Source: https://apps.leg.wa.gov/wac/default.aspx?cite=246-337&full=true
Timestamp: 2019-04-24 16:37:40+00:00

Document:
246-337-021 On-site surveys, complaint investigations, and enforcement.
246-337-025 Exemptions or alternative means and methods of compliance.
246-337-040 Construction review services requirements.
246-337-050 Management of human resources.
246-337-055 Personnel criminal history, disclosure, and background inquiries.
246-337-081 Residential services—Pediatric transitional care.
246-337-082 Pediatric transitional care services—Parent-infant visitation.
246-337-085 Accepting a child with a parent in treatment.
246-337-095 Resident health care records.
246-337-100 Resident's individual service plan.
246-337-103 Individual service plan—Pediatric transitional care services.
246-337-110 Use of restraint and seclusion.
246-337-111 Food and nutrition services.
246-337-113 Resident sleeping room accommodations.
246-337-116 Animal management and safety.
246-337-120 Facility and environment requirements.
246-337-126 Resident care room requirements.
246-337-127 Restraint or seclusion room requirements.
246-337-128 Laundry and housekeeping room requirements.
246-337-129 Resident sleeping room requirements.
246-337-130 Water supply, sewage and waste disposal.
246-337-135 Heating, ventilation and air conditioning.
246-337-140 Lighting, emergency lighting, and electrical outlets.
246-337-146 Cleaning, maintenance and refuse disposal.
246-337-020 Responsibilities and rights of the licensee and department. [Statutory Authority: Chapter 71.12 RCW. WSR 05-15-157, § 246-337-020, filed 7/20/05, effective 8/20/05.] Repealed by WSR 18-06-092, filed 3/6/18, effective 4/16/18. Statutory Authority: RCW 71.12.670.
246-337-035 Procedures to deny, suspend, modify or revoke a license. [Statutory Authority: Chapter 71.12 RCW. WSR 05-15-157, § 246-337-035, filed 7/20/05, effective 8/20/05.] Repealed by WSR 18-06-092, filed 3/6/18, effective 4/16/18. Statutory Authority: RCW 71.12.670.
246-337-090 Food and nutrition services. [Statutory Authority: Chapter 71.12 RCW. WSR 05-15-157, § 246-337-090, filed 7/20/05, effective 8/20/05.] Repealed by WSR 18-06-092, filed 3/6/18, effective 4/16/18. Statutory Authority: RCW 71.12.670.
246-337-115 Cleaning, maintenance and refuse disposal. [Statutory Authority: Chapter 71.12 RCW. WSR 05-15-157, § 246-337-115, filed 7/20/05, effective 8/20/05.] Repealed by WSR 18-06-092, filed 3/6/18, effective 4/16/18. Statutory Authority: RCW 71.12.670.
246-337-125 Toilet rooms and bathrooms. [Statutory Authority: Chapter 71.12 RCW. WSR 05-15-157, § 246-337-125, filed 7/20/05, effective 8/20/05.] Repealed by WSR 18-06-092, filed 3/6/18, effective 4/16/18. Statutory Authority: RCW 71.12.670.
246-337-145 Laundry. [Statutory Authority: Chapter 71.12 RCW. WSR 05-15-157, § 246-337-145, filed 7/20/05, effective 8/20/05.] Repealed by WSR 18-06-092, filed 3/6/18, effective 4/16/18. Statutory Authority: RCW 71.12.670.
246-337-150 Resident rooms, furnishings and storage. [Statutory Authority: Chapter 71.12 RCW. WSR 05-15-157, § 246-337-150, filed 7/20/05, effective 8/20/05.] Repealed by WSR 18-06-092, filed 3/6/18, effective 4/16/18. Statutory Authority: RCW 71.12.670.
246-337-155 Pet management and safety. [Statutory Authority: Chapter 71.12 RCW. WSR 05-15-157, § 246-337-155, filed 7/20/05, effective 8/20/05.] Repealed by WSR 18-06-092, filed 3/6/18, effective 4/16/18. Statutory Authority: RCW 71.12.670.
(1) This chapter implements chapter 71.12 RCW and sets the minimum health and safety standards for licensure and operations of twenty-four hour private, county or municipal residential treatment facilities (RTF) providing health care services to persons with mental disorders or substance use disorders.
(2) These rules are intended to supplement other applicable federal, state and local laws, rules and ordinances. If any provision of this chapter is more restrictive than local codes and ordinances this chapter shall prevail over any less restrictive provision.
(1) "Administrator" means an individual person responsible for managing the day-to-day operations of the residential treatment facility.
(2) "Adult" means an individual eighteen years of age or older.
(3) "Authorized" means mandated or permitted, in writing, by the administrator to perform an act that is within a health care provider's lawful scope of practice, or that was lawfully delegated to the health care provider or to the unlicensed staff member.
(4) "Bathroom" means a room containing at least one bathtub or shower.
(5) "Child" or "minor" means an individual under the age of eighteen. A child or minor may include an infant as defined in subsection (17) of this section.
(6) "Communicable disease" means a disease caused by an infectious agent that can be transmitted from one person, animal, or object to another individual by direct or indirect means including transmission via an intermediate host or vector, food, water or air.
(7) "Confidential" means information that may not be disclosed except under specific conditions permitted or mandated by law or legal agreement between the parties concerned.
(c) The conversion of an existing facility or portion of a facility for use as an RTF.
(9) "Co-occurring services" means services certified by the department that combine mental health services and substance use disorder services under a single RTF license.
(10) "Department" means the Washington state department of health.
(11) "Facility" means a building, portion of a building, or multiple buildings under a single RTF license.
(12) "Health assessment" means a systematic physical examination of the person's body conducted by an allopathic physician, osteopathic physician, naturopathic physician, allopathic physician's assistant, osteopathic physician's assistant, advanced registered nurse practitioner, registered nurse, or licensed practical nurse who is licensed under Title 18 RCW and operating within their scope of practice.
(13) "Health care" means any care, service, or procedure provided by a health care provider to diagnose, treat, or maintain a resident's physical or mental condition, or that affects the structure or function of the human body.
(14) "Health care prescriber" or "prescriber" means an allopathic physician, osteopathic physician, naturopathic physician, allopathic physician's assistant, osteopathic physician's assistant, or advanced registered nurse practitioner licensed under Title 18 RCW operating within their scope of practice who by law can prescribe drugs in Washington state.
(15) "Health care provider" means an individual who is licensed, registered or certified under Title 18 RCW to provide health care within a particular profession's statutorily authorized scope of practice.
(16) "Health care screen" means a systematic interview or use of a questionnaire approved by a health care prescriber to determine the health history and care needs of a resident.
(17) "Infant" means a resident less than twelve months of age at the time of admission for pediatric transitional care services.
(18) "Licensee" means the person, corporation, association, organization, county, municipality, public hospital district, or other legal entity, including any lawful successors to whom the department issues an RTF license.
(19) "Medication" means a legend drug prescribed for a resident by an authorized health care prescriber. Medication also means nonprescription drugs, also called "over-the-counter medications," that can be purchased by the general public without a prescription.
(20) "Medication administration" means the direct application of a medication or device by ingestion, inhalation, injection, or any other means, whether self-administered by a resident, or administered by a parent or guardian for a minor, or an authorized health care provider.
(21) "Medication administration error" means a resident failing to receive the correct medication, medication at the correct time, the correct dose, or medication by the correct route.
(22) "Mental health services" means services certified by the department under chapter 246-341 WAC to evaluate, stabilize, or treat one or more residents for a mental disorder.
(b) An individual or agency judicially appointed as legal guardian or custodian of the child.
(24) "Pediatric transitional care services" or "PTCS" means short-term, temporary, health and comfort services for drug exposed infants according to the requirements of this chapter.
(25) "Pediatric transitional care services unit" means the distinct spaces within a facility used exclusively for the provision of pediatric transitional care services.
(26) "Resident" means an individual admitted to an RTF licensed under this chapter.
(27) "Residential treatment facility" or "RTF" means a facility in which twenty-four hour on-site care is provided for the evaluation, stabilization, or treatment of residents for substance use, mental health, co-occurring disorders, or for drug exposed infants.
(c) Guide a resident from one location to another.
(29) "Seclusion" means the involuntary confinement of a resident alone in a room or area from which the resident is physically prevented from leaving.
(30) "Staff" means medical and administrative employees, independent contractors, trained caregivers, students, volunteers, and trainees performing duties at an RTF.
(31) "Substance use disorder services" means services certified by the department under chapter 246-341 WAC to evaluate, stabilize, or treat one or more residents for alcoholism, drug addiction, or dependence on alcohol and one or more other psychoactive chemicals, as the context requires.
(32) "Survey" means an inspection or investigation conducted by the department to evaluate and monitor a licensee's compliance with chapter 71.12 RCW and this chapter.
(33) "Toilet room" means a room containing a water closet (toilet).
(34) "Trained caregiver" means a noncredentialed, unlicensed person who may not provide medical care to infants, working under the supervision of a registered nurse as defined in RCW 18.79.020(6).
(4) Pediatric transitional care services.
Exemptions or alternative means and methods of compliance.
(d) Any supporting research or other documentation.
(d) Adversely affect the structural integrity of a facility.
(3) The department will send a copy of the exemption or alternative means or methods of compliance decision to the licensee, and shall maintain the exemption or alternative means or methods of compliance as part of the current RTF file. The licensee shall maintain the documented exemption or alternative means or methods of compliance decision on file in the RTF.
(1) Except as provided in subsections (2) and (3) of this section, any construction on or after August 20, 2005, must comply with this chapter.
(2) RTFs that are licensed and operating on August 20, 2005, may continue to operate without modifications to the facility, unless specifically required under this chapter, or as deemed necessary by either the local building official, the department, other licensing regulators, the state fire marshal, for the general safety and welfare of the occupants and public.
(3) Facilities providing pediatric transitional care services in a licensed capacity before January 1, 2019, are not subject to construction review by the department for an initial department of health license according to this chapter.
(1) Prior to beginning any construction or remodeling, the applicant or licensee must submit an application and fee specified in chapter 246-314 WAC, if applicable, to the department and receive written authorization by the department to proceed.
(2) The requirements of chapter 246-337 WAC in effect at the time the application and fee are submitted to the department, and the project number as assigned by the department, apply for the duration of the construction project.
(3) All facilities seeking to be licensed and existing licensed facilities seeking to renovate, alter, add, or relocate shall comply with the state building code as adopted by the state building code council under the authority of chapter 19.27 RCW.
(4) In addition to subsection (3) of this section, facilities, or any portion of the facility, licensed in their capacity to provide mental health, substance use disorder, or co-occurring services must follow physical environmental requirements in this chapter for new construction.
(B) Provides a minimum of seventy-two hours of effective facility operation.
(6) Preconstruction. The applicant or licensee must request and attend a presubmission conference with the department for projects with a construction value of two hundred fifty thousand dollars or more. The presubmission conference shall be scheduled to occur at the end of the design development phase or the beginning of the construction documentation phase of the project.
(vii) Electrical systems, including lighting, power, and communication/notification systems.
(ii) An automatic fire alarm system.
(g) An infection control risk assessment indicating appropriate infection control measures, keeping the surrounding area free of dust and fumes, and ensuring rooms or areas are well ventilated, unoccupied, and unavailable for use until free of volatile fumes and odors.
(8) Resubmittals. The licensee shall respond in writing when the department requests additional or corrected construction documents.
(c) Allow any necessary inspections for the verification of compliance with the construction documents, addenda, and modifications.
(iv) Additional information as required by the department.
(iii) Complied with by staff.
(b) Be available at all times either in person, by telephone or similar electronic means, or designate an alternate who has similar qualifications and is available to carry out the goals, objectives and standards of the governing body.
(e) Staff, contractors, consultants, students, volunteers, and trainees with unsupervised access to residents comply with WAC 246-337-055.
(1) Establish a written performance improvement plan that is periodically evaluated.
(i) Disruption of services through internal or external emergency or disaster event.
(3) Review serious or unanticipated resident or facility outcomes as specified in subsection (2) of this section, in a timely manner.
(4) Implement and document changes or improvements made to prevent future occurrences of any serious or unanticipated resident outcome specified in subsection (2) of this section.
(1) The licensee must ensure residents receive care from qualified staff authorized and competent to carry out assigned responsibilities.
(e) Carry out required monitoring activities.
(3) At least one staff trained in basic first aid and age appropriate cardiopulmonary resuscitation (CPR) must be on-site twenty-four hours per day. Additionally, all staff providing hands-on care to infants must have a current certification in infant CPR.
(4) Staff must be trained, authorized, and where applicable credentialed to perform assigned job responsibilities consistent with scopes of practice, resident population characteristics and the resident's individual service plan.
(d) Current basic first aid and age appropriate cardiopulmonary resuscitation for staff required to provide first aid or CPR.
(x) Managing complex psychosocial family dynamics.
(l) Annual signed performance evaluation(s).
Personnel criminal history, disclosure, and background inquiries.
The licensee shall screen all prospective staff with unsupervised access to residents for criminal history disclosure and background requirements using a Washington state patrol background check consistent with RCW 43.43.830 through 43.43.842. All background check reports and signed disclosure statements must be made available to the department upon request.
(2) Complying with chapters 246-100 and 246-101 WAC.
(3) Providing all necessary supplies and equipment to implement the infection control program.
Influenza vaccination is annual and must be received within the first month it becomes publicly available.
(b) The licensee may exempt a person working at their facility from one or more of the vaccinations required by this subsection if acceptable medical documentation of a medical contraindication, signed by a health care provider, is provided to the licensee.
(i) Full vaccination means vaccinations given at the ages and intervals according to the national Center for Disease Control and Prevention immunization guidelines in "Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule for Adults Aged 19 Years or Older—United States, 2018"; as published in the "Morbidity and Mortality Weekly Report (MMWR) 2018; 67(5):158-160."
(ii) Acquired immunity means a medically documented positive titer.
(v) Confidentiality parameters based on terms of admission or confinement.
(h) Be free from invasion of privacy; provided that reasonable means may be used to detect or prevent items that may be harmful or injurious to the resident or others, from being possessed or used on the premises.
(3) On or before admission, document that each resident, or the resident's personal representative, designee, parent or guardian receives a written copy of the resident's rights that includes all items in subsection (2) of this section.
(c) Residents receiving substance use disorder service in accordance with 42 C.F.R., Part II.
(5) Comply with reporting requirements of suspected incidents of child or adult abuse and neglect in accordance with chapters 26.44 and 74.34 RCW.
(6) Account for each resident's assets, including allowance, earnings from federal or state sources and expenditures.
(7) Assist each resident, upon request, in sending written communications of the fact of the resident's commitment in the RTF to friends, relatives, or other persons.
Nothing in this section applies to an RTF in its licensed capacity to provide pediatric transitional care services according to this chapter.
(b) Are reviewed and approved by a health care prescriber at least biennially.
(vii) When to consult with internal or external resource agencies or entities such as poison control, fire department or police.
(j) Assure provisions of each resident's personal care items and durable medical equipment including storing and labeling each resident's personal care items separately, preventing contamination, and preventing access by other residents.
(iii) Use restraint or seclusion.
(ii) A prescriber or registered nurse who is responsible for the supervision of resident care and nursing services must be available on-site at least four hours per calendar week.
(4) RTFs which do not perform any duties described in subsection (3)(a) of this section but have a health care prescriber initiate or adjust medication for residents to self-administer according to the resident's individual service plan must have a registered nurse or licensed practical nurse available at least by phone twenty-four hours per day, seven days per week.
(viii) If applicable, restraint or seclusion.
This section only applies to an RTF in its licensed capacity to provide pediatric transitional care services according to this chapter.
(b) Are reviewed and approved by a pediatrician, a pediatric physician's assistant, or pediatric ARNP at least biennially.
(d) Are medically assessed by a pediatrician, physician's assistant, or pediatric ARNP and referred to the RTF by the department of children, youth, and families regional hospitals or private parties.
(3) The licensee may only admit drug exposed infants that primarily require withdrawal management services and whose condition has been determined by a pediatrician, physician's assistant, or pediatric ARNP to be otherwise medically stable and predictable.
Admissions must contain a complete discharge summary from the sending facility.
(4) The licensee shall not admit infants solely for treatment of complex medical conditions requiring specialized care, monitoring, and equipment including, but not limited to, respiratory compromise requiring assisted ventilation or continuous oxygen, conditions requiring a peripherally inserted central catheter line, or conditions requiring nasogastric tubes.
(ii) One registered nurse or licensed practical nurse shall be present and on duty for every sixteen infants provided that the staffing ratio of subsection (3) of this section is not exceeded.
(d) A pediatrician, physician's assistant, or pediatric ARNP responsible for the supervision of infant medical care and nursing services must be available by phone twenty-four hours a day for consultation and on-site for medical examinations.
(6) The licensee may provide services for an infant for up to forty-five days. Pediatric transitional care services may be extended beyond forty-five days if the pediatrician, physician's assistant, or pediatric ARNP on staff determines it to be medically necessary and with consent of the infant's parent, legal guardian, or state agency with placement and care authority. The assessment and determination must be conducted and entered into the infant's record no less than two days before the infant's forty-fifth day at the RTF and must include the medical reasons for the extended stay.
(f) Therapeutic benefits of touch, sound and light in modulating infant behavior.
(8) The licensee shall provide for medical examinations and consultations by a pediatrician, physician's assistant, or pediatric ARNP for each infant with the frequency and regularity recommended by the American Academy of Pediatrics and according to the time frames in this subsection.
(f) If written consent is given by the parent or guardian, administration of all routinely recommended vaccinations to the infant at the ages and intervals according to the national immunization guidelines in the "Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger—United States, 2018"; as published in the "Morbidity and Mortality Weekly Report (MMWR) 2018; 67(5):156-157."
(iv) Child passenger restraint requirements must be in compliance with RCW 46.61.687.
(vii) When to consult with internal or external resource agencies or entities such as poison control, fire department, or police.
(10) In satisfying the requirements of this chapter, the licensee must also collaborate with the department of children, youth, and families regarding individual safety plans and to meet family and medical needs as contractually required.
(12) The licensee must develop and implement policies and procedures that ensure unauthorized persons do not access the pediatric transitional care services unit.
Pediatric transitional care services—Parent-infant visitation.
(1) The licensee, in collaboration with the infant's family, and the department of children, youth, and families, if applicable, shall identify persons who are authorized to visit the infant or call and receive verbal updates on the infant's condition.
(2) The licensee shall make all reasonable efforts to provide an initial visit between parents and infants at the facility within seventy-two hours of admission to the RTF, unless directed otherwise by a court order.
(3) At the first initial visit, the licensee shall develop a written visitation plan in collaboration with the infant's family and the department of children, youth, and families, if applicable.
(4) The licensee shall develop and implement policies and procedures regarding how to address safety concerns that are identified with persons visiting or wanting to visit an infant receiving pediatric transitional care services.
Accepting a child with a parent in treatment.
(1) An RTF providing substance use disorder services and no mental health services may accept a child or children along with a parent in treatment as long as the parent is not receiving withdrawal management services.
(2) If the RTF provides withdrawal management, the child must be kept physically and visually separate from residents receiving withdrawal management services.
(5) The RTF shall obtain a health history for each child following admission and, if needed, develop with the parent a plan of care for each child that addresses the child's health care needs, including medications.
(1) Develop and implement procedures for maintaining current health care records as required by chapter 70.02 RCW and other applicable laws.
(2) Health care records may be integrated into a resident's individual service plan so long as the requirements of this section are met.
(3) Make health care records accessible for review by appropriate direct care staff, the resident, the parent or guardian, and the department in accordance with applicable law.
(4) Document health care information in a standardized manner.
(5) Record health care information by the health care provider or direct care staff with resident contact to include typed or legible handwriting in ink, verified by signature or unique identifier, title, date and time.
(6) Maintain the confidentiality and security of health care records in accordance with applicable law.
(7) Maintain health care records in chronological order in their entirety or chronologically by sections.
(8) Keep health care records current with all documents filed according to the licensee's written timeline policy.
(E) Date and time of discharge.
(10) Retain the health care records at least six years beyond the resident's discharge or death date, whichever occurs sooner, and at least six years beyond the age of eighteen.
(11) Destroy the health care records in accordance with applicable law and in a manner that preserves confidentiality.
This section does not apply to an RTF in its licensed capacity to provide pediatric transitional care services according to this chapter.
(e) Include a discharge health care plan.
Individual service plan—Pediatric transitional care services.
(1) This section only applies to an RTF in its licensed capacity to provide pediatric transitional care services according to this chapter.
(b) Health assessment(s) described in WAC 246-337-081.
(ii) Working within their scope of practice.
(v) Assessment that the home environment and family dynamics are appropriate to receive and care for the infant.
(ii) Provide the infant's family appropriate staff contacts in case family needs consultation.
The licensee is responsible for implementing policies and procedures for the control and appropriate use of all drugs within the RTF in accordance with all applicable state and federal regulations. The policies and procedures to implement this section must be developed, approved, and reviewed by a health care prescriber and the RTF administrator, and must be consistent with this chapter.
(e) The resident brings his or her prescribed medication with them to the RTF.
(a) Storage of drugs must include limits on access to drugs to those staff authorized to assist, administer, or dispense drugs and addresses security, safety, sanitation, temperature, light, moisture and ventilation, and hand washing facilities. All drugs must be stored in accordance with United States pharmacopoeia standards and designated storage locations are constructed in accordance with WAC 246-337-126.
(iii) The RTF is operated in connection with a licensed hospital and complies with chapter 246-874 WAC and rules of the pharmacy quality assurance commission governing hospital pharmacy associated clinics.
(iii) Report to the Washington state pharmacy quality assurance commission if the controlled substance counts or inventory indicate disappearances or unaccounted for discrepancies of controlled substances in accordance with WAC 246-873-080 and 246-887-020, and 21 C.F.R. Sec. 1301.76(b).
(4) Prescribing and administering drugs.
(a) An organized system must be established and maintained that ensures accuracy in receiving, transcribing and implementing orders for medication administration that ensures residents receive the correct medication, dosage, route, time, and reason.
(b) An authorized health care prescriber shall sign all written orders for legend drugs, controlled substances and vaccines. Orders, including telephone or verbal orders for legend drugs, controlled substances and vaccines must be signed as soon as possible, but no later than seventy-two hours after the telephone or verbal order has been issued.
(c) If using electronic prescribing, prescribers shall comply with RCW 69.50.312, chapter 246-870 WAC, and 21 C.F.R. Sec. 1311(c).
(d) A prescriber shall approve the use of self-administered nonprescription drugs. Staff shall provide the nonprescription drugs according to prescriber instructions.
(ii) Review and approve the list annually.
(iv) Involuntary antipsychotic medication administration consistent with WAC 388-865-0570.
(ii) Drugs given to a resident on temporary leave from the RTF.
(j) Resident response to medication when given "as needed."
(6) RTF staff must have available to them a current established drug reference resource.
(b) Legend drugs has the same meaning as defined in RCW 69.41.010.
Use of restraint and seclusion.
(1) This section only applies to an RTF that uses restraint or seclusion. This section does not apply to an RTF in its licensed capacity to provide pediatric transitional care services according to this chapter, nor are any of the practices described in this section permitted when providing services to infants. The licensee shall have policies and procedures addressing the application and use of restraint or seclusion consistent with this chapter.
(b) Any RTF certified under chapter 388-877B WAC as a detoxification facility providing secure detoxification services as defined in RCW 70.96B.010.
(b) In the case of a minor, the resident's parent(s) or guardian(s) must be informed and provided a copy of the RTF policy and acknowledge in writing that the information has been received.
(5) Restraint or seclusion must only be used in emergency situations to ensure the physical safety of the individual resident or other residents or staff of the RTF, and when less restrictive measures have been found to be ineffective to protect the resident or others from harm.
(6) A prescriber must authorize use of the restraint or seclusion.
(7) If the order for restraint or seclusion is verbal, the verbal order must be received by a registered nurse or licensed practical nurse.
(8) "Whenever needed" or "as needed" orders for use of restraint or seclusion are prohibited.
(9) In emergency situations in which an order cannot be obtained prior to the application of restraint or seclusion, the order must be obtained either during the emergency application of the restraint or seclusion, or immediately after the restraint or seclusion has been applied. Policies and procedures must identify who can initiate the emergency application of restraint or seclusion prior to obtaining an order from a health care prescriber.
(10) Restraint and seclusion cannot be used simultaneously with persons under twenty-one years of age.
(b) Both direct sight video and two-way audio communications.
(iii) Children under nine years of age: One hour.
(d) Only renew the original order in accordance with the limits in (a) of this subsection for up to a total of twenty-four hours. For each subsequent twenty-four hour period of restraint or seclusion, repeat the examination.
(13) A health care prescriber or registered nurse must, within one hour of initiation of restraint or seclusion, conduct a face-to-face assessment of the resident including the residents' physical and psychological status, behavior, appropriateness of intervention, and any complications resulting from the intervention of the resident and consult the ordering health care prescriber. If restraint or seclusion is discontinued before the face-to-face assessment is performed, the face-to-face assessment must still be performed.
(e) Time and results of the one hour face-to-face assessment.
(d) Physical condition of the resident.
(e) In the case of a minor, notification of the parent or guardian including the date and time of notification, and the name of the staff person providing the notification.
(17) Within twenty-four hours after the initiation of the restraint or seclusion, staff and the resident shall have a face-to-face discussion. This discussion must, to the extent possible, include all staff involved in the intervention except when the presence of a particular staff person may jeopardize the well-being of the resident. Other staff and the resident's parent(s) or guardian(s) may participate in the discussion when it is deemed appropriate by the RTF. Discussions must be conducted in a language that is understood by the resident and by the resident's parent(s) or legal guardian(s). The discussion must provide both the resident and the staff the opportunity to discuss the circumstances resulting in the use of restraint or seclusion and strategies to be used by the staff, the resident, or others that could prevent the future use of restraint or seclusion.
(d) Ensure that restraint or seclusion rooms are constructed as required in WAC 246-337-127. Previously reviewed and approved seclusion rooms are permitted to comply with the requirements of the rule under which they were constructed.
(19) A seclusion room may be used for multiple purposes but must be equipped to allow immediate use for seclusion purposes.
(8) Use washing machines that have a continuous supply of hot water with a temperature of one hundred forty degrees Fahrenheit, or that automatically dispense a chemical sanitizer and detergent or wash additives as specified by the manufacturer. A resident's personal laundry, separate from other laundry, may be washed at temperatures below one hundred forty degrees Fahrenheit provided chemicals suitable for low temperature washing at proper use concentration and according to the cleaning instructions for the textile, fabric, or clothing are used.
(1) A bed at least thirty-six or more inches wide for adults and appropriate size for children, spaced at least thirty-six inches apart.
(2) No more than two infants per room using two single level nonstacking cribs or bassinets for licensees providing pediatric transitional care services.
(d) Bedding that is in good repair, changed weekly or more often as necessary to maintain cleanliness.
(iii) Free of crib bumpers, stuffed toys or pillows.
(5) A youth bed or regular bed for children twenty-five months of age and older.
(6) If bunk beds are used, prohibit children six years of age or less from using the upper bunk.
(4) Animal health care needs.
The RTF shall include rooms for social, educational, and recreational activities, visitation, dining, toileting and bathing, as described in this section.
(1) Common areas. Provide at least forty square feet per resident for the total combined area which is used for dining, social, educational, recreational activities and group therapies.
(2) Visiting room(s). At least one private area for visitation of residents by guests.
(3) Dining room(s). Dining rooms or areas must be large enough to accommodate all residents at a single sitting or in no more than three shifts. If the space is used for more than one purpose, that space must be designed to accommodate each of the activities without unreasonable interference with one another.
(x) Toilet tissue with a reachable mounted tissue dispenser by each toilet.
(ii) Providing access without passage through any food preparation area or from one bedroom through another bedroom.
(g) If a toilet room or bath room adjoins a bedroom, the bath room is restricted to use by those residents residing in the adjoining bedrooms.
The facility shall include rooms for individual and group therapy, medical examination when there is routine physical examination of residents, and medication storage if applicable, as described in this section.
(1) Therapy room(s). Therapy rooms for individual and group counseling must maintain visual and auditory confidentiality. The facility must have at least one room per twelve residents.
Restraint or seclusion room requirements.
(d) Electrical switches and receptacles within the room are prohibited or covered to make them inaccessible.
(2) Have a maximum capacity of one resident.
(3) Be located and designed to permit visual and audible observation of the resident by direct or electronic means.
(b) Have a staff-controlled, lockable, toilet room that adjoins either the treatment room or vestibule.
(c) Have a minimum of three feet of clear space on three sides of the bed, if a bed is provided.
(6) Have negative air pressure with all air exhausted to the exterior of the building with the exhaust fan at the discharge end of the system.
(1) The licensee shall provide residents with an accessible, clean, well-maintained room with sufficient space, light, and comfortable furnishings for sleeping and personal activities.
(iii) Are marked with a solid color or barrier if clear glass windows or doors extend to the floor.
(c) Secured storage facilities for storing clothing and, when requested by the resident, storage in a lockable drawer, cupboard, locker, or other secure space somewhere in the building.
Water supply, sewage and waste disposal.
(1) Water supply and waste disposal in each facility meet the provisions of chapter 246-290 or 246-291 WAC, whichever applies.
(2) Tempered water between one hundred and one hundred twenty degrees Fahrenheit in resident areas.
(3) Plumbing systems free of cross connections.
(4) Sewage and waste water drain into a public sewer system in compliance with applicable laws and rules, or meet the requirements of chapters 246-272 and 173-240 WAC, and local laws and rules.
(1) Rooms used by residents are able to maintain interior temperatures between sixty-five degrees Fahrenheit and seventy-eight degrees Fahrenheit year-round.
(2) Direct evaporative coolers are not used for cooling. In existing facilities, no new or replacement evaporative coolers may be used after adoption of these rules. Facilities currently using direct evaporative coolers such as swamp coolers or similar equipment shall follow manufacturer's instructions and develop and implement a written preventive maintenance program.
(3) Excessive odors and moisture are prevented in all areas of the building. The ventilation system must be in compliance with the mechanical code as adopted by the Washington state building code council.
(4) RTFs licensed prior to July 1991 may continue to use windows for ventilating toilet rooms, bathrooms, and janitor rooms if the windows are equipped with sixteen gauge mesh screens.
Lighting, emergency lighting, and electrical outlets.
(1) Protection of bulbs and tubes against breakage by using canned lights, appropriately fitted shields, or shatter resistant materials in all areas occupied by residents, and in medication and food preparation areas.
(2) Use of tamper resistant electrical outlets in each room or area occupied by children under age five or residents with unsafe behaviors.
(3) Use of electrical outlets of the ground fault interrupter type or be controlled by a ground fault circuit interrupter when the outlet is within six feet of a sink or wet area.
(4) Emergency lighting on each floor.
(5) Exterior lighting with solar or battery backup at the exit and entry doors.
Cleaning, maintenance and refuse disposal.
(d) A disposal program for biohazardous and nonmedical waste using appropriate containers and disposal services.
(c) Separate, locked storage for flammable materials or other fire and safety hazards.
(3) Provide a safe and cleanable area designated for pouring stock chemicals and cleaning supplies into separate, properly labeled containers if stock chemicals are used.
(4) Provide an effective pest control program so that the RTF is free of pests such as rodents and insects.
(b) The department has received an application and has conducted an on-site survey or provided technical assistance. The department shall refund one-third of the fees paid, less a fifty dollar processing fee.
(c) The amount to be refunded as calculated by subsection (1)(a) or (b) of this section is ten dollars or less.

References: § 246
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 § 246