Home Care Agency
Policies & Procedures Manual
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Home Care Agency
Home Care
Policy & Procedure
Manual
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Home Care Agency
Home Care Agency
Policies & Procedures Manual
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Agency Review of Policy and Procedure Manual
Reviewer Name/Title
Date of Review
Reviewed/Revised
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Home Care Agency
Home Care Agency
Numerically Numbered
I.
Policies & Procedures Manual
Home Care Agency
Policies and Procedures
TABLE OF
CONTENTS
Last three numbers of the
related regulation i.e. WAC
Change in Ownership
II. Rights and Responsibilities
1.
Display license to the public
2.
Change in Administrator or Supervisor of direct care
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P035
P040
Services
III. Plan of Operation for Home Care & Home Health
1.
Written plan of operation
2.
Update policies to reflect current practice
3.
Identify an administrator
IV. Delivery of Services
1.
Admission, Transfer and discharge
2.
Specific services including non-medical tasks to meet client needs
P055
P060
i. Medication Assistance
3.
Agency personnel, contractor, and volunteers roles and responsibilities related to
medication assistance
4.
Coordination of Care
5.
Actions to address client and/or family communication needs
6.
Infection control practices
7.
Reportable symptoms
8.
Management of Client medications
9.
Food storage, preparation, and handling
10. Reporting client abuse/neglect
11. Emergency care of client
12. Actions to be taken upon the death of a client
13. Implementation of advanced directives
14. Plans for service delivery when a natural or man-made disaster prevent normal
operation
15. Nurse delegation
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Home Care Agency
Home
Agency
V. Care
Personnel,
Policies & Procedures Manual
Contractor, and Volunteer Policies
1.
Employment criteria consistent with RCW 49.60
2.
Job descriptions
3.
References for personnel
4.
Credential of health care professionals
5.
In-person contact
6.
Orientation
7.
Ongoing training
8.
Infection control practices
9.
Annual performance evaluations of all personnel
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P065
10. Annual performance evaluations for contractors
11. Background Checks
VI. Personnel, Contractor, and Volunteer Records
1.
Current practice certification
2.
Documentation of references
3.
Evidence of orientation
4.
Verification of skills or training
5.
Evidence of disclosure statement
6.
Training on current policies &procedures and client care
P070
issues
7.
Current CPR for Home Health
8.
Communicable disease testing
9.
Documentation of evaluations of personnel providing direct
care
VII. Bill of Rights
1.
VIII.
1.
P075
Provide with a written bill of rights
Home Health Plan of Care
P080
Develop and implement a written plan of care
IX. H o m e Care Plan of Care
1.
Develop and implement care plan
P090
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Home Care Agency
Policies & Procedures Manual
Home Care Agency
X. Supervision of Home Health
1.
Director of Clinical Services
2.
Availability
3.
Qualified alternate
4.
Director must assure
5.
Document Supervision
6.
Use of Home Health Aides
P095
XI. Supervision of Home Care
1.
Employ a supervisor of direct care services
2.
Supervisor available during all hours
3.
Supervisor must designate alternative in absence
4.
Supervisor must assure:
5.
Document supervision with client contact every six months
P105
XII. Client Records
1.
Maintain a current health record
2.
Maintain records for:
3.
Agency must:
P110
XIII. Quality Improvement
P115
1.
Process for receipt, investigation, and disposition of complaints
2.
Method to identify, monitor, evaluate, and correct problems
3.
Client satisfaction
XIV. Abuse of Vulnerable Adults & Reports mandated
XV. Safety – Health Care Setting
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P74.34-35
P49.19.020-40
XVI. Implementing 1163
1. Training effective 1-7-12
2. Home Care Aide Certification effective 1-7-12
3. FBI Fingerprinting effective 1-2-12
4. Exempt Workers
5. Continuing Education
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Home Care Agency
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Policies & Procedures Manual
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APPENDICES
A. Organizational Chart
B. Job Descriptions
C. Services Provided
D. Disaster Priority Codes
E. Performance Evaluations
F. Client Bill of Rights
G. Universal Precautions
H. Food Safety Reference
I. RCW 74.34 Abuse of Vulnerable Adults
J. Partners in Prevention Training
K. Natural Death Act
L. RCW 70.02 Medical Records
M. Employee Handbook
N. Washington State Department of Health / Certified Home Care Aide Candidate
Informational Bulletin Effective January 7, 2012 [Prometic]
O. Washington State Department of Health/Home Care Aide Certification Application
Packet
P. Emergency Rules WAC 388-71-0500-1130 (Implementing I1163)
Navigation Note:
Gray boxes indicate Washington Administrative Code (WAC) verbiage that is directly
incorporated into the agency policy and procedure without creation of separate policies. i.e. the
agency follows the intent of the regulation as it stands and does not require additional verbiage.
In the event that additional text is required for clarity, text may fall outside the gray box.
Pink boxes contain the applicable state and or federal regulation(s).
Numbering & Ordering is based on applicable regulations from the
Washington State In-Home Services Law Book, and applicable RCW’s**
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035 WAC 246.335.035 Change in Ownership
(1) In the event of change of ownership The Home Care Agency will comply
with the Department of Health regulations and rules.
a. A t least 30 days prior to changing ownership, Your Home Care
Agency will submit in writing to the Department of Health;
I. The full name, address and phone number of the
prospective owner
ii. The name, address and phone number of the Your Home
Care Agency and the prospective name under which the
agency will operate
iii. The date of the proposed change in ownership
iv. Any change in the office location and service area if
relevant
b. The prospective new owner must submit:
i. I n f o r m a t i o n listed in WAC 246.335.025 (1))(b) through (d)
and
ii. C h a n g e of ownership fee;
iii. I f the new owner plans to expand the service area
references WAC 246.335.040 (1) – (v)
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P040 WAC 246.335.040 Applicant or Licensee Rights and Responsibilities
(1)
Your Home Care Agency will display the Your Home Care Agency
license used by the DOH in an area accessible to the public.
a.
License is posted in the main reception area of the office
(2) Your Home Care Agency will notify the DOH in writing for the following
conditions:
a.
Changes in administrator and/or supervisor of clinical services
b.
Within:
i. When there are changes in administrator, director of clinical
services or supervisor of direct care services
ii. Within 30 days of beginning of ceasing operation of any office
location(s)
iii. Thirty or more days before ceasing operation of any in-home
service category licensed by the department
iv. To Request approval to expand home service area (based on
criteria in WAC 246.335.005 (1)(a)(vi) and receive approval
for service area expansion prior to providing services in the
proposed expanded service area
v. When decreasing service areas
(3) Cooperate with DOH during surveys, which may include reviewing
agency records and conducting on-site visits with residents consent.
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P055 WAC 246.335.055 Plan of Operation
(1) [Home Care Agency Name] will establish and implement policies and
procedures to be maintained electronically and a hard copy retained
internally for reference.
(2) A written plan of operation identifying
(i) A description of the organizational structure.
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See Appendix A – Organizational Chart.
(ii) Personnel job descriptions.
•
See Appendix B – Job Descriptions
. (iii) Responsibilities of contractors and volunteers
•
• Not applicable at this time.
(iv) Services to be provided
•
See Appendix C – Services Provided.
(v) Days and hours of agency operation; and
• Your Home Care Agency (aka “the agency”) will provide care to clients within the
designated service areas, as needed 24-hours a day and up to seven days a week.
Administrative and/or supervisory staff will be available for consultation during all
hours of direct care services.
• The agency’s administrative or business hours will be Monday through Friday from
8:30am to 4pm.
• The agency will be closed on the following holidays (only scheduled and on-call
services will be available):
• New Years Day
• Memorial Day
• Independence Day
• Labor Day
• Thanksgiving Day
• Christmas Day
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(vi) Criteria for management and supervision of services throughout the
service area(s).
•
For Non-Medical services, the Client Manager or designee is responsible for all
aspects of non-medical client care. The individual with this role is available 24 hours
a day, seven days a week and can be contacted by calling the main line. The Client
Manager(s) will report directly to the administrator. In the absence of the Client
Manager(s), a similarly qualified alternative will be chosen to act.
• On-site or telephonic supervisory visits by the administrator or designee, are performed
on an as needed basis, but no less than every six months and preferably made to coincide
with employee performance evaluation
• The plan of care is reviewed and updated as needed and not less than annually
• The agency will arrange for an on-call answering service or equivalent, during nonbusiness hours for supervisory communication with clients and staff.
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(1.b.i) How the initial intake and development of the plan of care will be
completed per WAC 246.335.090
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For Non-Medical Care, before any services are offered, an in-home consultation will take
place.
The administrator, Client Manager or similarly qualified designee may perform this task.
A consultation will be scheduled to include all interested parties (as possible and required)
including family, friends and/or advisors.
• A thorough consultation will be made in the home utilizing the assessment form
approved by management.
• If it is determined by all parties that there is a match between the client’s needs and the
services the agency offers, the evaluator will suggest an appropriate Plan of Care.
• Prior to the first day of service, the Client Bill of Rights affirming each individual's
rights will be provided to each patient, client, or designated family member.
• If there is not a fit, the client will be referred to the appropriate agency for service (see
referral process).
• Initial consultations are to be performed face-to-face and on-site by the Administrator,
Client Manager, Director of Clinical Services, or delegated personnel, with input from
the Client and designated family member.
• Once the Plan of Care is developed, and written approval of the Plan of Care is obtained
from the Client and/or designated family member, the Plan of Care will be implemented
upon Clients signature of the Service Agreement form.
• The Plan of Care shall include, but not be limited to, the following: Clients functional
limitations, nutritional needs and food allergies (if any), home medical equipment and
supplies relevant to the Plan of Care, type and schedule of services to be provided, and
non- medical tasks required.
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Following Plan of Care completion, scheduling needs will be forwarded to the Schedule
Coordinator for action.
(1.b.ii) How client needs will be met when assigned personnel, volunteers, or
contractors are unable to serve the client.
•
•
The Client Manager, Director of Clinical Services, or designee will maintain a staff of
caregivers who will be available to accept assignments with clients in the event that the
assigned caregiver is not able to provide services, whether that is a last minute assignment
or scheduled change.
o If a suitable replacement cannot be found, and it is not possible to reschedule with the
client, the supervisor may choose to accept the assignment.
o In the event of a man-made or natural disaster (or inclement weather) the agency will:
 Instruct clients with greater care needs to contact their local fire/rescue resources
(911) and inform them of emergent medical/care needs
 The agency will maintain a list of clients assigned a priority disaster code based
on care needs
 The agency will make every effort to provide priority care to those high priority
clients
See Electronic Appendix D: Disaster Priority Codes
(1.b.iii) How supervision of personnel and volunteers and monitoring of
services provided by contractors will occur to meet the requirement, of
WAC 246.335.105
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In general, supervision of services, performance evaluations, and quality improvement are
the responsibility of the Administrator or designee
• For Non-Medical Care Your Home Care Agency employs Client Manager(s)
• The Client Manager(s) or designee(s) are available during all hours of client care.
• The Client Manager(s) will designate in writing a similarly qualified alternate to
act in their absence
• The Client Manager(s) will assure:
• Supervision of all client care provided by personnel;
• Evaluation of services provided by contractors (not applicable);
• Coordination, development, and revision of written client care policies;
• Participation in coordination of service when more than one licensee is
providing care to the client;
• Compliance with the plan of care;
• All direct care personnel, contractors, and volunteers observe and
recognize changes in the client’s needs, and report any changes to the
director or designee;
• All direct care personnel, contractors, and volunteers initiate emergency
procedures according to agency policy;
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• Each caregiver reviews the plan of care or written instructions for the care
of each client prior to providing services and whenever there is a change
in the plan of care;
• Each caregiver assists with medications according to WAC 246.335.015
and agency policy:
Your Home Care Agency will document supervision including, but not limited to,
client contact every six months to evaluate compliance.
• More frequent supervisory visits may be made under the following circumstance:
•
When there are reports by the client, family, or caregiver indicating
substantial changes in services are needed
•
The caregiver needs additional instruction and support in meeting the
client’s needs
•
Change in the client’s condition indicate a need for additional supervision
at the discretion of the Client Manager(s)
(1.b.iv) How performance evaluations for personnel and volunteers, and
evaluation of services provided by contractors will be conducted per
WAC 246.335.065 (10) and (11):
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Annual performance evaluations of all personnel and volunteers providing direct client
care will be performed, including on-site observation of care and skills specific to the care
needs of clients.
• Annual evaluation of services provided by contractors providing direct client care will be
performed.
• See Appendix E: Performance evaluations
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(1.b.v) How the quality improvement program required in WAC 246.335.115
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will be applied through the entire service area(s)
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• The quality improvement plan for the agency will be based on data gathered by the
Administrator or designee from the entire service area(s):
o Client and/or family grievances
o Client satisfaction interviews
o Caregiver interviews
o Incident reports
o Staffing problems
o Deficiencies identified during state survey
o Personnel selection and supervision
o Orientation and Safety
o In-service education
o Program planning and evaluation
• Problems and trends will be identified in each area and a plan of improvement will be
developed, implemented, monitored and evaluated for improvement.
• A process to receive complaints is required and shall include receipt, investigation,
and disposition of complaints regarding services provided under RCW 70.127.120(2):
The administrator may request the complaints be submitted in writing.
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o Problems will be reviewed within fourteen (14) business days of receiving the
complaint
o Problems will be resolved within thirty (30) days.
o If complaints and concerns cannot be resolved, clients will be informed of the
method for contacting the Department of Health using the toll-free hotline,
o See Appendix F: Client Bill of Rights
o Client complaints will be used as quality indicators for administrative review for
the performance improvement process
• Client satisfaction interviews and discontinuation of service surveys will be completed
periodically and upon discontinuation of services.
(1.b.v.a) A process to inform clients of alternative services prior to ceasing
operation or when the licensee is unable to meet the client’s needs
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When it has been determined by any interested party that our services are no longer
sufficient to meet the needs of our client, we will make all reasonable efforts to assist in
helping that client find an agency or facility that is better suited for their circumstances
as required. A written letter of termination of service will be sent to the client within 24
hours. We will make every effort to assist with the transfer to another provider within 72
hours.
• In the event of an agency closure, clients will be given 30-day notice of termination of
services which will detail discontinuation of services to include time frames and referral
to other care providers.
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(1.b.v.b) A plan for preserving records, including the process to preserve or
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dispose of records prior to ceasing operation.
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•
•
All client records will be maintained by the agency consistent with RCW 70.02 Medical
Records, including access and disclosure
All client records are the property of Your Home Care Agency
A record of care is established for each client and will be maintained by the agency.
Client records will be:
• Accessible in an integrated document
• Maintained in the agency offices for review by appropriate agency staff and the
department
• Legibly written in permanent ink (black or blue) and suitable for photocopying or
retrievable by electronic means
• Filed in reverse chronological order by date of service
• Maintained in a confidential manner
• Fastened together to avoid loss of record contents
• Kept current
• Client records shall include:
• Appropriate client identifier information including name, age, current address
and phone number
• Documented observations about the clients condition
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Appropriate service consents and agreements
Payment source and client’s responsibility for payment
Pertinent past and current client history information
Documentation of client assessment
Plan of Care
Signed or authenticated and dated notes documenting and describing services
provided during each client contact
• Documentation of supervision of caregivers
• Client records shall be retained by the agency in accordance with state laws and
regulations:
• Original paper and electronic records will be maintained for three years following the
last date of service for adults.
• For children, these records must be maintained for three years after reaching age 18,
or five years following discharge whichever is longer.
• Current active client records are maintained in the agency office in a secure manner.
• Closed client records will be maintained in a secure fashion and maintained by year
of discharge.
• When records are finally destroyed, they must be shredded so that the integrity of the
information and confidentiality is maintained. In the event that the agency ceases
operation, all records will be transferred to the senior officer of the Your Home Care
Agency for preservation and disposal accordingly.
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(1.b.v.c.) Time frames for filing documents in the client records;
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• Documents will be filed into a client record in a timely manner. Electronic records are 5
maintained via the agency server.
(2) The licensee must continue to update policies and procedures to reflect
current practice, services provided by the agency, and state and local
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Your Home Care Agency will establish and maintain policies and procedures on an
ongoing basis based on regulatory and operational requirements. Policies and procedures
will be maintained electronically and a hard copy will be retained internally for reference.
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(3.a) The licensee must identify an administrator or designee who is
responsible to oversee the management and fiscal affairs of the licensee
and:
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• The administrator or designee is responsible for management of all fiscal affairs for Your
Home Care Agency and:
• Supervising all aspects of agency operations.
• Supervising contract personnel.
•
Assuring that supplies and equipment are available and maintained in working order.
• Assuring the accuracy of all public information materials.
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Making current written policies and procedures accessible to personnel during hours
of operation.
Administrator or designee will designate in writing an alternate to act in the
administrator’s absence as required;
In the absence of the Administrator, the duties will fall to the Client Manager(s) or
Director of Clinical Services.
Will assure personnel, contractors, and volunteers are currently credentialed by the
State of Washington, when appropriate, according to applicable practice acts;
Will be responsible for all aspects of the company.
Will provide management and supervision of services through the approved
service area;
Will arrange for necessary services;
Will keep contracts current;
Will serve as liaison between the licensee, personnel, contractors and volunteers;
Will assure personnel, contractors and volunteers comply with the licensee’s policies
and procedures; including creating and enforcing all policies and procedures.
Will implement a quality improvement process;
Will manage recordkeeping according to this chapter.
Assure supplies and equipment is available and maintained in working order
Assure the accuracy of the public information materials, and;
Assure current written policies and procedures are accessible to personnel, contractors
and volunteers during hours of operation.
See Electronic Appendix B: Job Descriptions
P060 WAC 246.335.060 Delivery of Services
1. The licensee has established and implemented policies and procedures
that describe admission, transfer, discharge and referral processes;
(1.a) Admissions
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• All phone calls identified as a new home care or home health client are directed to the
Administrator or designee. If the Administrator or designee is not available, the office
manager or schedule coordinator will complete a client inquiry form to secure as much
information as possible.
• At a minimum, the office manager or schedule coordinator will complete the following:
o Clients full name, address, phone number (directions to home)
o 3rd party payer information
o Any information regarding the client activity level, medications, and home care
duties expected
o Standard rates quoted to the client/inquirer
• Prior to in-home services being offered, an assessment will be performed by the Client
Manager, Director of Clinical Services, or designee;
• An assessment will be scheduled to include all interested parties if reasonable and
appropriate; this may include family, friends, and/or advisors.
• A thorough assessment will be made in the home according to the assessment form
approved by management. The initial assessment shall be performed by way of an
informational contact and clinical assessment for care need determination
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• If it is determined by all parties that there is a match between the client’s needs and the
services Your Home Care Agency offers, suggest an appropriate Plan of Care. If there is
not a fit, refer this client to the appropriate agency for service (see referral process).
• At the time of admission, the Client Bill of Rights affirming each individual's rights must
be provided to each patient, client, or designated family member
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(1.b) Transfers
• In the event that services are no longer sufficient to meet the needs of the client, every
reasonable effort will be made to assist in helping that client find and agency or facility that
is better suited for their circumstances.
o A written letter of termination of service will be sent to the client within 24 hours,
upon notification. We will make every reasonable effort to assist with the transfer
to another provider within 72 hours.
• We request 24-hour advance notice for any changes in service if possible.
o In the event that the health status changes when an employee is not present, and the
client is transferred to a health care facility, the agency will make note of the transfer
and service will be suspended until the client and/or responsible party notifies the
agency to resume services.
• Where an emergent issue exists, as determined by the Administrator or designee, the
agency may transfer, discharge, or discontinue services immediately upon notice.
•
Upon return home, the client may be reassessed by the agency with the service plan
revised to reflect current needs.
• Payments made by the client for care not provided because of a transfer will be pro-rated
back to the client’s account. Client may be reimbursed through check or credit to the
account.
• Clients are informed of the following alternative services:
o Kitsap County Division of Aging Senior information & assistance 800.562.6418
o Elder Care locator
800.677.1116
o CCS Home Care
360.792.2066
o DSHS – Chore/Personal Care
360.478.4990
o Harrison Home Health
360.792.6750
o Hospice of Kitsap County
360.415.6911
o LSS-Respite Care, Day Care
360.377.5511
o Gentiva Health Services
360.373.6966
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(1.c) Discharges
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A Client may be discharged:
o When the client moves out of the service area
o When payment sources are exhausted (see referrals)
o If the agency can no longer provide the services needed
o If it has been determined that the care in the home cannot adequately meet the client’s
needs
o The client or family requests services be discontinued
o The client, member of the household, or other significant caregiver is physically
abusive or verbally threatening to agency staff
o The client has died
• The Home Care Agency requires two-week notification for clients that are
discontinuing Your Home Care Agency services, if realistic.
• In the event of death or transfer to a higher level of care, payment made by the client for
care not provided will be prorated back to the account or refunded.
• Your Home Care Agency will cooperate with the receiving facility to the farthest extent
allowable by law in regard to providing health care information and/or assistance in
determining emergency contacts, safety concerns, baseline confirmation etc.
• When services are discontinued, the client record will be closed in a timely manner.
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(1.d) Referral Process
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• Your Home Care Agency will always strive to do what is in the best interest of our
clients.
• We will maintain a list of reputable and qualified professionals to whom we refer our
clients whenever the need arises.
• The bulk of these professionals are in the healthcare field, but we will provide a referral
to others who provide a needed service to seniors.
(2) Specific services, including nonmedical tasks, available to meet patient
or client, or family needs as identified in plans of care;
•
See Electronic Appendix C (list of services)
(3) Agency personnel, contractor, and volunteer roles and responsibilities
related to medication assistance level 1 and 2;
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Non-Medical Home personnel may, in accordance with Medication Assistance
Level 1:
• Remind clients to take medications as prescribed
• Read medication label to client
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Hand the medication container to the client
Use an enabler or place the medication in the hand of the client
Open the medication container
•
Home Health: The Director of Clinical Services, or responsible Registered Nurse,
or to the extent delegated by the plan of care or delegation of tasks, a qualified
nursing assistant, may provide a client Medication Assistance Level 1 and in accordance
with the nursing assistant’s scope of practice.
• Reminding or coaching the client to take medications,
• Opening the medication
• Handing the medication container or enabler to the client
• Placing the medication in the clients hand
• Crushing, cutting or mixing a medication (only if a pharmacist or home health
provider determines it is safe)
• Steadying or guiding a clients wrist so he/she can apply drops, sprays, lotions or
ointments
•
The Administrator is responsible to make sure that any nurse delegation has been done
according to nurse delegation rules. This includes:
• Tasks delegated are allowed by law
• Nursing assistant has completed all requirements prior to receiving delegating
tasks
• Delegation of tasks has been completed correctly, and
• Tasks are performed accurately
•
The responsibilities of the Director of Clinical Services or similarly credentialed RN
include:
• Obtaining written informed consent from the client or authorized representative
for the process of delegation
• Delegating the task (includes making the decision to delegate and providing
training)
• Supervising the delegation (includes responding to questions from the nursing
assistant) and frequency of visitation based on patient condition
• Rescinding the delegation
• The Director of Clinical Services, or responsible RN, remains accountable and
responsible for the client’s care regardless of any task of delegation.
• Nursing Assistant roles and responsibilities related to Medication Assistance
• Performing the delegated task according to specific instructions of the Director of
Clinical Services or responsible RN
• Observing the client for change which may indicate: potential side effects from the
medication, negative reactions to procedures, complications from diseases
• Reporting changes in the client’s condition promptly to the Director of Clinical
Services or responsible RN
• Reporting to the Director of Clinical Services, or responsible RN, any new or changed
medication or treatments which require different or additional tasks
• New orders from the authorizing practitioner may be taken over the phone by a RN or
qualified designee. Any new order attempted to be relayed over the phone must be
directed to the Director of Clinical Services, or responsible RN. A faxed order signed
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by the physician may be used for immediate verification, however, the Director of
Clinical Services, or responsible RN, still must be contracted prior to making any
changes.
DEFINITIONS AND GUIDANCE REGARDING MEDICATION ASSISTANCE
(i) WAC 246.888.20 Medication Assistance (Self-Administration with
Assistance)
(a) Reminding or coaching a client to take their medication;
(b) Handing the medication container to the client;
(c) Opening the medication container;
(d) Using an enabler (cup or saucer);
(e) Placing the medication in the hand of the client (without touching
the medication being placed);
(ii) WAC 246.888.30 Medication Assistance Initiation
(a) A client who resides in an in-home setting or his/her
representative may request self-administration with assistance.
(iii) WAC 246.888.045 What is an enabler?
(a) Enablers are physical devises used to facilitate a client’s selfadministration of a medication.
(b) Physical devises include but are not limited to: medicine cup,
glass, cup, spoon, bowl, prefilled syringe, syringes used to
measure liquids, specially adapted table surface, straw, and
piece of cloth or fabric.
(c) A clients hand may also be used as an enabler although “hand
over hand” administration is not allowed.
(d) Medication administration with assistance includes steadying or
guiding an individual’s hand while he or she applies, instills or
inserts a medication such as an ointment, eye, ear and nasal
preparations.
(iv) WAC 246.888.050 Altering Medications for Medication
Administration with Assistance
(a) Includes but is not limited to: crushing tablets, cutting tablets in
half, opening capsules, mixing powdered medications with foods
or liquids, or mixing tablets or capsules with foods or liquids. A
pharmacist or other practitioner, practicing within their scope of
practice must determine that it is safe to alter a legend drug or
controlled substance. Such communication shall be in writing or
communicate orally.
(b) The client must be aware that the medication is being altered and
added to their food, beverage etc.
(v) WAC 246.888.070 Allowable Non-practitioner Assistance
ii. A non-practitioner can transfer a medication from one container to
another for the purpose of an individual dose. Examples include:
pouring a liquid medication from the container to a calibrated
spoon or medication cup.
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(vi) WAC 246.888.080 Is Oxygen covered under this rule?
(a) Under state law, oxygen is not a medication and is not covered
under this rule. While oxygen is not considered a medication
under state law, is does require an order/prescription from a
practitioner.
• Communicate a
(4) Coordination of care including:
a. Coordination of care services will occur among providers of in-home
services, and as required:
b. Coordination with other agencies or providers will occur when the
care being provided impacts client health
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The administrator and/or Client Manager, and Director of Clinical Services shall
coordinate any intra and inter-agency services to:
• Develop the non-medical plan of care
• Implement the home care plan of care
• Supervise direct care personnel
• Assure compliance with client’s non-medical plan of care
• When referring a client to another agency, or accepting another agency for
the care of a client, all members of the care team are to be advised. The
client care team may include: client, family members, POA, physician,
caregivers and other management staff of as necessary.
• A Transfer, Discharge Summary form is to be completed for the client file
and duplicated for the prospective agency with care coordination upon
request.
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(5) Actions to address patient or client, or family communication
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If the client requires assistance with communication, the Client Manager will coordinate
with the administrator to initiate measures to obtain appropriate assistance
Communication methods that are suited to the client and family needs will be tailored to
best deliver the message or support communication in an expeditious manner and includes
phone calls, email, electronic messages via eRSP, and the 24hr/On-call supervisor.
Non-emergent communication from a client or family member will be responded to
within three business days.
Communication
The client will communicate in their preferred spoken language and the agency will
provide staff that speaks the language or translator services.
Clients who require special communication boards, interpreters or TTY services will be
required to provide and maintain for these services themselves.
Your Home Care Agency will support the client and make referrals as needed to obtain
additional services as requested. The agency does not provide communication devices.
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The predominant language is English.
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(6) Infection control practices for direct care personnel, and contractors,
consistent with local health authorities;
The agency will implement appropriate infection control procedures and standards to
include:
• The administrator shall implement procedures assuring that all caregivers are informed
and comply with State Board of Health rules and regulations regarding the presence of
persons who have or have been exposed to infections and other contagious diseases.
• To prevent transmission of infection by a client or the caregiver, when any employee
becomes aware of the existence of any infection or communicable disease in their own
person or in the person of a staff member or client, said employee is expected to
immediately notify same to local health officials and the administrator or designee
• The Home Care Agency shall adhere to Labor and Industries recommendations and
guidelines with respect to Mycobacterim Tuberculosis.
• The Home Care Agency will concentrate teaching on the following at hire and * annually.
• Hand washing
• *Bloodborne Pathogens and HIV/Aids
• HIV/AIDS education
• *Universal precautions
• Direct care personnel; contractors and volunteers will observe universal
precautions with all clients when in contact with bodily fluids.
• Precautions other than universal will be noted on the plan of care as
appropriate and warranted for the safety of the client and direct care staff.
• Maintenance of safe environment:
• Food storing, preparation and handling
• See Appendix G: Universal Precautions
(7) Actions to take when personnel and contractors or clients exhibit or
report symptoms of a communicable disease in an infectious stage in
accordance with chapter 246-100 WAC, Communicable and certain other
diseases and chapter 246-101 WAC, Notifiable conditions:
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When a client or caregiver exhibits or reports symptoms of a communicable disease in an
infectious stage, it will be reported in accordance with WAC 246-100 and 101.
• In the event that agency staff is exposed to an infection case of tuberculosis or other
reportable diseases or conditions, the following will apply:

Agency personnel will report to the Client Manager’s any client who may be
suspected to have a communicable disease

Agency personnel with a communicable disease in the infectious state will not
provide direct client care

Agency personnel with a cough, sore throat, chills, fever or general malaise will
consult with a Client Manager before accepting client assignments

The administrator will notify the appropriate health department
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The agency will supply the health department with any names and identifying
information required for sufficient screening
The agency will implement any steps deemed necessary by the department of
health
8) Management of patient or client medications and treatments in
accordance with appropriate practice acts:
See WAC guidance below and (3) above
• See Appendix H: Reference: Food Safety is Everybody’s Business
• Included in a new hire’s safety orientation (and ongoing) is information regarding:
o Basic Food Safety knowledge including:
 Food storage
 Food preparation
 Food handling
o Introduction to food borne illness
o How to keep food from causing illness
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9) Food storage, preparation and handling;
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The food preparation process includes strict observation of personal hygiene, continuous
application of sanitary food-handling techniques, destroying harmful bacteria, thorough
washing, and minimal handling of food throughout the process.
Caregivers providing the service of food preparation shall observe hygienic and sanitary
practices. Foods that may contain harmful bacteria such as fish, poultry, eggs, meat and
seafood are to be stored in separate containers and should not be allowed to drip on other
foods.
Perishable foods are to be kept in the refrigerator. Refrigerators should be maintained at 40
degrees. Freezers should be maintained at zero degrees. Refrigerators and freezers should
be cleaned regularly.
Wash hands before, during and after handling food. Clean kitchen surfaces before, during
and after handling food.
Defrost foods on a plate in the refrigerator or in a microwave. Cook food immediately after
defrosting. Use different utensils for raw and cooked foods. Use different dishes for raw
and cooked foods.
Cook eggs well. Do not eat raw eggs or foods that contain raw eggs. Cook poultry to 180
degrees, meat to 160 degrees, fish till white and flaky.
Store left-over food promptly at 40 degrees. Do not leave perishable food out for more than
two (2) hours.
When in doubt, discard left-over food.
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(10) Reporting of client abuse and neglect according to chapter 74.34
RCW
• See Appendix I & J: Reference: Abuse and Neglect (74.34 RCW) and
Partners in Prevention”
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The Home Care Agency will not tolerate abuse or neglect situations; all employees must
complete a Disclosure Statement Child/Adult Abuse Information Act form prior to
employment and is included in the pre-employment criminal background check as per RCW
43.43.830 through 43.43.840.
If a Caregiver observes an incident of abuse or neglect, The Home Care Agency requires the
Caregiver to implement the following steps:
If in the case of a child: As per RCW 26.44.040, an immediate oral report must be made by
telephone to the proper law enforcement agency or the Department of Social and Health
Services and, upon request, must be followed by a written Incident Report. The telephone
number for Child Abuse & Neglect/Protective Services is (360) 475-3500 and/or the Crisis
Center is (360) 479-3033. Such reports must contain the following information, if known:
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The name, address and age of the child;
The name and address of the child’s parents, stepparents, guardians, or other
persons having custody of the child;
The nature and extent of the alleged:
• injury or injuries;
• neglect; and
• sexual abuse
Any evidence of previous injuries, including their nature and extent; and
Any other information that may be helpful in establishing the cause of the
child’s injury, injuries, or death and the identity of the alleged perpetrator or
perpetrators.
If in the case of an adult: as per RCW 74.34.036, when there is reasonable cause to believe
that abandonment, abuse, financial exploitation, or neglect of a vulnerable adult has
occurred, it shall immediately be report to the Department of Social and Health Services.
The telephone number for Adult Protective Services is (360) 478-4990 and/or the Crisis
Center is (360) 479-3033. If there is reason to suspect that sexual or physical assault has
occurred, such incidents shall immediately be reported to the appropriate law enforcement
agency and to the Department.
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Each report, oral or written, must contain the following information, if
known:
The name and address of the person making the report;
The name and address of the vulnerable adult and the name of the facility or
agency providing care for the vulnerable adult;
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The name and address of the legal guardian or alternate decision maker;
The nature and extent of the abandonment, abuse, financial exploitation,
neglect, or self-neglect; any history of previous abandonment, abuse,
financial exploitation, neglect, or self-neglect;
• The identity of the alleged perpetrator; and
• Other information that may be helpful in establishing the extent of
abandonment, abuse, financial exploitation, neglect, or the cause of death of
the deceased vulnerable adult.
• Unless there is a judicial proceeding or the person consents, the identity of
the person making the report under this section will be treated as confidential.
• Included in a new hire’s orientation (and ongoing) is information regarding:
o Definition of Vulnerable Adult
o Abuser Patterns
o Signs of Abuse
o Definitions of Abuse
 Physical
 Sexual
 Mental
 Neglect
 Exploitation
 Abandonment
 Who is a mandatory reporter
 Who to call
 Self-Neglect
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o Call for emergency medical services (EMS) (911)
o Stay with the client until EMS arrives
o Call the Client Manager and report the situation
o Have readily available for EMS personnel the clients advance directive if possible
o Inform the client that local emergency medical services has been summoned
• Change in client’s condition
o Report any changes immediately to the Client Manager for appropriate intervention &
guidance
• Death of a client
o If the client dies or is found dead, call 911 and then contact the Client Manager
o If the client is a Hospice client, contact the hospice nurse first (instead of calling 911),
then the Client Manager
o The Client Manager will contact family members
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12) Actions to be taken upon the death of a client;
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Only a licensed healthcare provider (Physician, Registered Nurse, and Paramedic) may
implement a Do Not Resuscitate order.
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In the event of sudden death or if a client is found non-responsive and not breathing the
following procedure will occur:
o Yell or have someone call for 911. If alone, call 911 first unlock the front door so
medics have access to the home.
o If certified in CPR, begin cardiopulmonary resuscitation. Continue until relieved by
medics.
o Call the office to report an update and advise if a supervisory presence is needed
and/or requested.
o When the medics arrive on the scene let them take charge of the situation. The medics
are authorized to honor a POLST and declare death in conjunction with an MD.
o The Client Manager or designee will notify the family of the incident.
o If a client is in a Hospice program, do not call 911. Notify the Hospice Nurse of the
situation and follow their directions.
o For Home Health – the Director of Clinical Services shall report the death to the
appropriate county coroner’s office (Kitsap County 360.337.7077 or Mason County
360.275.4467)
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• The Home Care Agency recognizes that all adults have a fundamental right to make
decisions relating to their own medical treatment or have duly authorized competent others
to make those decisions, including the right to accept or refuse medical care in accord with
state and regulations.
• It is the policy of the Home Care Agency to encourage clients and their families to
participate in decisions regarding care and treatment. Valid advance directives such as
living wills, durable powers of attorney and DNR (Do Not Resuscitate) orders will be
followed to the extent permitted by law.
• If a client has prepared an Advance Directive, or does so in the future, the Home Care
Agency requests that the client provide a copy or verbal information of a do not resuscitate
order so that the agency understands the individual’s wishes
• In the absence of an advance directives or surrogate decision making, the Home Care
Agency will provide care according to the home care Plan of Care compiled by
information from the Initial Assessment and subsequent updates, the Client’s health care
professionals (for home health), the Client and family members. [Home Care Agency
Name] will not condition the provision of care or otherwise discriminate against a Client
based on whether or not the Client has executed an advance directive or has a Surrogate
Decision Maker.
• The Home Care Agency provides clients with a POLST (Physician Order of Life
Sustaining Treatment) form on initiation of services and asks the client to complete the
form with the assistance of family and their attending physician. We ask that when
completed, the client post the POLST in a clearly visible area such as the refrigerator.
• See Appendix L: Natural Death Act
(14) Plans for service delivery when natural or man-made emergencies
occur that prevent normal agency operation
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• Emergency Closings:
o For emergencies such as severe weather, fires, power failures, or earthquakes
company operations can be disrupted. In extreme cases, these circumstances may
require the closing of the Your Home Care Agency Office. In the event that such an
emergency occurs during non-working hours, local radio and/or television stations
will be asked to broadcast notification of the closing.
o See also P005 1.b.i.i. Emergency Operations.
o When the decision to close is made AFTER the workday has begun, employees will
receive official notification from their immediate supervisor. In these situations, time
off from scheduled work will be paid. When the decision to close is made BEFORE
the workday has begun, time off from scheduled work will be unpaid. However, with
supervisory approval, employees may use available paid leave time, such as unused
vacation benefits.
o In cases where an emergency closing is not authorized, employees who fail to report
for work will not be paid for the time off. Employees may request available paid
leave time such as unused vacation benefits.
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(15) Nurse delegation as defined in RCW 18.79.260 (3) (e) and rules
adopted there-under, if applicable
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Within the scope of practice and in accordance with 18.79 RCW and 18.88A RCW, the
Director of Clinical Services, or other responsible RN, may delegate specific tasks to a
Registered or Certified Nursing Assistant (NAC). Such delegation must be in writing, and
signed by both the Director of Clinical Services, or responsible RN, and the NAC
accepting the delegation. Prior to delegating the RN must:
o determine the competence of the individual to perform the tasks,
o evaluate the appropriateness of the delegation,
o supervise the actions of the person performing the delegated task,
o delegate only those tasks that are within the RN’s scope of practice, and
o obtain written informed consent of the delegation from the client or authorized
representative and authorizing practitioner.
RN delegations must meet the following conditions:
o Only a licensed Registered Nurse may delegate performance of a specific task for a
specific Client to a specific NA.
o An RN may delegate the application, instillation, or insertion of medications to a
registered or certified nursing assistant under a plan of care.
o Under no circumstances may injections of any kind, any sterile procedures or
central line maintenance, or acts requiring nursing judgment within the scope of
practice of an RN be delegated;
o The Client must be stable and predictable;
o NA’s must have completed approved delegation training before they can be
delegated or accept delegation of nursing tasks;
o Determination of the client’s stability and predictability is the responsibility of the
delegating RN based on his or her professional judgment.
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o Once the delegation is in place, the responsible RN remains accountable and
responsible for the Client’s care.
o The RN may rescind the delegation of the nursing task at any time if any of the
following occur:
• The nurse believes the Client’s safety is at risk;
• The Client’s condition is no longer stable and predictable;
• Staff turnover makes it difficult to continue delegation in the setting;
• The NA is no longer able to perform the task safely;
• The NA is not performing the task correctly;
• The Client or authorized representative requests that the delegation be
rescinded;
• The Client goes into a hospital or other form of care facility.
o If the RN rescinds the delegation, The RN must coordinate a different plan to
make sure the Client’s needs are met. Reasons for the rescinding of a delegation
must be documented.
P065 WAC 246.335.065 Personnel, Contractor, and Volunteer Policies
The licensee has established and implemented policies and procedures
regarding the following:
(1) Employment criteria consistent with chapter 49.60 RCW, Discrimination
– Human rights commission;
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• The agency is an equal opportunity employer in accordance with RCW 49.60
• See APPENDIX M – Employee Handbook
(2) Job descriptions commensurate with responsibilities and consistent with
health care professional credentialing and scope of practice as defined in
relevant practice acts and rules adopted there under;
(3) References for personnel and contractors;
(4) Credentials of health care professionals that are current and in good
standing;
•
Those employees who maintain professional credentials will be entered into the
Washington State Quality Assurance website to validate current licensure and good
standing annually.
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(5) In-person contact with personnel and contractors prior to service
provision;
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Caregivers are personally introduced by a supervisor or designee to clients for orientation
before service is initiated or provided by an unfamiliar caregiver.
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(6) Orientation to current agency policies and procedures and verification of
skills or training specific to the care needs of patients or clients;
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Orientation is completed after hire but before an assignment is given, with a new hire
checklist to ensure completion.
At the time of assignment, 1:1 training resources are used as needed. Company judgment
by the Client Manager and or designee to verify skills or training specific to the care needs.
•(7)for
the client.
Ongoing
training pertinent to client care needs;
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Will be scheduled and supervised using current training resources as
Required and needed.
(8) Current Cardiopulmonary resuscitation training consistent with agency
policies and procedures for direct care personnel and contractors in
home health
• Direct care personnel and contractors include those having access to patients for
the purpose of providing home health services. This includes personnel and
contactors who transport patients.
(9) Infection control practices including communicable disease testing,
immunization, and vaccination according to current and local health
authorities and availability of equipment necessary to implement plans
of care and infection control policies and procedures;
•
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New hire orientation will teach universal precaution basics to include:
o Cause of infection
o Hand washing
o Gloves – when, where, why & how
(10) Annual performance evaluations of all personnel and volunteers
providing direct client care, including on-site observation of care and
skills specific to the care needs of clients;
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Are performed at least annually
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(11) Annual evaluations of services provided by contractors providing
direct client care; and
(12) Washington State patrol criminal background inquiries and disclosure
statements under RCW 43.43.830 through 43.43.845 for the [all
supervisors and the] administrator [and] supervisor of direct care
services per WAC 246.335.025 (1) (c), 246.335.060 (3), and
246.335.035 and personnel, contractors, students, and any other
individual associated with the licensee having direct contact with
children under 16 years of age, people with developmental disabilities
or vulnerable adults.
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• Criminal background checks are completed upon hire
• Background checks for all supervisors (Administrator and Client Managers) will be
completed every two years.
P070 WAC 246.335.070 Personnel, Contractor and Volunteer Records
The licensee maintains records on all personnel and has access to records
on all contractors to include:
(1) Current practice certification, credential or licensure, as applicable;
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Personnel records are maintained securely at the Human Resource office.
Employees wishing to review their personnel file may do so during regular business
hours, upon request to the Administrator. For the protection against loss of records, all
files are to be reviewed at the mutual convenience of both the employee and the
Administrator and must be reviewed in the presence of the Administrator. Employees
may receive, upon request, copies of any documents within their personnel file, which
they have signed.
Any employee wishing to dispute the contents of his or her personnel file may do so in
writing. The documentation submitted by the employee will be maintained in the
employees personnel file.
Personnel files are the property of the Home Care Agency and cannot be removed
from the office without prior approval of the Administrator.
The Home Care Agency will maintain records pertinent to agency protocol and
Department of Health as applicable.
See Appendix M – Your Home Care Agency Employee Handbook
(2) Documentation of references
(3) Evidence of orientation to current agency policies and procedures;
(4) Verification of personnel and contractor skills or training specific to
meeting the care needs of clients;
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Employee in-service documentation logs are maintained via written or electronic means
(5) Evidence of disclosure statement and Washington State Patrol criminal
background inquiry according to RCW 43.43.830 through 43.43.845;
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Disclosure statements and background checks are maintained in paper form within the
employee file
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Training is completed on an ongoing basis and as needed
(7) Current CPR training for direct care personnel (home health)
(8) Communicable disease testing, immunization, and vaccination
according to current local health authorities
(9) Documentation of evaluations of personnel providing direct client care
and evaluations of services provided by contractors providing direct
client care as required in WAC 246.335.065 (10) and (11)
• Onsite personnel evaluations (Supervisory Visits) and performance evaluations are
performed and found in the employee files.
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P075 WAC 246.335.075 Bill of Rights
(1) An in-home services licensee at the time of admission must provide
each client, or designated family member with a written bill of rights
affirming each individual’s rights. Your Home Care Agency provides all
client(s) with a Bill of Rights that includes:
(a) A listing of the services offered by the in-home services licensee
and those being provided;
(b) The name of the individual supervising the care and the manner in
which that individual may be contacted;
(c) A description of the process for submitting and addressing
complaints;
(d) Submit complaints without retaliation and to have the complaint
addressed by the licensee;
(e) Be informed of the state complaint hotline number;
(f) A statement advising the patient or client, or designated family
member of the right to ongoing participation in the development of
the plan;
(g) A statement providing that the client or designated family member is
entitled to information regarding access to the department’s listing
of providers and to select any licensee to provide care, subject to
the individual’s reimbursement mechanism or other relevant
contractual obligations;
(h) Be treated with courtesy, respect, privacy, and freedom from abuse
and discrimination;
(i) Refuse treatment or services;
(j) Have property treated with respect;
(k) Privacy of personal information and confidentiality of health care
records;
(l) Be cared for by properly trained personnel and contractors
with coordination of services;
(m) A fully itemized billing statement upon request, including the date of
each service and the charge. Licensees providing services through
a managed care plan are not required to provide itemized billing
statements and;
(n) Be informed about advanced directives and the licensee’s
responsibility to implement them.
(o) An in-home service license must ensure that the rights under this
Section are implemented and updated as appropriate.
a. Rights will be updated and amended as needed
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P075 WAC 246.335.080 Home Health Plan of Care
• 1. Home health licensee must, except as provided in subsections (2)
and (3) of this section:
a. Develop and implement a written home health plan of care for
each patient with input from the patient or designate family
and authorizing practitioner;
b. Assure each plan of care is developed by appropriate agency
personnel and is based on a patient assessment, except
when providing one-time visits;
c. Assure the home health plan of care includes:
i. Current diagnoses and other information on health
status;
ii. Goals or outcome measures;
iii. Types and frequency of services to be provided;
iv. Home medical equipment and supplies used by the
patient;
v. Orders for treatments and their frequency to be
provided and monitored by the licensee;
vi. Special nutritional needs and food allergies;
vii. Orders for medications to be administered and
monitored by the licensee including name, dose, route,
and frequency;
viii. Medication allergies;
ix. The patient’s physical, cognitive and functional
limitations;
x. Discharge and referral plan;
xi. Patient and family education needs pertinent to the
care being provided by the licensee;
xii. Resuscitation status of the patient according to
documentation consistent with the Natural Death Act
and advance directives
xiii. The level of medication assistance to be provided;
d. Develop and implement a system to:
i. Assure and document the plan of care is reviewed and
updated by appropriate interdisciplinary team members
within the first week of admission and every two weeks
thereafter;
ii. Assure that the plan of care is signed or authenticated
and dated by appropriate agency personnel and the
authorizing practitioner;
iii. Assure the plan of care is returned to the agency within
sixty days from the initial date of service;
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iv. Inform the authorizing practitioner regarding changes in the
patient’s condition that indicates a need to change the plan
of care.
v. Obtain approval from the authorizing practitioner for
additions and modifications; and
vi. Assure all verbal orders for modification to the plan of care
are immediately documented in writing and signed or
authenticated and dated by an agency individual within the
scope of practice to receive the order and signed or
authenticated by the authorizing practitioner and returned
to the agency within sixty days from the date the verbal
orders were received.
• Initial Assessments are to be performed face-to-face and on-site by the Director
of Clinical Services, or responsible RN, with input from the Client or authorized
representative, designated family member and authorizing practitioner.
• Once the Plan of Care is developed, and written approval of the Plan of Care is
obtained from the Client and/or designated family member and the authorizing
practitioner, the Plan of Care will be implemented upon Clients signature of the
Consent for Services form.
• The Home Health Plan of Care shall include, but not be limited to, the
following: current diagnoses and information on health status; clients physical,
cognitive and functional limitations; nutritional needs and food allergies (if
any); home medical equipment and supplies used by the Client and relevant to
the Plan of Care; type and schedule of services to be provided; goals or outcome
measures; orders for treatments and their frequency to be provided and
monitored, including name, dose, route, and frequency; medication allergies;
discharge and referral plan; patient and family education needs pertinent to the
care being provided; resuscitation status of the patient according to
documentation consistent with the Natural Death Act and advance directives;
and level of medication assistance to be provided
• A modified Plan of Care may be developed when providing home health aide
only services to a Client by providing only the following information: types and
frequency of services to be provided; home medical equipment and supplies
used by the Client, special nutritional needs and food allergies; client’s physical,
cognitive, and functional limitations; level of medication assistance to be
provided.
• After the Client is accepted and a Plan of Care is developed and approved, the
Director of Clinical Services, or responsible RN, provides direction to the
Schedule Coordinator for staffing the clients needs.
• Clients will not be admitted for care if:
• The range of the client’s needs cannot be met by the client, family, or
support systems even with part-time or full-time care services
• The client’s physical, medical, or environmental needs cannot be safely
maintained or manage in their existing residence
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The agency does not have adequate staff or staff with adequate skills to meet
the client’s needs. The clients will be referred to other providers within the
community
The safety of the home care staff is compromised
P090 WAC 246.335.090 Home Care Plan of Care
(1) HomeCare licensees must, except as provided in subsection (2) of this
section:
(a) Develop and implement a written HomeCare plan of care for each
client with input and written approval by the client or designated
family member;
(b) Assure each plan of care is developed by appropriate agency
personnel, lists services requested or recommended to meet client
needs, and is based on an on-site visit, under agency policies and
procedures;
(c) Assure the HomeCare plan of care includes:
(i) The client’s functional limitations;
(ii) Nutritional needs and food allergies for meal preferences;
(iii) Home medical equipment and supplies relevant to the plan of
care;
(iv) Type and schedule of services to be provided;
and;
(v) Non-medical tasks requested;
(d) Assure the plan of care is reviewed on-site, updated, approved and
signed by appropriate agency personnel and the client or designated
family member every twelve months and as necessary based on
changing client needs.
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P095 WAC 246.335.095 Supervision of Home Health Care
1. A licensee must employ a director of clinical services;
2. The director of clinical services or designee must be available during all
hours patient care is being provided;
3. The director of clinical services must designate in writing a similarly
qualified alternate to act in the director’s absence;
4. The director of clinical services or designee must assure:
a. Coordination, development, and revision of written patient
care policies and procedures related to each service provided;
b. Supervision of all patient care provided by personnel and
volunteers;
c. Evaluation of services provided by the contractors;
d. Coordination of services when one of more licensee is providing
care to the patient;
e. Compliance with the plan of care;
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f. All direct care personnel, contractors, and volunteers observe and
recognize changes in the client’s condition, and report any changes
to the director or designee;
g. All direct care personnel, contractors initiate emergency
procedures according to agency policy;
5. The licensee must document supervision including but not limited to:
a. RN supervision when using the services of a RN or LPN, in
accordance with chapter 18.79 RCW;
b. For patients receiving acute care services, supervision of the
home health aide services during an on-site visit with or without
the home health aide present must occur once a month to
evaluate compliance with the plan of care. The supervisory visit
must be conducted by a licensed nurse or therapist in
accordance with the appropriate practice acts;
c. For patients receiving maintenance care or home health aide
only services, supervision of the home health aide services
during an on-site visit with or without the home health aide
present must occur every six months to evaluate compliance
with the plan of care and patient satisfaction with care. The
supervisory visit must be conducted by a licensed nurse or
licensed therapist in accordance with the appropriate practice
acts; and
d. Supervision by a licensed therapist when using the services of a
therapy assistant in accordance with the appropriate practice
acts; and
•
6. The licensee using home health aides must assure:
• Your
a Director
of Clinical
Services
(DCS) .
a. Home
Each Care
homeAgency
healthemploys
aide reviews
the plan
of care
or written
• instructions
The DCS orfor
designee(s)
available
during
allto
hours
of client
care.
the care are
of each
patient
prior
providing
home
health aide services and whenever there is a change in the plan
of care; and
b. Each home health aide assists with medications according to
WAC 246-335-015, and agency policy
•
The (Director of Clinical Services) DCS will designate in writing a similarly
qualified alternate to act in their absence
• The DCS will assure:
• Supervision of all client care provided by personnel;
• Evaluation of services provided by contractors;
• Coordination, development, and revision of written client care
policies;
• Participation in coordination of service when more than one licensee
is providing care to the client;
• Compliance with the plan of care;
• All direct care personnel, contractors, and volunteers observe and
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recognize changes in the client’s needs, and report any changes to the
director or designee;
• All direct care personnel, contractors and volunteers initiate
emergency procedures according to agency policy;
• Each caregiver reviews the plan of care or written instructions for care of each
client prior to providing services and whenever there is a change in the plan of care;
and
• Each caregiver assists with medications according to WAC
246.335.015 and agency policy; and
• Your Home Care Agency will document supervision including, but not limited
to, client contact every six months to evaluate compliance
• More frequent supervisory visits may be made under the following circumstance:
•
When there are reports by the client, family or caregiver indicating
substantial changes in services are needed
•
The caregiver needs additional instruction and support in meeting the
client’s needs
•
Change in the client’s condition indicate a need for additional supervision
•
P105
246.335.105
Supervision
At theWAC
discretion
of the Client
Manager(s)of Home Care
(1) The licensee must employ a supervisor of direct care services;
(2) The supervisor or designee must be available during all hours of client
care;
(3) The supervisor or designee must be available during all hours of client
care;
(4) The supervisor of direct care services must assure:
(a) Supervision of all client care provided by personnel;
(b) Evaluation of services provided by contractors;
(c) Coordination, development and revision of written client care
policies;
(d) Participation in coordination of services when more than one
licensee is providing care to the client:
(e) Compliance with the plan of care;
(f) All direct care personnel, contractors, and volunteers observe and
recognize changes in the client’s needs, and report any changes to
the director or designee;
(g) All direct care personnel and contractors initiate emergency
procedures according to agency policy;
(h) Each HomeCare aide reviews the plan of care or written instructions
for the care of each client prior to providing HomeCare aide services
and whenever there is a change in the plan of care; and
(i) Each HomeCare aide assists with medications according to WAC
246.335.015, and agency policy; and
•
Services may include telehealth visits and contacts.
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P110 WAC 246.335.110 Client Records
(1) The licensee must:
(a) Maintain a current record for each client consistent with chapter
70.02 RCW Medical records – health care information access and
disclosure:
(b) Assure that the record is:
(i) Accessible, in an integrated document, in the licensee’s office
site for review by appropriate direct care personnel and
contractors, and the department;
(ii) Written legibly in permanent ink or retrievable by electronic
means
(iii) On standardized forms
(iv) In a legally acceptable manner;
(v) Kept confidential;
(vi) Chronological in its entirety or by the service provided;
(vii) Fastened together to avoid loss of record contents;
(viii) Kept current with all documents filed according to agency time
frames per agency policies and procedures
(c) Include documentation of the following in each record, unless
exempted in (d) of this subsection;
(i) Client name, age, current address and phone number;
(ii) Client’s consent for service, care and treatment;
(iii) Payment source and client responsibility for payment;
(v) Plan of care
(vi) Signed or authenticated and dated notes documenting and
describing services provided during each client contact;
(vii) Observations and changes in the client’s condition or needs;
(d) For clients receiving a one-time visit under WAC 246.335.080 (3),
246.335.085 (2), or 2465.335.090 (2) provide the documentation
required in these sections;
(e) Consider the records as property of the licensee and allow the client
access to his or her own record, and
(f) Upon request and according to agency policy and procedure,
provide client information or a summary of care when the client is
transferred or discharged to another agency or facility;
(2) The licensee must maintain records for:
(a) Adults- three years following the date of termination for services; and
(3) The licensee must:
(a) Store records to prevent loss of information and to maintain the
integrity of the record and protect against unauthorized use;
(b) Maintain or release records after a client’s death according to
chapter 70.02 RCW, Medical Records – Health Care information
access and disclosure; and
(c) After ceasing operation, retain or dispose of records in a confidential
manner according to the time frames in subsection (2) of this
section:
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(See APPENDIX M: Medical Records, WAC 70.02)
P115 WAC 246.335.115 Quality Improvement
Every in-home services licensee must maintain a quality improvement
program to assure the quality of care and services provided throughout its
service area that includes, at a minimum;
(1) A compliant process that includes a procedure for the receipt,
investigation, and disposition of complaints regarding services provided
under RCW 70.127.120 (2);
(2) A method to identify, monitor, evaluate and correct problems identified
by clients, families, personnel, or contractors; and
(3) Your Home Care Agency has a system to assess client satisfaction
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P74.34 RCW 74.34 Abuse of Vulnerable Adults
The legislature finds and declares that:
(1) Some adults are vulnerable and may be subjected to abuse, neglect,
financial exploitation, or abandonment by a family member, care
provider or other person who has a relationship with the vulnerable
adult:
(2) A vulnerable adult may be home bound or otherwise unable to represent
him or herself in court or retain legal counsel in order to obtain the relief
available under this chapter or other protections offered through the
courts:
(3) A vulnerable adult may lack the ability to perform or obtain those
services necessary to maintain his or her well being because he or she
lacks the capacity for consent.
(4) A vulnerable adult may have health problems that place him or her in a
dependent position;
(5) The department must provide protective services in the least restrictive
environment appropriate and available to the vulnerable adult.
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P74.34.035 RCW 74.34.035 Reports mandated and permissive content
confidentiality
(1) When there is reasonable cause to believe that abandonment, abuse,
financial exploitation, or neglect of a vulnerable adult has occurred,
mandated reporters shall immediately report to the department.
•
•
If you suspect that your client is the victim of abuse, or neglect, you are
required by law to report what is suspected
The care giver will contact Adult Protective Services (APS) then notify the
administrator, who must also contact APS.
2) When there is reason to suspect that sexual assault has occurred,
mandated reporters shall immediately report to the appropriate law
enforcement agency and to the department (adult protective services);
(3) When there is a reason to suspect that physical assault has occurred or
there is reasonable cause to believe that an act has caused fear or
imminent harm;
(
(a) Mandated reporters shall immediately report to the department; and
(b) Mandated reporters shall immediately report to the appropriate law
enforcement agency, except as provided in subsection (4) of this
section;
(4) Mandated reporters shall immediately report to the appropriate law
enforcement agency, except as provided in subsection (4) of this section;
(a) The injury appears on the back, face, head, neck, chest, breasts,
groin, inner thighs, buttock, genital or anal area:
(b) There is a fracture:
(c) There is a pattern of physical assault between the same vulnerable
adults or involving the same vulnerable adults; or
(d) There is an attempt to choke the vulnerable adult.
(5) Permissive reporters may report to the department or a law enforcement
agency when there is a reasonable cause to believe that a vulnerable
adult is being or has been abandoned, abused, financially exploited or
neglected.
(6) No agency required to be licensed under chapter 70.127 RCW, or an
agency under contract with the department to provide care for vulnerable
adults may develop policies that interfere with the reporting requirements
in this chapter.
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(7) Each report, oral or written, must contain as much as possible of the
following information:
(a) The name and address of the person making the report;
(b) The name and address of the vulnerable adult and the facility or
agency providing care for the vulnerable adult;
(c) The name and address of the legal guardian or alternative decision
maker;
(d) The nature and extent of the abandonment, abuse, financial
exploitation, neglect or self-neglect;
(e) Any history of previous abandonment, abuse, financial exploitation,
neglect or self-neglect;
(f) The identity of the alleged perpetrator, if known, and;
(8) Other information that may be helpful in establishing the extent of
abandonment, abuse, financial exploitation, neglect or self-neglect;
P49.19.020 Safety – Health Care Setting
(1) It is the policy of MMAH to ensure the personal safety of employee’s by addressing
security concerns related to the following items;
a) The physical attributes of the Your Home Care Agency setting:
1. Car;
2. Walking;
3. During Visits;
4. Visits after dark;
5. Staffing;
6. Personnel policies;
7. First aide and emergency procedures;
8. The reporting of violent acts; and
9. Employee education and training;
10. Appearance and Communication;
11. Defense Techniques
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P49.19.030 Safety – Violence Prevention Training
(1) Violence prevention training pertinent to the particular setting and to the
duties and responsibilities of the employee being trained based on
hazards identified in the Security and Safety Assessment;
a. General safety procedures;
b. Personal safety procedures;
c. The violence escalation cycle;
d. Verbal and physical techniques to de-escalate and minimize
violent behavior;
e. Strategies to avoid physical harm;
f. Documenting and reporting incidents;
g. The process whereby employees affected by a violent act by
debrief;
h. Resources available to employees for coping with violence; and
i. MMAH prevention plan
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P49.19.040 – Violent Act – Records
Beginning no later than July 1, 2000, each health care setting shall keep a
record of any violent act against an employee, a patient of a visitor
occurring at the home. At a minimum the record shall contain;
1) The health setting’s name and address;
2) The date, time, and specific location at the health care setting where the
act occurred;
3) The name, job title, department, assignment, and staff identification or
social security number of the victim if an employee;
4) A description of the person against whom the act was committed as:
a. A client;
b. A visitor;
c. An employee;
d. Other;
5) A description of the person committing the act as;
a. A client;
b. A visitor;
c. An employee; or
d. Other;
6) A description of the type of violent act as a:
a. Threat of assault with no physical contact;
b. Physical assault with contact by no physical injury;
c. Physical assault with mild soreness, surface abrasions,
scratches, or small bruises;
d. Physical assault with major soreness, cuts or large bruises;
e. Physical assault with severe lacerations, a bone fracture, or a
head injury; or
f. Physical assault with loss of limb or death;
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7) An identification of any body part injured;
8) A description of any weapon used;
9) The number of employees in the vicinity of the act when it occurred; and
10) A description of actions taken by employees and the health care setting
in response to the act. Each record shall be kept for at least five years
following the act reported, during which time it shall be available for
inspection by the department as requested.
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Who is exempt from basic Training after 1-7-2012:
•
•
•
•
A LTC worker employed between Jan 1, 2011 and January 6, 2012 who completed all of his or her basic training requirements
in effect as of the date of hire.
LTC workers employed in licensed AFH’s, BH’s and Medicaid contracted home care agencies and Individual
Providers hired from Jan 1, 2011 through Jan6, 2012 must complete basic training within 120 days of hire to be
exempt.
LTC workers employed by community residential providers (exempt until January 2016).
Workers with the following credentials:
 RN’s, LPN’s, nurse technician, advanced registered nurse practitioner, or NAC’s.
 Certified counselors, speech language pathologists or audiologists, OTs, PTs or a home health aide employed
by a Medicare certified home health agency.
 a person with special education training and endorsement granted by the superintendent of public instruction.
When these changes take effect:
• Jan 2, 2012 – Fingerprint background checks
• Jan 7, 2012 – New training requirements, home care aide certification
• Jul 1, 2012 – 12 hours for continuing education, on the job training allowed
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Implementing 1163
What
Current
Background
Checks
State
Checks
Orientation
and Safety
Training
Orientation
before
routine
interaction
with clients
or within 14
calendar
days of hire
28 hours
within 120
days of hire
Basic Training
Home Care
Aide
Certification
On-the-job
Training
N/A
Continuing
Education
10
hours/year
N/a
Begins
1-2-12
Federal
fingerprint
checks for
everyone
Begins
1-7-12
Begins
7-1-12
Determine the Impact
Orientation 2 hours
Safety 3 hours before
providing care
70 hours within 120 days
of hire
Workers who don’t meet
this deadline cannot
continue to work until
they complete training
and certification on their
own
Certification as home
care aide within 150
days
Not required.
If used, one
to twelve
hours
12
hours/year.
CE deadline
tied to
birthday
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Training Requirements
Orientation (OR) and Safety Training (SA) 5 hours
Orientation (2 hours)
Safety Training (2 hours)
Orientation topics include the care setting, job responsibilities, the Safety training topics include body mechanics, LTC worker
care plan and care team, client rights, documentation and
safety, accident prevention, emergency, disaster, and
reporting, mandatory reporting, and basic communication
evacuation preparedness, hand washing and gloves, infection
methods and techniques. DSHS must approve.
control and standard precautions, fire safety and prevention,
and fall prevention. DSHS must approve,
Basic Training (BT) 70 hours
Core Competencies
Population Specific Competencies
On-the-job Training
Competencies and skills needed to
provide personal care services effectively
and safely
For more on Core Competencies see
Emergency Rules:
WAC 388-71-0911
Competencies related to topics unique to the
care needs of the populations served
Not required. If used, one to twelve
training hours can be applied toward the
70 hour requirement after Jul 1, 2012
Topics can include: dementia, mental
health, developmental disabilities, young
adults with physical disabilities, aging and
older adults, children receiving services
under Chapter 71A RCW and Chapter 74.15
RCW, any other topic related to the unique
care needs of our clients
Detail: Basic Training must add up to 70 hours, must include core and population specific competencies, and curriculum and
instructors must be approved by DSHS.
Continuing Education (CE) 12 hours
Continuing education hours become tied to yearly certification
For non-certified or exempt staff, 12 hours of continuing
renewal for certified home care aides. The certification renewal education are required annually by 6-30-12 if their birthday is
date is the home care aide’s birthday
between 1-1-12 and 6-30-12, their actual birthday is after 7-1-12
CE’s must by taught by a qualified instructor: an RN or another DSHS must approve CE’s before use. DOH will perform random
person with specific knowledge, training and work experience
audits of persons who hold a home care aide credential. HCAC
in the provision of direct, hands-on personal care or other
must submit proof that you have completed 12 hours of
relevant services to the elderly or people with disabilities
continuing education. You can do this my providing a copy of
requiring long-term care
the certificate of complete for all continuing education courses
you completed.
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Home Care Aide Certification Requirements & Fees
Home Care Aide Certification Requirements and Fees
Who must be
Certified?
Providing Exempt proof
HCAC
Requirements
All LTC
workers (direct
care providers)
hired on or
after Jan 7,
2012 within
150 days of
hire
Obtain a letter from the
employer who employed them
between Jan 1, 2011 and Jan 6,
2012 that includes the
following: Date of Hire, Last of
work, job title and job
description, a description of the
training required on their date of
hire and verification that they
completed this training.
75 hours of training
of a DSHS
approved
curriculum and
program (see Basic
Training above)
If the worker received a
certificate of completion (COC)
for the training, they should
include a copy of the COC in
the file.
If an IP paid by DSHS, the
client is the employer. If there
are problems with obtaining
verification from the client, the
DSHS social worker of case
manager may be able to assist.
Successful
completion of the
certification exam
administered or
approved by the
department
An application,
submitted with
required
documentation and
fee, for certification
directly to the
department
Submit to a state
and fingerprint
based back group
check with the
DOH and
employers
Who Pays for
Certification?
What is the
cost?
The department
assumes no
financial
responsibility
Certification Examination fees
through Prometrix
First time tester:
Written Exam & Skills $115
Oral Exam & Skills $125
Application Fee:
$60
Certification
renewal fee:
$60.00 (annually
on birthdate)
Re-tester:
Skills Exam only $75
Written Exam only $40
Oral Exam only $50
Late penalty
renewal: $30.00
Expired
Certification
reactivation:
$30.00
Other:
Rescheduling Fee $25
Exam Review Session $40
Duplicate Score Report $10
Duplicate
certification:
$15.00
Verification of
certification:
$25.00
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Home Care Aide Certification Application Process
Background Check
& Fingerprinting
Submit Application
to Department of
Health (DOH)
•
•
•
•
•
•
Complete required
Training
•
•
•
•
Apply for the
Examination
through Prometrix
•
Taking the Home
Care Aide
Certification
Examination
•
•
•
•
•
•
•
•
•
Applicant completes background check, MMAH faxes complete background check to BCCU. When result is
received, the OCA number obtained and used to apply for fingerprinting (FBI) background check.
Applicant completes and submits Home Care Aide Certification Application to the Department of Health
WITHIN 3 DAYS OF HIRE, unless exempt
Uses OCA # from Fingerprinting background check
For application - http://www.doh.wa.gov/hsqa/HCAides/default.htm
DOH issues candidate number when they enter the Home Care Aide Certification Application into the
database. Once it is assigned, it is available at:
https://fortress.wa.gov/doh/providercredentialsearch/SearchCriteria.aspx
To obtain the long-term care worker’s candidate number, search by individual name, entering “home care
aide” in the credential type. Then enter the candidate’s last and first names in the designated boxes.
75 hours of training includes 2 hours of orientation and 3 hours of safety
By an approved instructor
With approved curriculum
With completion of the course, submit one copy of the 75-hour training to: DOH at Home Care Aide
Credentialing, PO Box 47877, Olympia, WA 98504-7877 retain another copy of your training for below
Apply for examination directly to the examination contractor, by completing the exam registration application
at the following web-site: http://www.prometric.com/WADOH/Default.htm
The candidate must include the DOH candidate number on the examination application, otherwise, the
application is incomplete and all application materials will be returned to the candidate
Submit payment and a copy of 75-hour training courses
Receive Admission to Test Letter (ATT letter) via email
Arrive 30 minutes before your scheduled exam appointment to sign in and for staff to verify your
identification
Bring with you: Admission to Test Letter (ATT) – it must be the original letter sent to you
Bring with you: Two valid forms of government issues identification (e.g. driver’s license, state issued
identification card, military identification card or passport) that contains: BOTH a current photo and your
signature, the name that exactly matches the names used to apply for the examination.
Bring with you: A second form of identification must include your name and signature. Examples of
acceptable second forms of identification include: library card, hunting license, social security care, or credit
card). Copies are not accepted.
If you do not provide correct identification at the time of the exam, if is considered a missed appointment. You
will be required to pay the entire exam fee in order to be scheduled for another exam.
Bring with you: a snack and/or lunch and a non-alcoholic beverages. While eating and drinking is not allowed
during the exam, you will be directed to areas where you are allowed to eat while waiting to test.
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Your Home Care Agency Name
•
•
•
Failing the Exam
Providing Care
Prior to
Certification
Meeting the 150 day
requirement
•
•
•
•
•
•
•
•
•
•
Disciplinary Action
•
•
•
Policies & Procedures
Read Candidate Information bulletin prior to testing.
The examination must be successfully completed or the applicant must retake the training
An application for re-examination can be submitted any time after the applicant receives notice of not passing
the exam
Persons who fail only one part of the examination (written/oral or skills) will be required to retake only that
portion of the examination
The candidate who fails only one portion of the exam will pay to retake only that portion of the examination
The applicant must successfully pass the examination in three tries or retake the training
Long Term Care workers can work before certification once they complete the five hours of safety and
orientation training
They must stop working if they have not received the home care aide certification within 150 days of hire
MMAH will request the background check immediately upon hire
The long-term care worker will apply for certification as soon as the employer gets the OCA# from the BCCU.
This is important since it can take four to six weeks to process the application
The applicant should enter and complete training as soon as possible. The law allows 120 days to complete the
training, doing so allows only 30 days completing the examination and obtaining certification.
Employers can check the provider credential search to assure that the DOH application has been received. The
candidate number should be in the system within two weeks from the date the DOH receives the application.
Home Care Aides are placed under the Uniform Disciplinary Act.
An application can be denied based on unprofessional conduct (including conviction data).
The department can also take action on a certification based on unprofessional conduct.
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Your Home Care Agency Name
Policies & Procedures
Training Curriculum Approval
If you plan on offering this course
Orientation, Safety Training
Submit this form:
(Submit a Training Program Application or Training Program Update form with any curriculum
forms you send to the department)
OR/SA Instructions Sheet
Instructions explaining what needs to be sent in to get these courses approved. There is no form required for
these courses.
DSHS has developed curriculum for these courses. Learn more.
Core Basic Training Using RFOC
w/enhancements
CB-RFOC Form
Core Basic Training Revised Fundamentals of Caregiving Enhancement Curriculum Approval
Use this form if you plan on using the current Revised Fundamentals of Caregiving (RFOC) and are
submitting your enhancements for approval.
CB-RFOC Instruction Sheet
An instruction outlining what is and is not considered enhancements to RFOC and tips for
developing curriculum. You are encouraged to review this Instruction Sheet before developing
curriculum.
New Core basic
Population Specific Basic Training
DSHS has developed a pre-approved three hour enhancement to RFOC on Navigating Through Challenging
Behaviors (PDF).
CB Form Core Basic Training Curriculum Approval
Use this form to submit a full Core Basic Training curriculum that does NOT use the Revised Fundamentals
of Caregiving.
PB Form Population Specific Training Curriculum Approval
Use this form to get population specific training approved.
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