Chapter 388-97 Nursing homes.

(1) Each nursing home must provide a minimum of 3.4 hours of direct care per resident day (HRD). Direct care means the staffing domain identified and defined in the Centers for Medicare and Medicaid Services' five star quality rating system and as reported through the Centers for…

The nursing home must:(1) Provide each resident with a nourishing, palatable, well-balanced diet that meets their daily nutritional and special dietary needs.(2) Serve food in an attractive manner and at temperatures safe and acceptable to each resident.(3) Ensure that food servi…

The nursing home must:(1) Provide a minimum of three meals in each twenty-four period, at regular times similar to normal meal times in the community;(2) Make fresh fruits and vegetables, in season, available to residents on a daily basis;(3) Make reasonable efforts to:(a) Accomm…

The nursing home must:(1) Encourage residents to continue eating independently;(2) Provide effective adaptive utensils as needed to promote independence;(3) Allow sufficient time for eating in a relaxed manner;(4) Provide individualized assistance as needed;(5) Provide table serv…

The nursing home must have sufficient support personnel capable of carrying out the functions of dietary services and must:(1) Employ a qualified dietitian either full-time, part-time or on a consultant basis who must:(a) Approve regular and therapeutic menus which meet the dieta…

The nursing home must:(1) Ensure that menus are followed;(2) Post the current dated general menu, including substitutes, in the food service area and in a place accessible and conspicuous to residents and visitors, in print the residents can read; and(3) Note any changes to the r…

The nursing home must:(1) Ensure that residents' diets are provided as prescribed by the physician. Diet modifications, for texture only, may be used as an interim measure when ordered by a registered nurse; and(2) Provide supplementary fluid and nourishment in accordance with ea…

The nursing home must review a resident's modified diet to ensure that the food form and texture are consistent with the resident's current needs and functional level:(1) At the request of the resident.(2) When the resident's condition warrants.(3) At the time of the plan of care…

If the nursing home prepares tube feeding formula, or mixes additives to the prepared formula it must ensure that:(1) Each resident's tube feedings are of uniform consistency and quality; and(2) Tube feeding formulas are prepared, stored, distributed, and served in such a manner …

The department amended or suspended portions of this section from April 28, 2020, through May 7, 2022, in response to the state of emergency related to the COVID-19 pandemic. For requirements in place during that time, see WAC 388-97-12601.(1) The nursing home must ensure that th…

In response to the state of emergency related to the COVID-19 pandemic, the department adopted emergency rules under RCW 34.05.350 on April 28, 2020, to amend and suspend portions of WAC 388-97-1260. The emergency rules remained in effect until May 7, 2022. The following rule was…

(1) If specialized habilitative and rehabilitative services such as, but not limited to, physical therapy, speech-language pathology, occupational therapy, and mental health rehabilitative services for mental illness and mental retardation, are required in the resident's comprehe…

(1) The nursing home must:(a) Obtain routine and emergency drugs and biologicals for its residents under an agreement with a licensed pharmacy;(b) Ensure that pharmaceutical services:(i) Meet the needs of each resident;(ii) Establish and monitor systems for the accurate acquiring…

(1) The nursing home must:(a) Establish and maintain an effective infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection;(b) Prohibit any employee with a communicabl…

(1) The nursing home shall provide residents access on-site or make available elsewhere, the ability to obtain the influenza virus immunization on an annual basis.(2) Upon admission, the nursing home shall inform residents or the resident's representative, verbally and in writing…

(1) The nursing home must develop and implement policies and procedures that comply with nationally recognized tuberculosis standards set by the Centers for Disease Control (CDC), and applicable state law. Such policies and procedures include, but are not limited to, the followin…

The department amended or suspended portions of this section from January 25, 2021, through September 23, 2021, in response to the state of emergency related to the COVID-19 pandemic. For requirements in place during that time, see WAC 388-97-13801.(1) The nursing home must devel…

In response to the state of emergency related to the COVID-19 pandemic, the department adopted emergency rules under RCW 34.05.350 on January 25, 2021, to amend and suspend portions of WAC 388-97-1380. The emergency rules remained in effect until September 23, 2021. The following…

The nursing home must ensure that all tuberculosis testing is done through either:(1) Intradermal (Mantoux) administration with test results read:(a) Within forty-eight to seventy-two hours of the test; and(b) By a trained professional; or(2) A blood test for tuberculosis called …

The nursing home is not required to have a person tested for tuberculosis if the person has:(1) A documented history of a previous positive skin test results;(2) A documented history of a previous positive blood test; or(3) Documented evidence of:(a) Adequate therapy for active d…

The nursing home is only required to have a person take one test if the person has any of the following:(1) A documented history of a negative result from a previous two step test done no more than one to three weeks apart; or(2) A documented negative result from one skin or bloo…

Unless the person meets the requirement for having no skin testing or only one test, the nursing home, choosing to do skin testing, must ensure that each person has the following two-step skin testing:(1) An initial skin test within three days of employment; and(2) A second test …

When there is a positive result to tuberculosis skin or blood testing the nursing home must:(1) Ensure that the person has a chest X-ray within seven days;(2) Evaluate each resident or person with a positive test result for signs and symptoms of tuberculosis; and(3) Follow the re…

The nursing home may be required by the public health provider or licensing authority to ensure that persons with negative test results have follow-up testing in certain circumstances, such as:(1) After exposure to active tuberculosis;(2) When tuberculosis symptoms are present; o…

The nursing home must ensure that a person take the blood test for tuberculosis if they decline the skin test.[Statutory Authority: Chapters 18.51 and 74.42 RCW. WSR 10-02-021, § 388-97-1540, filed 12/29/09, effective 1/29/10. Statutory Authority: Chapters 18.51 and 74.42 RCW and…

The nursing home must:(1) Report any person with tuberculosis symptoms or a positive chest X-ray to the appropriate health care provider or public health provider;(2) Follow the infection control and safety measures ordered by the person's health care provider, including a public…

(1) The department amended or suspended portions of this section from January 25, 2021, through September 23, 2021, in response to the state of emergency related to the COVID-19 pandemic. For requirements in place during that time, see WAC 388-97-15801.(2) The nursing home must:(…

(1) In response to the state of emergency related to the COVID-19 pandemic, the department adopted emergency rules under RCW 34.05.350 on January 25, 2021, to amend and suspend portions of WAC 388-97-1580. The emergency rules remained in effect until September 23, 2021. The follo…

(1) When the nursing home accepts the care of a resident with suspected or confirmed tuberculosis, the nursing home must:(a) Coordinate the resident's admission, nursing home care, discharge planning, and discharge with the health care provider;(b) Provide necessary education abo…

(1) The nursing home must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.(2) The nursing home must:(a) Be licensed under chap…

(1) The nursing home must immediately notify the department's home and community living administration of:(a) Any allegations of resident abandonment, abuse, or neglect, including substantial injuries of an unknown source, financial exploitation and misappropriation of a resident…

(1) Resident roster;The nursing home must:(a) Create and regularly maintain a current resident roster containing the name and room number of each resident; and(b) Provide a written copy of the resident roster upon an in-person request from any long-term care ombuds at the time of…

(1) The nursing home must ensure that:(a) Sufficient numbers of appropriately qualified and trained staff are available to provide necessary care and services safely under routine conditions, as well as fire, emergency, and disaster situations;(b) Adequate equipment, supplies and…

(1) The nursing home must have a staff development program that is under the direction of a designated registered nurse or licensed practical nurse.(2) The nursing home must:(a) Ensure each employee receives initial orientation to the facility and its policies and is initially as…

(1) The nursing home must designate a physician to serve as medical director.(2) The medical director is responsible for:(a) Implementation of resident care policies; and(b) The coordination of medical care in the facility.[Statutory Authority: Chapters 18.51 and 74.42 RCW and 42…

(1) The nursing home must:(a) Maintain clinical records on each resident in accordance with accepted professional standards and practices that are:(i) Complete;(ii) Accurately documented;(iii) Readily accessible; and(iv) Systematically organized.(b) Safeguard clinical record info…

The department amended or suspended portions of this section from June 23, 2020, through June 7, 2022, in response to the state of emergency related to the COVID-19 pandemic. For requirements in place during that time, see WAC 388-97-17401.(1) The nursing home must develop and im…

In response to the state of emergency related to the COVID-19 pandemic, the department adopted emergency rules under RCW 34.05.350 on June 23, 2020, to amend and suspend portions of WAC 388-97-1740. The emergency rules remained in effect until June 7, 2022. The following rule was…

The department amended or suspended portions of this section from June 23, 2020, through May 7, 2022, in response to the state of emergency related to the COVID-19 pandemic. For requirements in place during that time, see WAC 388-97-17601.(1) The nursing home must maintain a proc…

In response to the state of emergency related to the COVID-19 pandemic, the department adopted emergency rules under RCW 34.05.350 on June 23, 2020, to amend and suspend portions of WAC 388-97-1760. The emergency rules remained in effect until May 7, 2022. The following rule was …

(1) The nursing home must develop and implement written policies and procedures, including those specified in RCW 74.42.430, for all services provided in the facility.(2) The nursing home must ensure the written policies and procedures:(a) Promote and protect each resident's:(i) …

(1) If any background check results show that an employee or prospective employee has a conviction or pending charge for a crime that is not automatically disqualifying under chapter 388-113 WAC, then the nursing home must:(a) Determine whether the person has the character, compe…

(1) As used in this section, the term "nursing home" includes a nursing facility and a skilled nursing facility.(2) The nursing home must:(a) Have a valid criminal history background check for any individual employed, directly or by contract, or any individual accepted as a volun…

(1) The nursing home must not employ directly or by contract, or accept as a volunteer or student, any individual:(a) Who has a criminal conviction or pending charge for a crime, which is automatically disqualifying under chapter 388-113 WAC;(b) Who has one or more of the followi…

(1) The licensee or the nursing home must not discriminate or retaliate in any manner against a resident or employee in its nursing home who has initiated or participated in any action or proceeding authorized under nursing home licensing law. Examples of such participation inclu…

(1) The nursing home must meet the requirements of WAC 388-97-2780, and:(a) Launder nursing home linens on the premises; or(b) Contract with a laundry service capable of meeting quality standards, infection control, and turn-around time requirements; and(c) Make provision for lau…

(1) The nursing home may provide short-term care to individuals which include:(a) Respite services to provide relief care for families or other caregivers of individuals with disabilities which must:(i) Provide short-term care and supervision in substitution for the caregiver;(ii…

(1) The nursing home must ensure that appropriate care, treatment, and services are provided to each nursing home resident who receives dialysis in the nursing home.(2) For the purposes of this section the following definitions apply:(a) "Dialysis" means the process of separating…

"AAA" means area agency on aging."Advance categorical determination" means a determination by a mental health or DDA PASRR evaluator that an individual may be admitted to a nursing facility on a temporary basis. The PASRR evaluator will do an abbreviated evaluation that is suffic…

The department amended or repealed portions of this section to help facilitate care to align state nursing home rules with federal rules that were amended or suspended to facilitate care during the COVID-19 pandemic from April 13, 2020, through May 10, 2023, in response to the st…