal, state and local taxation
- Employment laws and fair labor practices
- Industrial safety
- Business and accounting practices
This course does provide a summary overview of those laws and rules that most directly affect the care and services provided to residents in boarding homes, are requirements for licensing as a boarding home, and may be enforced directly or indirectly by the Department of Social and Health Services (DSHS) as part of the licensing responsibilities.
The summary points outlined below are provided to familiarize you with the general contents of the law or rule and assist you in locating the governing authority. Click on the links attached to review the full text of the law or rule.
While there are other applicable statutes, the four that are most relevant to the licensing of boarding homes are:
- RCW 18.20 Boarding Homes http://apps.leg.wa.gov/RCW/default.aspx?cite=18.20
RCW 18.20 is the statute that creates the basic requirement to license boarding homes. Major points to remember include, the statute:
- Creates the framework for developing, establishing and enforcing the standards for operating a boarding home
- Defines a boarding home and other concepts related to operating a boarding home.
- Specifies when a boarding home license is and is not required
- Outlines broad parameters for who may obtain a boarding home license, how to obtain a boarding home license, creates the requirement for a licensing fee, and directs when a change in licensees must occur
- Directs DSHS to adopt rules to further specify boarding home licensing requirements
- Requires DSHS to inspect boarding homes at least once every eighteen months, and to focus the inspections primarily on resident outcomes
- Specifies that the State Fire Marshal (director of fire protection in the Washington State Patrol) is responsible for establishing and enforcing fire protection standards in boarding homes
- Prohibits boarding homes from accepting residents who require the frequent presence and evaluation of a registered nurse
- Requires boarding homes to disclose, on forms provided by the department, the scope of care and services the boarding home provides
- Permits boarding homes to provide domiciliary care services as defined
- Permits boarding homes to provide, but does not require them to provide, assistance with activities of daily living
- Permits boarding homes to provide, but does not require them to provide, health support services as defined
- Permits boarding homes to provide, but does not require them to provide, intermittent nursing services as described
- Permits boarding homes to allow family members to administer or assist with a resident’s medications and treatments, and describes the limits of the boarding home’s duty of care when family members provide such services
- Specifies requirements for pre-admission assessments, initial resident service plans, and for completing a full assessment within 14 days of residents moving in
- Specifies the requirements for developing a negotiated service agreement with the resident
- Requires boarding homes to allow residents to arrange for outside health services
- Specifies the Long-Term Care Resident Rights Statute, chapter 70.129 RCW applies in boarding homes
- Outlines the requirements for DSHS to accept and investigate complaints against boarding homes
- Outlines what sanctions DSHS may or must impose on boarding homes that fail to meet licensing standards
- Outlines the context for training standards in boarding homes
- Spells out the bed-hold requirements when boarding homes serve department clients, and that resident must be transferred to a hospital or nursing home
- Requires boarding homes to assume general responsibility, as defined, for residents and to coordinate boarding home services with the care and services residents arrange to receive from other sources
- Requires notice to resident applicants before admission and to current residents regarding the home’s policy on accepting Medicaid as a payment source.
RCW 70.129 is the statute that outlines the rights of residents in long term care facilities. The legislature intended in this statute for residents to receive appropriate services and be treated with courtesy, and enjoy their basic legal and civil rights. The legislature further intended for residents to have reasonable control over life decisions, and found that choice, participation, privacy and the opportunity to engage in religious, political, civic, recreational, and social activities enhance self-worth and the quality of life for residents. Major points of the statute include:
- Specifies a boarding home must protect and promote the rights of each resident
- Requires boarding homes to inform a resident of all of the boarding home rules and resident responsibilities, and residents’ rights before moving in
- Requires boarding homes to only admit or retain individuals whose needs the boarding home can meet
- Requires the boarding home to assess potential residents’ needs and preferences prior to the individual moving into the boarding home
- Requires the boarding home to inform residents of the services, items and activities customarily available in the boarding home and their costs
- Outlines the requirements when a boarding home manages a resident’s personal funds
- Ensures residents’ personal privacy and records confidentiality
- Specifies residents have a number of rights including a right to voice grievances and a right to a prompt response by the boarding home, a right to examine the results of inspections, a right to privacy in communications and visitations, and a right to retain and use personal possessions
- Specifies boarding homes may not require or request residents to sign any waiver of liability
- Outlines the reasons a resident may be discharged from a boarding home, and specifies the notices that must precede any discharge
- Prohibits the use of restraints and abuse, corporal punishment and involuntary seclusion
- Outlines the residents’ rights for quality of life and how boarding homes must promote the residents’ quality of life
- Specifies the requirements for boarding homes to disclose their policies on refunds of deposits, admission fees, prepaid charges or minimum stay fees
- Requires the long term care ombudsman to monitor the implementation of the resident rights statute
RCW 43.43 establishes the Washington State Patrol, and outlines its major operations. RCW 43.43.830 through RCW 43.43.842 are the sections of this statute that are most applicable to boarding homes. The major points relevant to the operation of boarding homes are that these sections:
- Require the Washington State Patrol to furnish criminal conviction records for the purposes of pre-employment screening
- Require that any person associated with a licensed boarding home that has unsupervised access to a vulnerable adult must not have been:
- Convicted of a crime against a person,
- Convicted of crimes relating to financial exploitation,
- Found by any disciplinary board to have abused a vulnerable adult, or
- The subject in a protective proceeding under chapter 74.34 RCW
- Establish the broad parameters for obtaining a criminal history background check for an employee
- Require long-term care workers hired after January 1, 2012 to have background checks, including fingerprint checks.
RCW 74.34 is the statute that outlines the requirements for reporting abuse and/or neglect of vulnerable adults. The legislature declared that the department must be able to receive reports of abuse and neglect, and provide protective services in the least restrictive most appropriate environment. Among the major points to remember are, the statute:
- Identifies employees of licensed boarding homes, among others, as mandated reporters of abuse and neglect
- Requires mandated reporters to immediately report to the department when there is reasonable cause to believe that abandonment, abuse, financial exploitation, or neglect of a vulnerable adult has occurred
- Requires mandated reporters to immediately report to the department when there is reason to suspect that physical assault has occurred or there is reasonable cause to believe an act has caused fear of imminent harm, and identifies specific criteria when mandated reporters are required to report such incidents to the appropriate law enforcement agency, including incidents of physical assault between vulnerable adults
- Requires mandated reporters to immediately report to the appropriate law enforcement agency and to the department when there is reason to suspect that sexual assault has occurred
- Prohibits any boarding home from developing policies or procedures that interfere with the reporting requirements of this chapter
- Makes the identity of the person making a report of abuse or neglect confidential
- Provides immunity from liability to the person making a report in good faith
- Makes it a gross misdemeanor for a mandated reporter to knowingly fail to make a report of abuse or neglect
- Outlines the department’s responsibilities after receiving a report of abuse or neglect
There also are a number of WACs that are relevant to the operation of a boarding home. Six of the more important WACs are briefly summarized below. Washington State and local building rules, and licensing rules regulating the practice of licensed professionals such as nurses who may work in your boarding home, while important, are not included in this overview.
- WAC 388-78A Boarding Home Licensing Rules:
Chapter 388-78A WAC is the administrative rule that provides the most detail regarding boarding home licensing standards. It contains references to other statutes and rules that a boarding home must also meet in order to have a license. The authority for DSHS to write this rule comes from RCW 18.20.090. Among the major points to remember are, the rule:
- Requires boarding homes to accept and retain an individual as a resident only if certain criteria are met including that the boarding home can safely and appropriately serve the resident and the individual does not require the frequent presence and frequent evaluation of a registered nurse
- Requires that a qualified assessor, as defined, completes a pre-admission assessment of specified areas for each resident before the resident moves into the boarding home
- Requires the boarding home to complete a full resident assessment of specified areas within 14 days of the resident moving into the boarding home
- Requires the boarding home to monitor each resident and reassess each resident when there is a change in the resident’s condition or the resident’s negotiated service plan no longer is appropriate
- Specifies the process a boarding home must use to develop initial and on-going negotiated service agreements for residents, and the content of the negotiated service agreement
- Specifies the boarding home’s requirements for implementing negotiated service agreements
- Specifies the required services a boarding home must provide
- Describes optional services a boarding home may provide, including assistance with activities of daily living and health support services, as defined
- Specifies the boarding home’s requirements for medication services, including family assistance with medications, the use of medication organizers, and storing and accounting for medications
- Specifies the boarding home’s requirements for food service menus and diets, delivery and sanitation consistent with WAC 246-215
- Specifies intermittent nursing services are optional for boarding homes and specifies the boarding home’s requirements if the boarding home chooses to provide nursing services
- Specifies the requirements regarding resident-arranged services, and coordinating health care services with outside providers
- Specifies the requirements if a boarding home provides adult day care and dementia care, and the requirements for operating a unit with restricted egress
- Specifies the boarding home’s requirements associated with documenting resident care, and maintaining records regarding residents’ care
- Specifies the boarding home’s requirements for hiring and training sufficient staff for the boarding home, including requirements for criminal history background checks and testing for tuberculosis
- Specifies the training requirements for staff consistent with WAC 388-112, including when staff are required to receive specialized training for working with persons with dementias, developmental disabilities, and mental illnesses
- Specifies the qualifications and training requirements for boarding home administrators
- Specifies the administrative requirements of operating a boarding home, including use of management agreements, development of policies and procedures, infection control practices, and reporting requirements
- Specifies resident rights in boarding homes consistent with RCW 70.129
- Specifies the boarding home’s requirements regarding disaster preparedness and disclosing available services
- Specifies the requirements for obtaining a boarding home license and the procedures for applying for a license
- Specifies the licensee’s responsibilities in a boarding home
- Specifies the requirements for the building to be used as a boarding home
- Specifies the rights and responsibilities of the boarding home during the inspection process
- Specifies the enforcement actions the department may take in response to a boarding home’s non-compliance with rules, and the boarding home’s appeal rights
Chapter 388-112 WAC establishes training requirements for employees of boarding homes. Among the major points to remember are, the rule:
- Identifies and establishes the requirements for various training including: (1) an employee orientation, (2) a basic course for caregivers, (3) specialized training in boarding homes that serve persons with dementias, developmental disabilities, and mental illnesses, (4) nurse delegation, (5) continuing education, and (6) CPR and first aid.
- Requires boarding home administrators (or their designees), caregivers, and all paid or volunteer staff to receive introductory information (orientation) appropriate to the boarding home and population served
- Requires boarding home administrators (or their designees), and caregivers to complete (basic) training and demonstrate competency in the core knowledge and skills that caregivers need in order to provide personal care services effectively and safely, within one hundred twenty days of employment.
- Prohibits caregivers from providing hands-on personal care without direct supervision until competency in the basic training has been demonstrated
- Allows certain health care workers to take a modified version of the required basic training
- Requires caregivers to take a specialized care course, and demonstrate competency in the required skills, whenever the boarding home provides services to a person with dementia, a developmental disability, or a mental illness
- Requires that a registered nursing assistant successfully complete the basic training course, and that registered or certified nursing assistants complete a DSHS-designated nurse delegation core training class, before performing any delegated nursing tasks in the boarding home. (RCW 18.79.260 does not require nurse delegation for the set up of diabetic insulin devices and verbally verification of insulin dosage for sight-impaired residents.)
- Requires boarding home administrators (or their designees) and caregivers to complete ten hours of continuing education each calendar year
- Specifies the requirements for boarding home staff to have training in first aid and cardio-pulmonary resuscitation
- Specifies the qualifications of instructors and curriculum for training
Chapter 246-840 WAC outlines the practice of licensed registered nurses and licensed practical nurses in Washington. While the entire chapter applies to any nursing care provided in a boarding home, sections WAC 246-840-910 through 236-840-970 specifically apply to the practice of nurse delegation in community based care settings. These sections of the rule:
- Specify the conditions under which a licensed registered nurse may delegate specific nursing care tasks to nursing assistants who meet certain requirements
- Require that before delegating a task, the registered nurse delegator must determine that specific criteria described in the protocol are met and ensure that the patient is in a stable and predictable condition
- Specify that the registered nurse delegator and nursing assistant are accountable for their own individual actions in the delegation process
- Prohibit any person from coercing a registered nurse into compromising patient safety by requiring the registered nurse to delegate if the registered nurse delegator determines it is inappropriate to do so
- Prohibit registered nurse delegators from delegating these care tasks: sterile procedures, central line maintenance, and the administration of medications by injection (intramuscular, intradermal, subcutaneous, intraosseous and intravenous) with the exception of insulin injections.
- Require that before delegating a nursing task, the registered nurse delegator must determine that it is appropriate to delegate based on the elements of the nursing process: assess, plan, implement, evaluate, and set out the requirements of each of these elements
Chapter 246-888 WAC establishes requirements for residents and caregivers in boarding homes and other settings regarding medication assistance and administration. Since medication assistance is a required service in all boarding homes, it is important to understand the requirements and limitations associated with this activity. Among the major points to remember are, the rule:
- Differentiates between medication assistance and medication administration
- Specifies medication assistance includes reminding or coaching the resident to take his or her medication, handing the medication container to the resident, opening the medication container, using an enabler, or placing the medication in the hand of the resident
- Requires that in order for medication assistance to occur, the resident must be able to put the medication into his or her mouth or apply or instill the medication
- Specifies that medication assistance specifically excludes assistance with the administration of intravenous and injectable medications
- Specifies that if a resident is not able to physically ingest or apply a medication independently or with assistance, then the medication must be administered to the resident by a person legally authorized to do so (e.g., physician, nurse, pharmacist)
- Specifies that if a resident cannot safely self-administer medication or self-administer with assistance and/or cannot indicate an awareness that he or she is taking a medication, then the medication must be administered to the resident by a person legally authorized to do so
- Specifies how medication assistance is initiated in a boarding home
- Specifies the conditions under which an “enabler” may be used and when medications may be altered in providing medication assistance
Requirements for food services provided in Washington State, including those provided by boarding homes, are described in chapter 246-215 of the Washington Administrative Code (WAC). The Washington State Board of Health (BOH) incorporated most, but not all, parts of the federal Food and Drug Administration’s 2001 Food Code (2001 Food Code) into WAC 246-215.
- WAC 246-215 does not address all food service requirements; it only addresses requirements that differ from the 2001 Food Code requirements.
- You must follow the 2001 Food Code, unless a different requirement is described in WAC 246-215.
- The 2001 Food Code can be viewed at: http://www.cfsan.fda.gov/~dms/fc01-toc.html.
The Department of Health developed a “working document” merging the new WAC 246-215 with the 2001 Food Code to help explain the new food services requirements. This document is only a guide for viewing Washington’s modifications to the 2001 Food Code. Do not rely solely on the “working document”. You are responsible for complying with WAC 246-215 and if applicable, the 2001 Food Code. You may find the “working document” by going to the Department of Health Food Service Rule Revision web page, http://www.doh.wa.gov/ehp/food/rule.html and scrolling down to “Working Document”:
- The original 2001 Food Code wording is in black Arial font.
- The 246-215 WAC revisions are in blue Times New Roman.
The purpose of food services rules is to promote and protect the health, safety and well-being of the public and prevent the spread of disease through food. Some of the important issues the rules address are:
- Qualifications of the person in charge of the food services.
- Food service workers’ personal hygiene practices and health conditions affecting their work.
- Approved sources of food.
- Protecting food from contamination.
- Requirements for food preparation including heating and cooling of food and proper cooking, holding and serving temperatures for food.
- Special requirements for “highly susceptible populations,” which include boarding home residents.
- Requirements for food service equipment and utensils, and their cleaning and sanitization.
- Requirements for the physical facilities surrounding food preparation.
Chapter 388-110 WAC contains the requirements boarding homes must meet if they wish to serve residents whose care is partially or fully funded by DSHS’s Home and Community Services Division in ADSA. (Separate requirements exist for boarding homes that serve clients of the Division of Developmental Disabilities.) Among the major points to remember are, the rule:
- Establishes the qualifications of licensees with whom DSHS will enter into a contract
- Specifies the general service standards for all DSHS contracts with boarding homes
- Creates three contract types: Adult Residential Care; Enhanced Adult Residential Care and Enhanced Adult Residential Care-Special Dementia Care; and Assisted Living
- Specifies the physical environment and service standards for Assisted Living contracts
- Specifies the service standards for Adult Residential Care and Enhanced Adult Residential Care
- Specifies the remedies for boarding home contractors who do not meet contract requirements
Useful Internet Links For Boarding Home Administrators
- Revised Code of Washington
- RCW 34.05 Administrative Procedures Act
- Washington Administrative Code
- RCW 18.20 Boarding Home Licensing Statute
- RCW 70.129 Long-Term Care Resident Rights Statute
- RCW 43.43 Criminal History Background Check Statute
- RCW 74.34 Abuse of Vulnerable Adults Statute
- WAC 388-78A Boarding Home Licensing Rules
- WAC 388-112 Residential Long Term Care Services (Training)
- WAC 246-840 Nurse Delegation
- WAC 246-888 Medication Assistance
- WAC 246-215 Food Services
- WAC 388-110 Contracted Residential Care