Washington Regulatory Compliance Resources for Residential Care Facilities

• ALFs may not admit or retain any individual requiring nursing or medical care of a type provided by nursing facilities, except when a registered nurse (RN) is available.
• Facilities may not admit or retain persons who require frequent evaluation by an RN, excluding persons who are receiving hospice care or persons with a short-term illness expected to be resolved within 14 days.
• A facility must only admit or retain individuals whose needs it can safely and appropriately serve with appropriate available staff and reasonable accommodations.
• Residents may be discharged for their own welfare or if the health or safety of other individuals in the facility is endangered.

• Facilities must complete a negotiated service agreement using information from the pre-admission assessment, initial resident service plan, and full reassessment. This agreement must include the resident, their representative (if any), and the Department’s case manager if the resident is a Medicaid client.
• The negotiated service agreement must be completed or updated within 30 days of move-in, as necessary after the annual full assessment, and whenever it no longer adequately addresses the resident’s current needs and preferences.
• Facilities are required to disclose information on a Department-provided form, including the scope and cost of services offered, activities not covered by the per diem rate, facility operation rules, and how residents can arrange for outside services. This form must be provided to residents, their representative, and interested consumers upon request.
• Except in emergencies, a thorough assessment of the individual’s needs and preferences must be obtained before admission. This assessment must cover recent medical history, necessary and contraindicated medications, diagnosis (unless religious objection), significant behaviors/symptoms, mental illness, level of personal care needs, and activity/service preferences.
• Based on the assessment, an initial resident service plan must be completed upon move-in to identify immediate needs and direct staff.
• Within 14 days of move-in, a full assessment of the resident’s functional and health needs must be completed as specified in regulation.
• A limited assessment must be repeated when a resident’s condition changes and the negotiated service agreement is no longer adequate.
• Residents’ negotiated service agreements must state whether they will receive medication assistance or medication administration services.
• If a facility permits a resident’s family member to administer medications or treatments, the facility must request and the family member must provide a written medication or treatment plan with information specified in the rules.
• Nutrient concentrates and supplements must be made available when prescribed in writing by a health care practitioner.

• Facilities must have an administrator.
• Facilities that admit and retain individuals requiring limited nursing services (LNS) or certain types of medical care must have a registered nurse available.
• There are no minimum staff ratios specified.
• Facilities must provide sufficient, trained staff to furnish the services and care needed by each resident according to their negotiated service agreement, maintain a safe facility, and implement fire/disaster plans.
• At least one staff person 18 years of age or older with current cardiopulmonary resuscitation (CPR) and first-aid certification must be present and available at all times.
• All ALF staff must complete 2 hours of HIV/AIDS training within 30 days of employment, although this topic is included in basic training.
• Caregivers accepting delegated tasks must be a certified or RN assistant, or certified home care aide, and complete nurse delegation core training. Those accepting insulin injections must complete Special Focus on Diabetes training. This training must use DSHS curriculum and DSHS-contracted community instructors.
• If an ALF serves residents with special needs (including dementia), the administrator or designee must complete manager specialty training and demonstrate competency by passing the DSHS test. If a resident develops special needs, the administrator or designee has 120 days to complete this training and competency demonstration.
• If an ALF serves residents with special needs, all long-term care (LTC) workers must receive training regarding the specialty needs of individual residents in the facility.
• Facilities that offer specialized dementia care must have awake staff 24 hours a day.
• Caregivers providing hands-on care to residents with special needs must complete specialty training within 120 days of starting to provide such care, or within 90 days of completing basic training if specialty training is not integrated. Until competency is demonstrated, they must be directly supervised.
• If a facility serves residents with dementia, the administrator or designee must complete specialty training and demonstrate competency within 120 days of being hired.

Training Requirements (summarized in a table format in the source):

• Orientation: 2 hours for ALF Administrator or Designee and ALF Long-Term Care (LTC) Worker. Prior to providing care unless exempt. Covers residents’ rights, communication skills, fire and life safety, and universal precautions.
• First-aid and CPR: Within 30 days of employment; must maintain a valid card for both Administrator/Designee and LTC Worker.
• Safety training: 3 hours for both Administrator/Designee and LTC Worker. Prior to providing care unless exempt.
• Basic training: 70 hours for both Administrator/Designee and LTC Worker. Within 120 days of employment unless exempt. Must be outcome-based and measured by competency test. Covers core knowledge/skills, specific duties, abuse reporting, policies/procedures, and residents’ negotiated service agreements.
• Continuing education: 12 hours per year for both Administrator/Designee and LTC Worker.
• Specialty training: For facilities serving residents with special needs (including dementia). Required for Administrator/Designee and LTC Workers. Must be outcome-based with demonstrated competency via a test.