WAC 246-337-080   Resident care services.  (1) Policies and procedures: The licensee must establish and implement policies and procedures that describe how residents are provided care and personal equipment to meet their health care needs including:

     (a) Admission, transfer, discharge and referral process.

     (b) Addressing how the licensee provides or makes provision for health care services.

     (c) Addressing the action of RTF personnel when medical emergencies or a threat to life arises when a physician or authorized health care provider is not present including:

     (i) Having current policies and procedures signed by a physician or authorized health care provider, reviewed as needed and at least biennially;

     (ii) How resident medical and related data shall be transmitted in the event of a transfer;

     (iii) Need for the notification of legal guardian or next of kin, the department or other regulatory agencies in the event of a serious change in the resident's condition, transfer of a resident to another facility, elopement, death, or when unusual circumstances occur; and

     (iv) When to consult with internal or external resource agencies or persons e.g., poison control, fire department and police.

     (d) Addressing how the RTF must provide for each resident's need for personal care items and durable medical equipment.

     (e) Addressing provisions for transfer and appropriate prenatal and postnatal care services for pregnant residents.

     (f) Addressing how a licensee providing twenty-four hours per day nursing service functions provides systems for supervision, assessment and delegation in accordance with applicable statute and rules including chapter 18.79 RCW, Nursing care.

     (g) Addressing how a licensee providing acute detoxification services must ensure resident health and safety including:

     (i) A licensed nurse must be on-site when a resident is receiving acute detoxification services;

     (ii) Registered nurse responsible for supervising resident care nursing services shall be on-site at least four hours per week and available on-call to the licensed practical nurse; and

     (iii) Policies and procedures for acute detoxification services approved by an authorized health care provider.

     (h) Addressing how licensees providing subacute detoxification services must ensure resident health and safety, including:

     (i) Implementing policies and procedures establishing agreements with authorized health care providers or hospitals that includes:

     (A) Criteria for determining the degree of medical stability of a potential resident in a subacute detoxification facility;

     (B) Monitoring the resident after being admitted;

     (C) Reporting abnormal symptoms according to established criteria;

     (D) Criteria requiring immediate transfer to a hospital; and

     (E) Resident discharge or transfer criteria;

     (ii) Monitoring of residents by a staff including observing a resident for signs and symptoms of illness or trauma; and

     (iii) Observing the resident to self-administer his or her own medication as prescribed by the resident's health care provider.

     (2) Delivery of resident care services: The licensee must ensure the provision of or for that resident care services to meet the health care needs of the resident including:

     (a) Admission is limited to residents for whom a facility is qualified by staff, services, equipment, building design and occupancy to give safe care.

     (b) A health care screen of each resident that is to be conducted upon admission and updated as changes occur or when additional health care needs are identified.

     (c) A completed comprehensive health assessment and medical history that is to be conducted by a health care provider following admission to an RTF, unless a current comprehensive health assessment or review was performed and is available upon admission to an RTF providing mental health or acute detoxification services.

     (d) A health assessment by a health care provider, any time a resident exhibits signs and symptoms of an injury, illness or abnormality for which medical diagnosis and treatment are indicated.

     (e) Access to and availability of authorized health care providers to develop and implement the resident plan of care.

     (f) Sufficient numbers of trained personnel who are available to provide health care according to the resident's health care plan.

     (g) Provision for or access by referral to health care for residents admitted to the RTF including, but not limited to:

     (i) Assisting residents in following all prescribed treatments, modified diets, activities or activity limitations.

     (ii) Assisting residents to keep health care appointments.

     (iii) Medication administration or observing the resident self-administer his or her own medication as prescribed by the resident's authorized health care provider.

     (iv) Incorporating resident's health care needs and behavioral needs into the resident's overall health care plan;

     (v) Emergency health care.

     (h) Provision for twenty-four hours per day nursing service functions to include availability by phone; when the RTF provides mental health inpatient evaluation and treatment, mental health adult residential treatment, mental health child long-term inpatient treatment, mental health child inpatient evaluation and treatment, and/or chemical dependency acute detoxification.

     (i) Provision is made either on the premises, through a contract laboratory or through a health care provider for service(s) required by the resident.

     (j) Storing and labeling each resident's personal care items separately preventing contamination and access by other residents.

     (3) Documentation: The licensee must ensure documentation of health care received or provided in the resident's health care record.



[Statutory Authority: Chapter 71.12 RCW. 05-15-157, § 246-337-080, filed 7/20/05, effective 8/20/05.]