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PDFWAC 246-341-0320

Agency licensure and certificationOn-site reviews and plans of correction.

To obtain and maintain a department-issued license and to continue to provide department-certified behavioral health services, each agency is subject to an on-site review to determine if the agency is in compliance with the minimum licensure and certification standards.
(1) A department review team representative(s) conducts an entrance conference with the agency and an on-site review that may include:
(a) A review of:
(i) Agency policies and procedures;
(ii) Personnel records;
(iii) Clinical records;
(iv) Facility accessibility;
(v) The agency's internal quality management plan, process, or both, that demonstrates how the agency evaluates program effectiveness and individual participant satisfaction; and
(vi) Any other information, including the criteria in WAC 246-341-0335 (1)(b), that the department determines to be necessary to confirm compliance with the minimum standards of this chapter; and
(b) Interviews with:
(i) Individuals served by the agency; and
(ii) Agency staff members.
(2) The department review team representative(s) concludes an on-site review with an exit conference that includes a discussion of findings.
(3) The department will send the agency a statement of deficiencies report that will include instructions and time frames for submission of a plan of correction.
(4) The department requires the agency to correct the deficiencies listed on the plan of correction:
(a) By the negotiated time frame agreed upon by the agency and the department review team representative; or
(b) Immediately if the department determines health and safety concerns require immediate corrective action.
[Statutory Authority: 2018 c 201 and 2018 c 291. WSR 19-09-062, § 246-341-0320, filed 4/16/19, effective 5/17/19.]
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