Chapter 18.51 RCW

NURSING HOMES

Sections

18.51.005Purpose.
18.51.007Legislative intent.
18.51.009Resident rights.
18.51.010Definitions.
18.51.030License required.
18.51.040Application for license.
18.51.050LicenseIssuance, renewalFeeDisplay.
18.51.054Denial of license.
18.51.060PenaltiesGrounds.
18.51.062Temporary managersDepartment shall indemnify, defend, and hold harmless.
18.51.065PenaltiesHearing (as amended by 1989 c 175).
18.51.065PenaltiesHearing (as amended by 1989 c 372).
18.51.067License suspensionNoncompliance with support orderReissuance.
18.51.070Rules.
18.51.091Inspection of nursing homes and community-based servicesNotice of violationsApproval of alterations or new facilities.
18.51.140Fire protectionDuties of chief of the Washington state patrol.
18.51.145Building inspectionsAuthority of chief of the Washington state patrol.
18.51.150Operating without licensePenalty.
18.51.160Operating without licenseInjunction.
18.51.170Application of chapter to homes or institutions operated by certain religious organizations.
18.51.180Outpatient servicesAuthorizedDefined.
18.51.185Outpatient servicesCost studiesVendor rates.
18.51.190Complaint of violationRequest for inspectionNoticeConfidentiality.
18.51.200Preliminary review of complaintOn-site investigation.
18.51.210Authority to enter and inspect nursing homeAdvance noticeDefense.
18.51.220Retaliation or discrimination against complainant prohibited, penaltyPresumption.
18.51.230General inspection before license renewalRequiredAdvance notice prohibited.
18.51.240Alterations or additionsPreliminary inspection and approval.
18.51.250Nursing homes without violationsPublic agencies notifiedPriority.
18.51.260Posting citations for violation of RCW 18.51.060.
18.51.270Annual report of citationsPublicationContents.
18.51.280Chapter cumulative.
18.51.290Writings as public records.
18.51.300Retention and preservation of records of patients.
18.51.310Comprehensive plan for utilization reviewLicensing standardsRegulations.
18.51.320Contact with animalsRules.
18.51.350Conflict with federal requirements.
18.51.400ReceivershipLegislative findings.
18.51.410ReceivershipPetition to establishGrounds.
18.51.420ReceivershipDefenses to petition.
18.51.430ReceivershipPersons qualified to act as receiver.
18.51.440ReceivershipJudicial hearing.
18.51.450ReceivershipAppointment of receiver.
18.51.460ReceivershipTerminationConditions.
18.51.470ReceivershipAccounting of acts and expenditures by receiver.
18.51.480ReceivershipCompensation, liabilityRevision of medicaid reimbursement rate.
18.51.490ReceivershipPowers of receiver.
18.51.500ReceivershipFinancial assistanceUse of revenues and proceeds of facility.
18.51.510ReceivershipState medical assistance.
18.51.520ReceivershipForeclosures and seizures not allowed.
18.51.530Notice of change of ownership or management.
18.51.540Cost disclosure to attending physicians.
18.51.550Investigation of complaints of violations concerning nursing technicians.
18.51.560Employment of physicians.
18.51.920ConstructionChapter applicable to state registered domestic partnerships2009 c 521.

NOTES:

Assisted living facilities: Chapter 18.20 RCW.
Birthing centers: Chapter 18.46 RCW.
Employment of dental hygienist without supervision of dentist authorized: RCW 18.29.056.
Labor regulations, collective bargainingHealth care activities: Chapter 49.66 RCW.
Resident care, operating standards: Chapter 74.42 RCW.


18.51.005
Purpose.

The purpose of this chapter is to provide for the development, establishment, and enforcement of standards for the maintenance and operation of nursing homes, which, in the light of advancing knowledge, will promote safe and adequate care and treatment of the individuals therein. An important secondary purpose is the improvement of nursing home practices by educational methods so that such practices eventually exceed the minimum requirements of the basic law and its original standards.



18.51.007
Legislative intent.

It is the intent of the legislature in enacting chapter 99, Laws of 1975 1st ex. sess. to establish (1) a system for the imposition of prompt and effective sanctions against nursing homes in violation of the laws and regulations of this state relating to patient care; (2) an inspection and reporting system to insure that nursing homes are in compliance with state statutes and regulations pertaining to patient care; and (3) a mechanism to insure that licenses are issued to or retained by only those nursing homes that meet state standards for resident health and safety.

NOTES:

SeverabilityEffective dates1981 1st ex.s. c 2: See notes following RCW 18.51.010.



18.51.009
Resident rights.

RCW 70.129.007, 70.129.105, and 70.129.150 through 70.129.170 apply to this chapter and persons regulated under this chapter.

NOTES:

Conflict with federal requirements1994 c 214: See RCW 70.129.901.



18.51.010
Definitions.

(1) "Community-based care" means but is not limited to the following:
(a) Home delivered nursing services;
(b) Personal care;
(c) Day care;
(d) Nutritional services, both in-home and in a communal dining setting;
(e) Habilitation care; and
(f) Respite care.
(2) "Department" means the state department of social and health services.
(3) "Nursing home" means any home, place or institution which operates or maintains facilities providing convalescent or chronic care, or both, for a period in excess of twenty-four consecutive hours for three or more patients not related by blood or marriage to the operator, who by reason of illness or infirmity, are unable properly to care for themselves. Convalescent and chronic care may include but not be limited to any or all procedures commonly employed in waiting on the sick, such as administration of medicines, preparation of special diets, giving of bedside nursing care, application of dressings and bandages, and carrying out of treatment prescribed by a duly licensed practitioner of the healing arts. It may also include care of mentally incompetent persons. It may also include community-based care. Nothing in this definition shall be construed to include general hospitals or other places which provide care and treatment for the acutely ill and maintain and operate facilities for major surgery or obstetrics, or both. Nothing in this definition shall be construed to include any *assisted living facility, guest home, hotel or related institution which is held forth to the public as providing, and which is operated to give only board, room and laundry to persons not in need of medical or nursing treatment or supervision except in the case of temporary acute illness. The mere designation by the operator of any place or institution as a hospital, sanitarium, or any other similar name, which does not provide care for the acutely ill and maintain and operate facilities for major surgery or obstetrics, or both, shall not exclude such place or institution from the provisions of this chapter: PROVIDED, That any nursing home providing psychiatric treatment shall, with respect to patients receiving such treatment, comply with the provisions of RCW 71.12.560 and 71.12.570.
(4) "Person" means any individual, firm, partnership, corporation, company, association, or joint stock association, and the legal successor thereof.
(5) "Secretary" means the secretary of the department of social and health services.

NOTES:

Reviser's note: *(1) The term "boarding home" was changed to "assisted living facility" throughout the code by 2012 c 10. However, in this section, "assisted living facility" appears to be the incorrect term.
(2) The definitions in this section have been alphabetized pursuant to RCW 1.08.015(2)(k).
Application2012 c 10: See note following RCW 18.20.010.
Construction1983 c 236: "Nothing in this 1983 act affects the provisions of chapter 70.38 RCW." [ 1983 c 236 § 3.]
Severability1981 1st ex.s. c 2: "If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected." [ 1981 1st ex.s. c 2 § 28.]
Effective dates1981 1st ex.s. c 2: "This act is necessary for the immediate preservation of the public peace, health, and safety, the support of the state government and its existing public institutions. Sections 1, 2, 3, and 10 through 26 of this act shall take effect on July 1, 1981. Section 4 of this act shall take effect on July 1, 1983. Sections 5 through 9 of this act shall take effect on July 1, 1984." [ 1981 1st ex.s. c 2 § 27.]



18.51.030
License required.

After July 1, 1951 no person shall operate or maintain a nursing home in this state without a license under this chapter.



18.51.040
Application for license.

An application for license shall be made to the department upon forms provided by it and shall contain such information as the department reasonably requires, which may include affirmative evidence of ability to comply with the rules and regulations as are lawfully prescribed hereunder.



18.51.050
License—Issuance, renewal—Fee—Display.

(1)(a) Upon receipt of an application for a license, the department may issue a license if the applicant and the nursing home's facilities meet the requirements established under this chapter, except that the department shall issue a temporary license to a court-appointed receiver for a period not to exceed six months from the date of appointment.
(b)(i) Except as provided in (b)(ii) of this subsection, prior to the issuance or renewal of the license, the licensee shall pay a license fee. Beginning July 1, 2011, and thereafter, the per bed license fee must be established in the omnibus appropriations act and any amendment or additions made to that act. The license fees established in the omnibus appropriations act and any amendment or additions made to that act may not exceed the department's annual licensing and oversight activity costs and shall include the department's cost of paying providers for the amount of the license fee attributed to medicaid clients.
(ii) No fee shall be required of government operated institutions or court-appointed receivers.
(c) A license issued under this chapter may not exceed twelve months in duration and expires on a date set by the department.
(d) In the event of a change of ownership, the previously established license expiration date shall not change.
(2) All applications and fees for renewal of the license shall be submitted to the department not later than thirty days prior to the date of expiration of the license. All applications and fees, if any, for change of ownership shall be submitted to the department not later than sixty days before the date of the proposed change of ownership. A nursing home license shall be issued only to the person who applied for the license. The license is valid only for the operation of the facility at the location specified in the license application. Licenses are not transferable or assignable. Licenses shall be posted in a conspicuous place on the licensed premises.

NOTES:

Effective date2011 1st sp.s. c 3 §§ 401-403: "Sections 401 through 403 of this act are necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and take effect July 1, 2011." [ 2011 1st sp.s. c 3 § 603.]
FindingIntent2011 1st sp.s. c 3: See note following RCW 70.128.005.
Effective date1991 sp.s. c 8: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect July 1, 1991." [ 1991 sp.s. c 8 § 21.]
SeverabilityEffective dates1981 1st ex.s. c 2: See notes following RCW 18.51.010.



18.51.054
Denial of license.

The department may deny a license to any applicant if the department finds that the applicant or any partner, officer, director, managerial employee, or owner of five percent or more of the applicant:
(1) Operated a nursing home without a license or under a revoked or suspended license; or
(2) Knowingly or with reason to know made a false statement of a material fact (a) in an application for license or any data attached thereto, or (b) in any matter under investigation by the department; or
(3) Refused to allow representatives or agents of the department to inspect (a) all books, records, and files required to be maintained or (b) any portion of the premises of the nursing home; or
(4) Willfully prevented, interfered with, or attempted to impede in any way (a) the work of any authorized representative of the department or (b) the lawful enforcement of any provision of this chapter or chapter 74.42 RCW; or
(5) Has a history of significant noncompliance with federal or state regulations in providing nursing home care. In deciding whether to deny a license under this section, the factors the department considers shall include the gravity and frequency of the noncompliance.



18.51.060
Penalties—Grounds.

(1) In any case in which the department finds that a licensee, or any partner, officer, director, owner of five percent or more of the assets of the nursing home, or managing employee failed or refused to comply with the requirements of this chapter or of chapter 74.42 RCW, or the standards, rules, and regulations established under them or, in the case of a medicaid contractor, failed or refused to comply with the medicaid requirements of Title XIX of the social security act, as amended, and regulations promulgated thereunder, the department may take any or all of the following actions:
(a) Suspend, revoke, or refuse to renew a license;
(b) Order stop placement;
(c) Assess monetary penalties of a civil nature;
(d) Deny payment to a nursing home for any medicaid resident admitted after notice to deny payment. Residents who are medicaid recipients shall not be responsible for payment when the department takes action under this subsection;
(e) Appoint temporary management as provided in subsection (7) of this section.
(2) The department may suspend, revoke, or refuse to renew a license, assess monetary penalties of a civil nature, or both, in any case in which it finds that the licensee, or any partner, officer, director, owner of five percent or more of the assets of the nursing home, or managing employee:
(a) Operated a nursing home without a license or under a revoked or suspended license; or
(b) Knowingly or with reason to know made a false statement of a material fact in his or her application for license or any data attached thereto, or in any matter under investigation by the department; or
(c) Refused to allow representatives or agents of the department to inspect all books, records, and files required to be maintained or any portion of the premises of the nursing home; or
(d) Willfully prevented, interfered with, or attempted to impede in any way the work of any duly authorized representative of the department and the lawful enforcement of any provision of this chapter or of chapter 74.42 RCW; or
(e) Willfully prevented or interfered with any representative of the department in the preservation of evidence of any violation of any of the provisions of this chapter or of chapter 74.42 RCW or the standards, rules, and regulations adopted under them; or
(f) Failed to report patient abuse or neglect in violation of chapter 70.124 RCW; or
(g) Fails to pay any civil monetary penalty assessed by the department pursuant to this chapter within ten days after such assessment becomes final.
(3) The department shall deny payment to a nursing home having a medicaid contract with respect to any medicaid-eligible individual admitted to the nursing home when:
(a) The department finds the nursing home not in compliance with the requirements of Title XIX of the social security act, as amended, and regulations promulgated thereunder, and the facility has not complied with such requirements within three months; in such case, the department shall deny payment until correction has been achieved; or
(b) The department finds on three consecutive standard surveys that the nursing home provided substandard quality of care; in such case, the department shall deny payment for new admissions until the facility has demonstrated to the satisfaction of the department that it is in compliance with medicaid requirements and that it will remain in compliance with such requirements.
(4)(a) Civil penalties collected under this section or under chapter 74.42 RCW shall be deposited into a special fund administered by the department to be applied to the protection of the health or property of residents of nursing homes found to be deficient, including payment for the costs of relocation of residents to other facilities, maintenance of operation of a facility pending correction of deficiencies or closure, and reimbursement of residents for personal funds lost.
(b) Civil monetary penalties, if imposed, may be assessed and collected, with interest, for each day a nursing home is or was out of compliance. Civil monetary penalties shall not exceed three thousand dollars per violation. Each day upon which the same or a substantially similar action occurs is a separate violation subject to the assessment of a separate penalty.
(c) Any civil penalty assessed under this section or chapter 74.46 RCW shall be a nonreimbursable item under chapter 74.46 RCW.
(5)(a) The department shall order stop placement on a nursing home, effective upon oral or written notice, when the department determines:
(i) The nursing home no longer substantially meets the requirements of chapter 18.51 or 74.42 RCW, or in the case of medicaid contractors, the requirements of Title XIX of the social security act, as amended, and any regulations promulgated under such statutes; and
(ii) The deficiency or deficiencies in the nursing home:
(A) Jeopardize the health and safety of the residents, or
(B) Seriously limit the nursing home's capacity to provide adequate care.
(b) When the department has ordered a stop placement, the department may approve a readmission to the nursing home from a hospital when the department determines the readmission would be in the best interest of the individual seeking readmission.
(c) The department shall terminate the stop placement when:
(i) The provider states in writing that the deficiencies necessitating the stop placement action have been corrected; and
(ii) The department staff confirms in a timely fashion not to exceed fifteen working days that:
(A) The deficiencies necessitating stop placement action have been corrected, and
(B) The provider exhibits the capacity to maintain adequate care and service.
(d) A nursing home provider shall have the right to an informal review to present written evidence to refute the deficiencies cited as the basis for the stop placement. A request for an informal review must be made in writing within ten days of the effective date of the stop placement.
(e) A stop placement shall not be delayed or suspended because the nursing home requests a hearing pursuant to chapter 34.05 RCW or an informal review. The stop placement shall remain in effect until:
(i) The department terminates the stop placement; or
(ii) The stop placement is terminated by a final agency order, after a hearing, pursuant to chapter 34.05 RCW.
(6) If the department determines that an emergency exists as a result of a nursing home's failure or refusal to comply with requirements of this chapter or, in the case of a medicaid contractor, its failure or refusal to comply with medicaid requirements of Title XIX of the social security act, as amended, and rules adopted thereunder, the department may suspend the nursing home's license and order the immediate closure of the nursing home, the immediate transfer of residents, or both.
(7) If the department determines that the health or safety of residents is immediately jeopardized as a result of a nursing home's failure or refusal to comply with requirements of this chapter or, in the case of a medicaid contractor, its failure or refusal to comply with medicaid requirements of Title XIX of the social security act, as amended, and rules adopted thereunder, the department may appoint temporary management to:
(a) Oversee the operation of the facility; and
(b) Ensure the health and safety of the facilities residents while:
(i) Orderly closure of the facility occurs; or
(ii) The deficiencies necessitating temporary management are corrected.
(8) The department shall by rule specify criteria as to when and how the sanctions specified in this section shall be applied. Such criteria shall provide for the imposition of incrementally more severe penalties for deficiencies that are repeated, uncorrected, pervasive, or present a threat to the health, safety, or welfare of the residents.

NOTES:

SeverabilityEffective dates1981 1st ex.s. c 2: See notes following RCW 18.51.010.



18.51.062
Temporary managers—Department shall indemnify, defend, and hold harmless.

The department shall indemnify, defend, and hold harmless any temporary manager appointed and acting under RCW 18.51.060(7) against claims made against the temporary manager for any actions by the temporary manager or its agents that do not amount to intentional torts or criminal behavior.



18.51.065
Penalties—Hearing (as amended by 1989 c 175).

((All orders of the department denying, suspending, or revoking the license or assessing a monetary penalty shall become final twenty days after the same has been served upon the applicant or licensee unless a hearing is requested. All hearings hereunder and judicial review of such determinations shall be in accordance with the administrative procedure act, chapter 34.04 RCW.)) RCW 43.20A.205 governs notice of a license denial, revocation, suspension, or modification and provides the right to an adjudicative proceeding. RCW 43.20A.215 governs notice of a civil fine and provides the right to an adjudicative proceeding.

NOTES:

Effective date1989 c 175: See note following RCW 34.05.010.

PenaltiesHearing (as amended by 1989 c 372).

(1) All orders of the department denying, suspending, or revoking the license or assessing a monetary penalty shall become final twenty days after the same has been served upon the applicant or licensee unless a hearing is requested. All orders of the department imposing stop placement, temporary management, emergency closure, emergency transfer, or license suspension, shall be effective immediately upon notice. Orders of the department imposing denial of payment shall become final twenty days after the same has been served, unless a hearing is requested, except that such orders shall be effective immediately upon notice and pending any hearing when the department determines the deficiencies jeopardize the health and safety of the residents or seriously limit the nursing home's capacity to provide adequate care. All hearings hereunder and judicial review of such determinations shall be in accordance with the administrative procedure act, chapter ((34.04)) 34.05 RCW, except that all orders of the department imposing stop placement, temporary management, emergency closure, emergency transfer, or license suspension shall be effective pending any hearing, and except that chapter 34.05 RCW shall have no application to receivership, which is instituted by direct petition to superior court as provided for in RCW 18.51.410 through 18.51.520.

NOTES:

Reviser's note: RCW 18.51.065 was amended twice during the 1989 legislative session, each without reference to the other. For rule of construction concerning sections amended more than once during the same legislative session, see RCW 1.12.025.
SeverabilityEffective dates1981 1st ex.s. c 2: See notes following RCW 18.51.010.



18.51.067
License suspension—Noncompliance with support order—Reissuance.

The department shall immediately suspend the license of a person who has been certified pursuant to RCW 74.20A.320 by the department of social and health services, division of [child] support, as a person who is not in compliance with a child support order or a *residential or visitation order. If the person has continued to meet all other requirements for reinstatement during the suspension, reissuance of the license shall be automatic upon the department's receipt of a release issued by the division of child support stating that the person is in compliance with the order.

NOTES:

*Reviser's note: 1997 c 58 § 886 requiring a court to order certification of noncompliance with residential provisions of a court-ordered parenting plan was vetoed. Provisions ordering the department of social and health services to certify a responsible parent based on a court order to certify for noncompliance with residential provisions of a parenting plan were vetoed. See RCW 74.20A.320.
Short titlePart headings, captions, table of contents not lawExemptions and waivers from federal lawConflict with federal requirementsSeverability1997 c 58: See RCW 74.08A.900 through 74.08A.904.
Effective datesIntent1997 c 58: See notes following RCW 74.20A.320.



18.51.070
Rules.

The department, after consultation with the board of health, shall adopt, amend, and promulgate such rules, regulations, and standards with respect to all nursing homes to be licensed hereunder as may be designed to further the accomplishment of the purposes of this chapter in promoting safe and adequate medical and nursing care of individuals in nursing homes and the sanitary, hygienic, and safe conditions of the nursing home in the interest of public health, safety, and welfare.

NOTES:

Effective date1979 ex.s. c 211 § 64: "Section 64 of this 1979 act is necessary for the immediate preservation of the public peace, health, and safety, the support of the state government and its existing public institutions, and shall take effect immediately [May 30, 1979]." [ 1979 ex.s. c 211 § 71.]



18.51.091
Inspection of nursing homes and community-based services—Notice of violations—Approval of alterations or new facilities.

The department shall make or cause to be made at least one inspection of each nursing home prior to license renewal and shall inspect community-based services as part of the licensing renewal survey. The inspection shall be made without providing advance notice of it. Every inspection may include an inspection of every part of the premises and an examination of all records, methods of administration, the general and special dietary and the stores and methods of supply. Those nursing homes that provide community-based care shall establish and maintain separate and distinct accounting and other essential records for the purpose of appropriately allocating costs of the providing of such care: PROVIDED, That such costs shall not be considered allowable costs for reimbursement purposes under chapter 74.46 RCW. Following such inspection or inspections, written notice of any violation of this law or the rules and regulations promulgated hereunder, shall be given the applicant or licensee and the department. The notice shall describe the reasons for the facility's noncompliance. The department may prescribe by regulations that any licensee or applicant desiring to make specified types of alterations or additions to its facilities or to construct new facilities shall, before commencing such alteration, addition or new construction, submit its plans and specifications therefor to the department for preliminary inspection and approval or recommendations with respect to compliance with the regulations and standards herein authorized.

NOTES:

Construction1983 c 236: See note following RCW 18.51.010.
Effective date1979 ex.s. c 211: See RCW 74.42.920.
Nursing home standards: Chapter 74.42 RCW.



18.51.140
Fire protection—Duties of chief of the Washington state patrol.

Standards for fire protection and the enforcement thereof, with respect to all nursing homes to be licensed hereunder, shall be the responsibility of the chief of the Washington state patrol, through the director of fire protection, who shall adopt such recognized standards as may be applicable to nursing homes for the protection of life against the cause and spread of fire and fire hazards. The department upon receipt of an application for a license, shall submit to the chief of the Washington state patrol, through the director of fire protection, in writing, a request for an inspection, giving the applicant's name and the location of the premises to be licensed. Upon receipt of such a request, the chief of the Washington state patrol, through the director of fire protection, or his or her deputy, shall make an inspection of the nursing home to be licensed, and if it is found that the premises do not comply with the required safety standards and fire regulations as promulgated by the chief of the Washington state patrol, through the director of fire protection, he or she shall promptly make a written report to the nursing home and the department as to the manner and time allowed in which the premises must qualify for a license and set forth the conditions to be remedied with respect to fire regulations. The department, applicant or licensee shall notify the chief of the Washington state patrol, through the director of fire protection, upon completion of any requirements made by him or her, and the chief of the Washington state patrol, through the director of fire protection, or his or her deputy, shall make a reinspection of such premises. Whenever the nursing home to be licensed meets with the approval of the chief of the Washington state patrol, through the director of fire protection, he or she shall submit to the department, a written report approving same with respect to fire protection before a full license can be issued. The chief of the Washington state patrol, through the director of fire protection, shall make or cause to be made inspections of such nursing homes at least every eighteen months.
In cities which have in force a comprehensive building code, the provisions of which are determined by the chief of the Washington state patrol, through the director of fire protection, to be equal to the minimum standards of the code for nursing homes adopted by the chief of the Washington state patrol, through the director of fire protection, the chief of the fire department, provided the latter is a paid chief of a paid fire department, shall make the inspection with the chief of the Washington state patrol, through the director of fire protection, or his or her deputy and they shall jointly approve the premises before a full license can be issued.

NOTES:

Conflict with federal requirementsSeverabilityEffective date1995 1st sp.s. c 18: See notes following RCW 74.39A.030.
Effective date1995 c 369: See note following RCW 43.43.930.
Severability1986 c 266: See note following RCW 38.52.005.
State fire protection: Chapter 43.44 RCW.



18.51.145
Building inspections—Authority of chief of the Washington state patrol.

Inspections of nursing homes by local authorities shall be consistent with the requirements of chapter 19.27 RCW, the state building code. Findings of a serious nature shall be coordinated with the department and the chief of the Washington state patrol, through the director of fire protection, for determination of appropriate actions to ensure a safe environment for nursing home residents. The chief of the Washington state patrol, through the director of fire protection, shall have exclusive authority to determine appropriate corrective action under this section.

NOTES:

Effective date1995 c 369: See note following RCW 43.43.930.
Severability1986 c 266: See note following RCW 38.52.005.
Effective dates1983 1st ex.s. c 67: See note following RCW 74.46.475.
SeverabilityEffective dates1981 1st ex.s. c 2: See notes following RCW 18.51.010.
Conflict with federal requirements and this section: RCW 74.46.840.



18.51.150
Operating without license—Penalty.

Any person operating or maintaining any nursing home without a license under this chapter shall be guilty of a misdemeanor and each day of a continuing violation after conviction shall be considered a separate offense.



18.51.160
Operating without license—Injunction.

Notwithstanding the existence or use of any other remedy, the department, may, in the manner provided by law, upon the advice of the attorney general who shall represent the department in the proceedings, maintain an action in the name of the state for an injunction or other process against any person to restrain or prevent the operation or maintenance of a nursing home without a license under this chapter.

NOTES:

Injunctions: Chapter 7.40 RCW.



18.51.170
Application of chapter to homes or institutions operated by certain religious organizations.

Nothing in this chapter or the rules and regulations adopted pursuant thereto shall be construed as authorizing the supervision, regulation, or control of the remedial care or treatment of residents or patients in any nursing home or institution conducted for those who rely upon treatment by prayer or spiritual means in accordance with the creed or tenets of any well-recognized church or religious denomination, or for any nursing home or institution operated for the exclusive care of members of a convent as defined in RCW 84.36.800 or rectory, monastery, or other institution operated for the care of members of the clergy.



18.51.180
Outpatient services—Authorized—Defined.

A nursing home may, pursuant to rules and regulations adopted by the department of social and health services, offer outpatient services to persons who are not otherwise patients at such nursing home. Any certified nursing home offering outpatient services may receive payments from the federal medicare program for such services as are permissible under that program.
Outpatient services may include any health or social care needs, except surgery, that could feasibly be offered on an outpatient basis.



18.51.185
Outpatient services—Cost studies—Vendor rates.

The department of social and health services shall assist the nursing home industry in researching the costs of outpatient services allowed under RCW 18.51.180. Such cost studies shall be utilized by the department in the determination of reasonable vendor rates for nursing homes offering such services to insure an adequate return to the nursing homes and a cost savings to the state as compared to the cost of institutionalization.



18.51.190
Complaint of violation—Request for inspection—Notice—Confidentiality.

Any person may request an inspection of any nursing home subject to licensing under this chapter in accordance with the provisions of this chapter by giving notice to the department of an alleged violation of applicable requirements of state law. The complainant shall be encouraged to submit a written, signed complaint following a verbal report. The substance of the complaint shall be provided to the licensee no earlier than at the commencement of the inspection. Neither the substance of the complaint provided the licensee nor any copy of the complaint or record published, released, or otherwise made available to the licensee shall disclose the name of any individual complainant or other person mentioned in the complaint, except the name or names of any duly authorized officer, employee, or agent of the department conducting the investigation or inspection pursuant to this chapter, unless such complainant specifically requests the release of such name or names.

NOTES:

SeverabilityEffective dates1981 1st ex.s. c 2: See notes following RCW 18.51.010.



18.51.200
Preliminary review of complaint—On-site investigation.

Upon receipt of a complaint, the department shall make a preliminary review of the complaint. Unless the department determines that the complaint is willfully intended to harass a licensee or is without any reasonable basis, or unless the department has sufficient information that corrective action has been taken, it shall make an on-site investigation within a reasonable time after the receipt of the complaint or otherwise ensure complaints are responded to. In either event, the complainant shall be promptly informed of the department's proposed course of action. If the complainant requests the opportunity to do so, the complainant or his or her representative, or both, may be allowed to accompany the inspector to the site of the alleged violations during his or her tour of the facility, unless the inspector determines that the privacy of any patient would be violated thereby.

NOTES:

SeverabilityEffective dates1981 1st ex.s. c 2: See notes following RCW 18.51.010.



18.51.210
Authority to enter and inspect nursing home—Advance notice—Defense.

(1) Any duly authorized officer, employee, or agent of the department may enter and inspect any nursing home, including, but not limited to, interviewing residents and reviewing records, at any time to enforce any provision of this chapter. Inspections conducted pursuant to complaints filed with the department shall be conducted in such a manner as to ensure maximum effectiveness. No advance notice shall be given of any inspection conducted pursuant to this chapter unless previously and specifically authorized by the secretary or required by federal law.
(2) Any public employee giving such advance notice in violation of this section shall be suspended from all duties without pay for a period of not less than five nor more than fifteen days.
(3) In any hearing held pursuant to this chapter, it shall be a defense to a violation relating to the standard of care to be afforded public patients to show that the department does not provide reasonable funds to meet the cost of reimbursement standard allegedly violated.

NOTES:

SeverabilityEffective dates1981 1st ex.s. c 2: See notes following RCW 18.51.010.



18.51.220
Retaliation or discrimination against complainant prohibited, penalty—Presumption.

(1) No licensee shall discriminate or retaliate in any manner against a patient or employee in its nursing home on the basis or for the reason that such patient or employee or any other person has initiated or participated in any proceeding specified in this chapter. A licensee who violates this section is subject to a civil penalty of not more than three thousand dollars.
(2) Any attempt to expel a patient from a nursing home, or any type of discriminatory treatment of a patient by whom, or upon whose behalf, a complaint has been submitted to the department or any proceeding instituted under or related to this chapter within one year of the filing of the complaint or the institution of such action, shall raise a rebuttable presumption that such action was taken by the licensee in retaliation for the filing of the complaint.



18.51.230
General inspection before license renewal—Required—Advance notice prohibited.

The department shall, in addition to any inspections conducted pursuant to complaints filed pursuant to RCW 18.51.190, conduct at least one general inspection prior to license renewal of all nursing homes in the state without providing advance notice of such inspection. Periodically, such inspection shall take place in part between the hours of 7 p.m. and 5 a.m. or on weekends.



18.51.240
Alterations or additions—Preliminary inspection and approval.

The department may prescribe by regulations that any licensee or applicant desiring to make specific types of alterations or additions to its facilities or to construct new facilities shall, before commencing such alteration, addition or new construction, submit its plans and specifications therefor to the department for preliminary inspection and approval or recommendations with respect to compliance with the regulations and standards herein authorized.

NOTES:

SeverabilityEffective dates1981 1st ex.s. c 2: See notes following RCW 18.51.010.



18.51.250
Nursing homes without violations—Public agencies notified—Priority.

On or before February 1st of each year, the department shall notify all public agencies which refer patients to nursing homes of all of the nursing homes in the area found upon inspection within the previous twelve-month period to be without violations. Public agencies shall give priority to such nursing homes in referring publicly assisted patients.



18.51.260
Posting citations for violation of RCW 18.51.060.

Each citation for a violation specified in RCW 18.51.060 which is issued pursuant to this section and which has become final, or a copy or copies thereof, shall be prominently posted, as prescribed in regulations issued by the director, until the violation is corrected to the satisfaction of the department up to a maximum of one hundred twenty days. The citation or copy shall be posted in a place or places in plain view of the patients in the nursing home, persons visiting those patients, and persons who inquire about placement in the facility.



18.51.270
Annual report of citations—Publication—Contents.

The department shall annually publish a report listing all licensees by name and address, indicating (1) the number of citations and the nature of each citation issued to each licensee during the previous twelve-month period and the status of any action taken pursuant to each citation, including penalties assessed, and (2) the nature and status of action taken with respect to each uncorrected violation for which a citation is outstanding.
The report shall be available to the public, at cost, at all offices of the department.



18.51.280
Chapter cumulative.

The remedies provided by this chapter are cumulative, and shall not be construed as restricting any remedy, provisional or otherwise, provided by law for the benefit of any party, and no judgment under this chapter shall preclude any party from obtaining additional relief based upon the same facts.



18.51.290
Writings as public records.

Any writing received, owned, used, or retained by the department in connection with the provisions of this chapter is a public record and, as such, is open to public inspection. Copies of such records provided for public inspection shall comply with RCW 42.56.070(1). The names of duly authorized officers, employees, or agents of the department shall be included.

NOTES:

Conflict with federal requirements1980 c 184: See RCW 74.42.630.



18.51.300
Retention and preservation of records of patients.

Unless specified otherwise by the department, a nursing home shall retain and preserve all records which relate directly to the care and treatment of a patient for a period of no less than eight years following the most recent discharge of the patient; except the records of minors, which shall be retained and preserved for a period of no less than three years following attainment of the age of eighteen years, or ten years following such discharge, whichever is longer.
If a nursing home ceases operations, it shall make immediate arrangements, as approved by the department, for preservation of its records.
The department shall by regulation define the type of records and the information required to be included in the records to be retained and preserved under this section; which records may be retained in photographic form pursuant to chapter 5.46 RCW.

NOTES:

Conflict with federal requirementsSeverabilityEffective date1995 1st sp.s. c 18: See notes following RCW 74.39A.030.
SeverabilityEffective dates1981 1st ex.s. c 2: See notes following RCW 18.51.010.



18.51.310
Comprehensive plan for utilization review—Licensing standards—Regulations.

(1) The department shall establish, in compliance with federal and state law, a comprehensive plan for utilization review as necessary to safeguard against unnecessary utilization of care and services and to assure quality care and services provided to nursing facility residents.
(2) The department shall adopt licensing standards suitable for implementing the civil penalty system authorized under this chapter and chapter 74.46 RCW.
(3) No later than July 1, 1981, the department shall adopt all those regulations which meet all conditions necessary to fully implement the civil penalty system authorized by this chapter, chapter 74.42 RCW, and chapter 74.46 RCW.

NOTES:

Effective date1991 sp.s. c 8: See note following RCW 18.51.050.
SeverabilityEffective dates1981 1st ex.s. c 2: See notes following RCW 18.51.010.
Conflict with federal requirements1980 c 184: See RCW 74.42.630.
Effective date1979 ex.s. c 211: See RCW 74.42.920.



18.51.320
Contact with animals—Rules.

(1) A nursing home licensee shall give each patient a reasonable opportunity to have regular contact with animals. The licensee may permit appropriate animals to live in the facilities and may permit appropriate animals to visit if the animals are properly supervised.
(2) The department shall adopt rules for the care, type, and maintenance of animals in nursing home facilities.

NOTES:

Intent1984 c 127: "The legislature finds that the senior citizens of this state, particularly those living in low-income public housing or in nursing homes, often lead lonely and harsh lives. The legislature recognizes that the warmth and companionship provided by pets can significantly improve the quality of senior citizens' lives. This legislation is intended to insure that senior citizens and persons in nursing homes will not be deprived of access to pets." [ 1984 c 127 § 1.]



18.51.350
Conflict with federal requirements.

If any part of this chapter is found to conflict with federal requirements which are a prescribed condition to the allocation of federal funds to the state, the conflicting part of this chapter is hereby declared to be inoperative solely to the extent of the conflict, and such finding or determination shall not affect the operation of the remainder of this chapter.



18.51.400
Receivership—Legislative findings.

The legislature finds that the closure of a nursing home can have devastating effects on residents and, under certain circumstances, courts should consider placing nursing homes in receivership. As receivership has long existed as a remedy to preserve assets subject to litigation and to reorganize troubled affairs, the legislature finds that receivership is to be used to correct problems associated with either the disregard of residents' health, safety, or welfare or with the possible closure of the nursing home for any reason.



18.51.410
Receivership—Petition to establish—Grounds.

A petition to establish a receivership shall allege that one or more of the following conditions exist and that the current operator has demonstrated an inability or unwillingness to take actions necessary to immediately correct the conditions alleged:
(1) The facility is operating without a license;
(2) The facility has not given the department prior written notice of its intent to close and has not made arrangements within thirty days before closure for the orderly transfer of its residents: PROVIDED, That if the facility has given the department prior written notice but the department has not acted with all deliberate speed to transfer the facility's residents, this shall bar the filing of a petition under this subsection;
(3) The health, safety, or welfare of the facility's residents is immediately jeopardized;
(4) The facility demonstrates a pattern and practice of violating chapter 18.51 or 74.42 RCW and rules adopted thereunder such that the facility has demonstrated a repeated inability to maintain minimum patient care standards; or
(5) The facility demonstrates a pattern or practice of violating a condition level as defined by the federal government under the authority of Title XIX of the social security act.
The department may file a petition in the superior court in the county in which the nursing home is located or in the superior court of Thurston county. The current or former operator or licensee and the owner of the nursing home, if different than the operator or licensee, shall be made a party to the action. The court shall grant the petition if it finds, by a preponderance of the evidence, that one or more of the conditions listed in subsections (1) through (5) of this section exists and, subject to RCW 18.51.420, that the current operator is unable or unwilling to take actions necessary to immediately correct the conditions.



18.51.420
Receivership—Defenses to petition.

It shall be a defense to the petition to establish a receivership that the conditions alleged do not in fact exist. It shall not be a defense to the petition to allege that the respondent did not possess knowledge of the alleged condition or could not have been reasonably expected to know about the alleged condition. In a petition that alleges that the health, safety, or welfare of the residents of the facility is at issue, it shall not be a defense to the petition that the respondent had not been afforded a reasonable opportunity to correct the alleged condition.



18.51.430
Receivership—Persons qualified to act as receiver.

A petition for receivership shall include the name of the candidate for receiver. The department shall maintain a list of qualified persons to act as receivers, however, no person may be considered to be qualified to be a receiver who:
(1) Is the owner, licensee, or administrator of the facility;
(2) Is affiliated with the facility;
(3) Has a financial interest in the facility at the time the receiver is appointed; or
(4) Has owned or operated a nursing home that has been ordered into receivership.
If a receiver is appointed, he or she may be drawn from the list but need not be, but an appointee shall have experience in providing long-term health care and a history of satisfactory operation of a nursing home. Preference may be granted to persons expressing an interest in permanent operation of the facility.



18.51.440
Receivership—Judicial hearing.

Upon receipt of a petition for receivership, the court shall hear the matter within fourteen days. Temporary relief may be obtained under chapter 7.40 RCW and other applicable laws. In all actions arising under RCW 18.51.410 through 18.51.530, the posting of a certified copy of the summons and petition in a conspicuous place in the nursing home shall constitute service of those documents upon the respondent.



18.51.450
Receivership—Appointment of receiver.

Upon agreement of the candidate for receiver to the terms of the receivership and any special instructions of the court, the court may appoint that person as receiver of the nursing home if the court determines it is likely that a permanent operator will be found or conditions will be corrected without undue risk of harm to the patients. Appointment of a receiver may be in lieu of or in addition to temporary removal of some or all of the patients in the interests of their health, security, or welfare. A receiver shall be appointed for a term not to exceed six months, but a term may be extended for good cause shown.



18.51.460
Receivership—Termination—Conditions.

(1) The receivership shall terminate:
(a) When all deficiencies have been eliminated and the court determines that the facility has the management capability to ensure continued compliance with all requirements; or
(b) When all residents have been transferred and the facility closed.
(2) Upon the termination of a receivership, the court may impose conditions to assure the continued compliance with chapters 18.51 and 74.42 RCW, and, in the case of medicaid contractors, continued compliance with Title XIX of the social security act, as amended, and regulations promulgated thereunder.



18.51.470
Receivership—Accounting of acts and expenditures by receiver.

The receiver shall render to the court an accounting of acts performed and expenditures made during the receivership. Nothing in this section relieves a court-appointed receiver from the responsibility of making all reports and certifications to the department required by law and regulation relating to the receiver's operation of the nursing home, the care of its residents, and participation in the medicaid program, if any.



18.51.480
Receivership—Compensation, liability—Revision of medicaid reimbursement rate.

If a receiver is appointed, the court shall set reasonable compensation for the receiver to be paid from operating revenues of the nursing home. The receiver shall be liable in his or her personal capacity only for negligent acts, intentional acts, or a breach of a fiduciary duty to either the residents of the facility or the current or former licensee or owner of the facility.
The department may revise the nursing home's medicaid reimbursement rate, consistent with reimbursement principles in chapter 74.46 RCW and rules adopted under that chapter, if revision is necessary to cover the receiver's compensation and other reasonable costs associated with the receivership and transition of control. Rate revision may also be granted if necessary to cover start-up costs and costs of repairs, replacements, and additional staff needed for patient health, security, or welfare. The property return on investment components of the medicaid rate shall be established for the receiver consistent with reimbursement principles in chapter 74.46 RCW. The department may also expedite the issuance of necessary licenses, contracts, and certifications, temporary or otherwise, necessary to carry out the purposes of receivership.



18.51.490
Receivership—Powers of receiver.

Upon appointment of a receiver, the current or former licensee or operator and managing agent, if any, shall be divested of possession and control of the nursing home in favor of the receiver who shall have full responsibility and authority to continue operation of the home and the care of the residents. The receiver may perform all acts reasonably necessary to carry out the purposes of receivership, including, but not limited to:
(1) Protecting the health, security, and welfare of the residents;
(2) Remedying violations of state and federal law and regulations governing the operation of the home;
(3) Hiring, directing, managing, and discharging all consultants and employees for just cause; discharging the administrator of the nursing home; recognizing collective bargaining agreements; and settling labor disputes;
(4) Receiving and expending in a prudent manner all revenues and financial resources of the home; and
(5) Making all repairs and replacements needed for patient health, security, and welfare: PROVIDED, That expenditures for repairs or replacements in excess of five thousand dollars shall require approval of the court which shall expedite approval or disapproval for such expenditure.
Upon order of the court, a receiver may not be required to honor leases, mortgages, secured transactions, or contracts if the rent, price, or rate of interest was not a reasonable rent, price, or rate of interest at the time the contract was entered into or if a material provision of the contract is unreasonable.



18.51.500
Receivership—Financial assistance—Use of revenues and proceeds of facility.

Upon order of the court, the department shall provide emergency or transitional financial assistance to a receiver not to exceed thirty thousand dollars. The receiver shall file with the court an accounting for any money expended. Any emergency or transitional expenditure made by the department on behalf of a nursing home not certified to participate in the Medicaid Title XIX program shall be recovered from revenue generated by the facility which revenue is not obligated to the operation of the facility. An action to recover such sums may be filed by the department against the former licensee or owner at the time the expenditure is made, regardless of whether the facility is certified to participate in the Medicaid Title XIX program or not.
In lieu of filing an action, the department may file a lien on the facility or on the proceeds of the sale of the facility. Such a lien shall take priority over all other liens except for liens for wages to employees. The owner of the facility shall be entitled to the proceeds of the facility or the sale of the facility to the extent that these exceed the liabilities of the facility, including liabilities to the state, receiver, employees, and contractors, at the termination of the receivership.
Revenues relating to services provided by the current or former licensee, operator, or owner and available operating funds belonging to such licensee, operator, or owner shall be under the control of the receiver. The receiver shall consult the court in cases of extraordinary or questionable debts incurred prior to his or her appointment and shall not have the power to close the home or sell any assets of the home without prior court approval.
Priority shall be given to debts and expenditures directly related to providing care and meeting the needs of patients. Any payment made to the receiver shall discharge the obligation of the payor to the owner of the facility.



18.51.510
Receivership—State medical assistance.

If the nursing home is providing care to recipients of state medical assistance, the receiver shall become the medicaid contractor for the duration of the receivership period and shall assume all reporting and other responsibilities required by applicable laws and regulations. The receiver shall be responsible for the refund of medicaid rate payments in excess of costs during the period of the receivership.



18.51.520
Receivership—Foreclosures and seizures not allowed.

No seizure, foreclosure, or interference with nursing home revenues, supplies, real property, improvements, or equipment may be allowed for the duration of the receivership without prior court approval.



18.51.530
Notice of change of ownership or management.

At least sixty days before the effective date of any change of ownership, change of operating entity, or change of management of a nursing home, the current operating entity shall notify separately and in writing, each resident of the home or the resident's guardian of the proposed change. The notice shall include the identity of the proposed new owner, operating entity, or managing entity and the names, addresses, and telephone numbers of departmental personnel to whom comments regarding the change may be directed. If the proposed new owner, operating entity, or managing entity is a corporation, the notice shall include the names of all officers and the registered agent in the state of Washington. If the proposed new owner, operating entity, or managing entity is a partnership, the notice shall include the names of all general partners. This section shall apply regardless of whether the current operating entity holds a medicaid provider contract with the department and whether the operating entity intends to enter such a contract.



18.51.540
Cost disclosure to attending physicians.

(1) The legislature finds that the spiraling costs of nursing home care continue to surmount efforts to contain them, increasing at approximately twice the inflationary rate. The causes of this phenomenon are complex. By making nursing home facilities and care providers more aware of the cost consequences of care services for consumers, these providers may be inclined to exercise more restraint in providing only the most relevant and cost-beneficial services and care, with a potential for reducing the utilization of those services. The requirement of the nursing home to inform physicians, consumers, and other care providers of the charges of the services that they order may have a positive effect on containing health costs.
(2) All nursing home administrators in facilities licensed under this chapter shall be required to develop and maintain a written procedure for disclosing patient charges to attending physicians with admitting privileges. The nursing home administrator shall have the capability to provide an itemized list of the charges for all health care services that may be ordered by a physician. The information shall be made available on request of consumers, or the physicians or other appropriate health care providers responsible for prescribing care.

NOTES:

FindingsIntent1993 c 492: See notes following RCW 43.20.050.
Short titleSavingsReservation of legislative powerEffective dates1993 c 492: See RCW 43.72.910 through 43.72.915.



18.51.550
Investigation of complaints of violations concerning nursing technicians.

The department shall investigate complaints of violations of RCW 18.79.350 and 18.79.360 by an employer. The department shall maintain records of all employers that have violated RCW 18.79.350 and 18.79.360.

NOTES:

SeverabilityEffective date2003 c 258: See notes following RCW 18.79.330.



18.51.560
Employment of physicians.

(1) A nursing home licensed under this chapter may employ physicians for the provision of professional services to its residents under the following conditions:
(a) The nursing home may not in any manner, directly or indirectly, supplant, diminish, or regulate any employed physician's judgment concerning the practice of medicine or the diagnosis and treatment of any patient; and
(b) The employed physicians may provide professional services only to residents of the nursing home or a related living facility.
(2) The employment of physicians as authorized by this section may be through the following entities:
(a) The entity licensed to operate the nursing home; or
(b) A separate entity authorized to conduct business in the state of Washington that has common or overlapping ownership as an affiliate or subsidiary of the licensee, as long as the licensee complies with subsection (3) of this section.
(3) Nothing in this section relieves the licensee of its ultimate responsibility for the daily operations of the nursing home.
(4) Nothing in this section may be construed to interfere with the federal resident rights requirements found in 42 C.F.R. 483.10, or successor rules, or found in this chapter, chapter 74.42 RCW, or the rules adopted by the department addressing resident's rights under this chapter or chapter 74.42 RCW.
(5) As used in this section, "related living facility" means (a) a separate nursing home that is owned, controlled, or managed by the same or an affiliated or subsidiary entity; or (b) a facility that (i) provides independent living services or *boarding home services under chapter 18.20 RCW, in a single contiguous campus as the nursing home, and (ii) is owned, controlled, or managed by the same or related entity as the nursing home. For purposes of this subsection "contiguous" means land adjoining or touching property on which the nursing home is located, including land divided by a public road.

NOTES:

*Reviser's note: The term "boarding home" was changed to "assisted living facility" by 2012 c 10.



18.51.920
Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.

For the purposes of this chapter, the terms spouse, marriage, marital, husband, wife, widow, widower, next of kin, and family shall be interpreted as applying equally to state registered domestic partnerships or individuals in state registered domestic partnerships as well as to marital relationships and married persons, and references to dissolution of marriage shall apply equally to state registered domestic partnerships that have been terminated, dissolved, or invalidated, to the extent that such interpretation does not conflict with federal law. Where necessary to implement chapter 521, Laws of 2009, gender-specific terms such as husband and wife used in any statute, rule, or other law shall be construed to be gender neutral, and applicable to individuals in state registered domestic partnerships.