DSHS Assisted Living Facility Administrator Online Training

NOTE: This training is NOT the sole requirement for becoming an administrator!

Please review all qualifications, training and documentation requirements, which can be found on the ADSA ALF Professional Page under “Administrators”.

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 Assisted Living Facilities. It is not intended to be legal advice. It is your responsibility to know the law affecting the operation of an assisted living facility. You should seek advice from your attorney if you have questions about your legal obligations.

Instructions:

  • Review information
  • Complete practice exercise
  • Print and sign certificate, maintain on premises

Introduction and Objectives:

The operation of an assisted living facility 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 an assisted living facility.

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:
    • Assisted Living Facilities (Licensing)
    • Long Term Care Resident Rights
    • Criminal History Background Checks
    • Abuse of Vulnerable Adults (Reporting Requirements)
  • Identify the following WACs and their general subject:
    • Assisted Living Facility 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 an assisted living facility, list the correct requirement and cite at least one corresponding statutory/ regulatory reference to at least 8 of 10 questions.

Handout/Favorites:

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 Assisted Living Facility Administrators  

Overview:

Statutes

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/  

Session Laws

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/

Administrative Rules

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 .

Title-Chapter-Section

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:

Type

Title

Chapter

Section

Sub-Section

RCW

18

.20

.125

(3)

WAC

388

-78A

-2520

(2)

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 an assisted living facility. 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
  • Etc.

This course does provide a summary overview of those laws and rules that most directly affect the care and services provided to residents in Assisted Living Facilities, are requirements for licensing as an assisted living facility, 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.

Relevant Statutes:

While there are other applicable statutes, the four that are most relevant to the licensing of Assisted Living Facilities are:

  1. RCW 18.20 Assisted Living Facilities http://apps.leg.wa.gov/RCW/default.aspx?cite=18.20
    RCW 18.20 is the statute that creates the basic requirement to license Assisted Living Facilities. Major points to remember include, the statute:
    • Creates the framework for developing, establishing and enforcing the standards for operating an assisted living facility
    • Defines an assisted living facility and other concepts related to operating an assisted living facility.
    • Specifies when an assisted living facility license is and is not required
    • Outlines broad parameters for who may obtain an assisted living facility license, how to obtain an assisted living facility 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 assisted living facility licensing requirements
    • Requires DSHS to inspect Assisted Living Facilities 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 Assisted Living Facilities
    • Prohibits Assisted Living Facilities from accepting residents who require the frequent presence and evaluation of a registered nurse
    • Requires Assisted Living Facilities to disclose, on forms provided by the department, the scope of care and services the assisted living facility provides
    • Permits Assisted Living Facilities to provide domiciliary care services as defined
    • Permits Assisted Living Facilities to provide, but does not require them to provide, assistance with activities of daily living
    • Permits Assisted Living Facilities to provide, but does not require them to provide, health support services as defined
    • Permits Assisted Living Facilities to provide, but does not require them to provide, intermittent nursing services as described
    • Permits Assisted Living Facilities to allow family members to administer or assist with a resident’s medications and treatments, and describes the limits of the assisted living facility’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 Assisted Living Facilities to allow residents to arrange for outside health services
    • Specifies the Long-Term Care Resident Rights Statute, chapter 70.129 RCW applies in Assisted Living Facilities
    • Outlines the requirements for DSHS to accept and investigate complaints against Assisted Living Facilities
    • Outlines what sanctions DSHS may or must impose on Assisted Living Facilities that fail to meet licensing standards
    • Outlines the context for training standards in Assisted Living Facilities
    • Spells out the bed-hold requirements when Assisted Living Facilities serve department clients, and that resident must be transferred to a hospital or nursing home
    • Requires Assisted Living Facilities to assume general responsibility, as defined, for residents and to coordinate assisted living facility 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.
  2. RCW 70.129 Long-Term Care Resident Rights
    http://apps.leg.wa.gov/RCW/default.aspx?cite=70.129
    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 an assisted living facility must protect and promote the rights of each resident
    • Requires Assisted Living Facilities to inform a resident of all of the assisted living facility rules and resident responsibilities, and residents’ rights before moving in
    • Requires Assisted Living Facilities to only admit or retain individuals whose needs the assisted living facility can meet
    • Requires the assisted living facility to assess potential residents’ needs and preferences prior to the individual moving into the assisted living facility
    • Requires the assisted living facility to inform residents of the services, items and activities customarily available in the assisted living facility and their costs
    • Outlines the requirements when an assisted living facility 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 assisted living facility, 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 Assisted Living Facilities may not require or request residents to sign any waiver of liability
    • Outlines the reasons a resident may be discharged from an assisted living facility, 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 Assisted Living Facilities must promote the residents’ quality of life
    • Specifies the requirements for Assisted Living Facilities 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
  3. RCW 43.43 Washington State Patrol (Criminal History Background Checks)
    http://apps.leg.wa.gov/RCW/default.aspx?cite=43.43 
    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 Assisted Living Facilities. The major points relevant to the operation of Assisted Living Facilities 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 assisted living facility 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.
  4. RCW 74.34 Abuse of Vulnerable Adults
    http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34
    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 Assisted Living Facilities, 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 assisted living facility 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

Relevant Rules:

There also are a number of WACs that are relevant to the operation of an assisted living facility. 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 assisted living facility, while important, are not included in this overview.

  1. WAC 388-78A Assisted Living Facility Licensing Rules:
    http://apps.leg.wa.gov/WAC/default.aspx?cite=388-78A
    Chapter 388-78A WAC is the administrative rule that provides the most detail regarding assisted living facility licensing standards. It contains references to other statutes and rules that an assisted living facility 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 Assisted Living Facilities to accept and retain an individual as a resident only if certain criteria are met including that the assisted living facility 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 assisted living facility
    • Requires the assisted living facility to complete a full resident assessment of specified areas within 14 days of the resident moving into the assisted living facility
    • Requires the assisted living facility 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 an assisted living facility must use to develop initial and on-going negotiated service agreements for residents, and the content of the negotiated service agreement
    • Specifies the assisted living facility’s requirements for implementing negotiated service agreements
    • Specifies the required services an assisted living facility must provide
    • Describes optional services an assisted living facility may provide, including assistance with activities of daily living and health support services, as defined
    • Specifies the assisted living facility’s requirements for medication services, including family assistance with medications, the use of medication organizers, and storing and accounting for medications
    • Specifies the assisted living facility’s requirements for food service menus and diets, delivery and sanitation consistent with WAC 246-215
    • Specifies intermittent nursing services are optional for Assisted Living Facilities and specifies the assisted living facility’s requirements if the assisted living facility chooses to provide nursing services
    • Specifies the requirements regarding resident-arranged services, and coordinating health care services with outside providers
    • Specifies the requirements if an assisted living facility provides adult day care and dementia care, and the requirements for operating a unit with restricted egress
    • Specifies the assisted living facility’s requirements associated with documenting resident care, and maintaining records regarding residents’ care
    • Specifies the assisted living facility’s requirements for hiring and training sufficient staff for the assisted living facility, 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 assisted living facility administrators
    • Specifies the administrative requirements of operating an assisted living facility, including use of management agreements, development of policies and procedures, infection control practices, and reporting requirements
    • Specifies resident rights in Assisted Living Facilities consistent with RCW 70.129
    • Specifies the assisted living facility’s requirements regarding disaster preparedness and disclosing available services
    • Specifies the requirements for obtaining an assisted living facility license and the procedures for applying for a license
    • Specifies the licensee’s responsibilities in an assisted living facility
    • Specifies the requirements for the building to be used as an assisted living facility
    • Specifies the rights and responsibilities of the assisted living facility during the inspection process
    • Specifies the enforcement actions the department may take in response to an assisted living facility’s non-compliance with rules, and the assisted living facility’s appeal rights
  2. WAC 388-112 Residential Long Term Care Services (Training):
    http://apps.leg.wa.gov/WAC/default.aspx?cite=388-112
    Chapter 388-112 WAC establishes training requirements for employees of Assisted Living Facilities. 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 Assisted Living Facilities that serve persons with dementias, developmental disabilities, and mental illnesses, (4) nurse delegation, (5) continuing education, and (6) CPR and first aid.
    • Requires assisted living facility administrators (or their designees), caregivers, and all paid or volunteer staff to receive introductory information (orientation) appropriate to the assisted living facility and population served
    • Requires assisted living facility 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 assisted living facility 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 assisted living facility. (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 assisted living facility administrators (or their designees) and caregivers to complete ten hours of continuing education each calendar year
    • Specifies the requirements for assisted living facility staff to have training in first aid and cardio-pulmonary resuscitation
    • Specifies the qualifications of instructors and curriculum for training
  3. WAC 246-840 Nurse Delegation:
    http://apps.leg.wa.gov/WAC/default.aspx?cite=246-840
    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 an assisted living facility, 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
  4. WAC 246-888 Medication Assistance
    http://apps.leg.wa.gov/WAC/default.aspx?cite=246-888
    Chapter 246-888 WAC establishes requirements for residents and caregivers in Assisted Living Facilities and other settings regarding medication assistance and administration. Since medication assistance is a required service in all Assisted Living Facilities, 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 an assisted living facility
    • Specifies the conditions under which an “enabler” may be used and when medications may be altered in providing medication assistance
  5. WAC 246-215 Food Services
    Requirements for food services provided in Washington State, including those provided by Assisted Living Facilities, 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. 

    This means:

    • 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 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, https://www.doh.wa.gov/CommunityandEnvironment/Food/FoodWorkerandIndustry/FoodSafetyRules 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 assisted living facility residents.
    • Requirements for food service equipment and utensils, and their cleaning and sanitization.
    • Requirements for the physical facilities surrounding food preparation.
  6. WAC 388-110 Contracted Residential Care
    http://apps.leg.wa.gov/WAC/default.aspx?cite=388-110
    Chapter 388-110 WAC contains the requirements Assisted Living Facilities 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 Assisted Living Facilities 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 Assisted Living Facilities
    • 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 assisted living facility contractors who do not meet contract requirements

Useful Internet Links For Assisted Living Facility Administrators

Test Your Knowledge

Assisted Living Facility Administrator practice exercises.