Washington State’s continuing education (CE) requirements vary, depending on the person’s job title as well as which (if any) credential they hold. This article is written to clarify CE expectations based on those two factors.

WAC 388-112A-0611 highlights who needs CE and by when. For administrators, if the administrator is also a long term care worker (home care aide/HCA or nursing assistant certified/NAC) then 12 hours of CE, approved by DSHS and documented on an approved certificate, must be completed each year on or before the administrator’s birthday. If the administrator does not provide activities of daily living (including hands-on care and/or verbally cueing a resident), s/he can opt out of completing CE by selecting a designee to complete this training instead. It is highly recommended that the AL administrator complete at least 12 hours of CE each year in order to maintain or enhance current knowledge of regulations and care expectations. If the assisted living administrator is also licensed in Washington State as a nursing home administrator, no proof of CE is required by DSHS; CE is addressed via the nursing home administrator board. 

Long term care workers (including NARs, NACs, HCAs, and long term care workers exempt from certification under WAC 388-112A-0090(1)(2)) must have proof of completing at least 12 hours of DSHS-approved CE each year on their birthday. For HCAs, this is also a requirement to renew their credential with the Department of Health.

WAC 388-112A-0600 highlights topics that may be covered during a CE class. WHCA seeks out and obtains CE approval from DSHS for all assisted living-focused educational classes offered through the association. DSHS licensors will, during an inspection, review staff’s personnel files to ensure completion of necessary CEs.

DSHS approves CE courses that are instructor-led in-person, instructor-led online (such as a live webinar), and self-paced interactive online. They do not approve recorded content that does not include active evaluation of learning and access to an instructor, nor do they approve self-study courses. For more information on CE coursework and expectations, visit the DSHS training website

During the COVID state of emergency, CE completion was postponed. DSHS granted 12 hours of CE to all long term care workers and administrators during the first year of the pandemic, given the fact that intense and ongoing infection control training occurred during that timeframe. Now that the state of emergency has been lifted, WAC 388-112A-0613 (5) emphasizes a deadline for completion of all CEs that may have become due while training waivers were in place. 

CE requirements for nurses are a bit different than for administrators and caregivers. Regardless of where a nurse works, s/he is responsible for completing and maintaining proof of at least eight hours of CE each year. The nursing commission’s expectations on these continuing education hours are not specific: CE can include seminars, webinars, and/or self-study and do not need to be approved by any governing body; the nurse must maintain proof of completing the coursework. The subjects of these trainings are unique to the nurse and may be self-selected based on the nurse’s area of expertise or nursing interest; the CE courses are geared to maintain or enhance the nurse’s competency. DSHS licensors will not review a nurse’s CE hours; this is done by DOH via an attestation format and random license audits.

If you have questions about assisted living regulations, contact Vicki McNealley via email or call (800) 562-6170 extension 107.


As you are aware, on October 24, the changes to Phase 2 and the Phase 3 ROP became effective. Residential Care Services (RCS) will be surveying facilities and holding facilities to these requirements. It is important that all facilities ensure compliance with any policies and procedures, training, and implementation of activities and practices.

There were a number of changes and clarifications made to the 483.10 Resident Rights F-tags found in the CMS SOM-Appendix PP. Some of the changes regarding Resident Rights are touched on in the article below. These changes are not all inclusive and facilities must refer to Appendix PP for the entirety of any changes and guidance.

Throughout the requirements there are themes, one of which is that CMS is increasing scrutiny on the care for residents with substance use disorder (SUD). At F557 and F563, CMS adds the following guidance:

  • Facility staff must have consent to search a resident’s body or personal possessions
  • Facility staff should have knowledge of signs, symptoms, and triggers of substance use, and
  • If the facility determines illegal substances have been brought into the facility by a visitor, the facility should refer the issue to local law enforcement 

CMS further clarifies facility staff are expected to have knowledge of signs, symptoms, and triggers of substance use, such as changes in resident behavior, increased unexplained drowsiness, lack of coordination, slurred speech, mood changes, and/or loss of consciousness, etc. Staff will be interviewed by surveyors regarding the signs and symptoms and how to respond. Residents should also be monitored after visiting with individuals who have a history of bringing illegal substances into the facility. Clarification regarding asking residents about any drug use and possession of substances can be found in the Interpretive Guidelines. 

Under F563 specifically, guidance is given about how a facility may restrict access or provide supervised visitation to individuals who have a history of bringing illegal substances into the facility as a reasonable clinical and safety restriction. Also, CMS clearly states that if the facility determines illegal substances have been brought into the facility, the facility should not act as an arm of law enforcement. These cases may warrant a referral to local law enforcement. 

Additional areas of focus include changes under the following F-tags:

F561-Self-Determination-requirements about when a facility changes from a smoking to a non-smoking facility are now specifically outlined by CMS. The facility must allow current residents who smoke to continue smoking in an area that maintains the quality of life for these residents and considers the safety and preferences of non‐smoking residents. The smoking areas outside must be safe and necessary supervision must be provided. Residents admitted after the facility changes its policy must be informed of this policy at the time of admission.

F582-Beneficiary Notices-In 2018, the Skilled Nursing Facility Advanced Beneficiary Notice of Non‐coverage (or SNFABN) form was revised. In this F-tag, CMS worked to ensure guidance under F582 remained accurate. Some previous guidance did not align with the Medicare Claims Processing Manual, so revisions were made. The content related to the Notice of Medicare Non‐coverage (or NOMNC) form and the SNFABN form were also simplified. 

More information will be coming in future Survey and Regulatory Updates regarding the CMS requirements for skilled nursing facilities. For questions about Resident Rights or the ROP for skilled nursing facilities, contact Elena Madrid via email or call (800) 562-6170 extension 105.

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