1. (1) Licensees providing care and services for medically fragile children and youth must:

   1. (a) Use licensed health care providers to provide care that meets the child's or youth's unique needs;
   2. (b) Have sufficient nursing personnel to meet the nursing care needs of the children and youth in care, including at least one RN as required by WAC 110-145-3450;

   3. (c) Offer to develop individualized treatment plans using information from the children's or youth's licensed health care providers that addresses their unique needs and includes:

      1. (i) The care and services to be provided, with details on the child's or youth's preferences and choices; and
      2. (ii) How the services will be delivered to accommodate those preferences and choices; and
   4. (d) Have an infection control program supervised by an RN or a certified infection preventionist.

2. (2) RNs caring for medically fragile children or youth must:

   1. (a) Complete and document an initial assessment of each child and youth admitted to the facility;
   2. (b) Update assessments as needed; and

   3. (c) Advise and assist nonmedical personnel providing care at the facility with:

      1. (i) Maintaining health records;
      2. (ii) Meeting children's and youth's daily health needs; and
      3. (iii) Caring for their minor illnesses and injuries.

3. (3) Licensees may provide specialized care to medically fragile children and youth in care who need intensive personal care including:

   1. (a) Skilled health care;
   2. (b) Physical therapy; or
   3. (c) Other forms of therapy.

[Statutory Authority: RCW 74.15.030. WSR 25-23-103, s 110-145-3460, filed 11/18/25, effective 5/1/26.]