STATE OF WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES Division of Occupational Safety and Health PO Box 44600 • Olympia, Washington 98504-4600 March 22, 2019 WA ST SOCIAL & HEALTH SERVICES DEPT OF WESTERN STATE HOSPITAL Po Box 45882 Attn: Sandra Chakones Olympia, WA 98504-5882 OSHA #: 1352293 Inspection: 317951354 UBI: 342007865 Region: 3-Health Inspector ID: J2313 Reference: 203403842 Dear Employer: Enclosed are the results of the safety and health inspection of your workplace. This packet contains: · · · · Citation Invoice – The total assessed penalty is $4,900.00 Citation and Notice of Assessment –Washington Administrative Code (WAC) Violations. Employer Certification of Abatement instruction and form - Correct all violations and return written verification or additional penalties may result. Employer Appeal Rights – You have 15 working days to appeal this citation. You must immediately post this Citation and Notice of Assessment at or near where the violation(s) occurred, where employees can easily find and read it, or where employees normally receive posted information. All postings must remain until you have corrected all violations, or for three working days, whichever is longer. “Working day” means a calendar day, except Saturdays, Sundays and all legal state holidays. Because this inspection is public information, the result will be posted online 30 days after the above date by the Department of Labor & Industries. You may view it at www.secure.lni.wa.gov/verify . Please visit www.lni.wa.gov/PublicRecords if you would like to request a copy of the inspection file. Your choices are: · · · · Safety & Health Citation Only Safety & Health Brief Inspector Summary Report (short description the inspector writes to summarize the reason for the inspection only – not complete file) Safety & Health Detailed Inspection Summary Report (detailed summary of inspection including penalty calculation only – not complete file) Safety & Health Citation and Complete Inspection File (The complete legal file which contains the detailed information regarding the inspector’s findings, the citation, and calculation of any penalty. This will be especially helpful if you are contemplating filing an appeal.) If you have questions, call the compliance supervisor, Lyndsey Banks, at (360) 902-5409. Respectfully, Anne F. Soiza Anne F. Soiza L&I Assistant Director Division of Occupational Safety Health Enclosure(s) Invoice Inspection: 317951354 UBI: Legal Name: DBA Name: Inspection Site: 342007865 WA ST SOCIAL & HEALTH SERVICES DEPT OF WESTERN STATE HOSPITAL 9601 Steilacoom Blvd, Lakewood, WA, 98498 Issued: Opening Conference: Closing Conference: Inspector ID: March 22, 2019 October 10, 2018 March 15, 2019 J2313 Summary of Assessed Penalties Due The Citation and Notice of Assessment includes a full description of each violation. Violation Item 1-1 2-1 2-2 Violation Type Serious General General WAC WAC 296-800-11010 WAC 296-27-031(3)(a) WAC 296-800-14025 Correction Due Date 4/24/2019 4/24/2019 4/24/2019 Penalty Amount $4,900.00 $0.00 $0.00 Total Penalty Due $4,900.00 PAYMENT INFORMATION _____________________________________________________ Payment is due 15 working days from receipt of this citation. Make check payable to the Department of Labor and Industries. Write Inspection number 317951354 on the check and mail to: Attn: DOSH Cashier Department of Labor and Industries PO Box 44835 Olympia, WA 98504-4835 Or deliver to: Any L&I office 1 Post This Document Citation and Notice of Assessment Inspection: 317951354 UBI: 342007865 Legal Name: WA ST SOCIAL & HEALTH SERVICES DEPT OF DBA Name: WESTERN STATE HOSPITAL Inspection 9601 Steilacoom Blvd Lakewood, WA 98498 Site: Issued: March 22, 2019 Opening Conference: October 10, 2018 Closing Conference: March 15, 2019 Inspector ID: J2313 Violation Type: Serious Violation 1 Item 1 WAC 296-800-11010 The employer, Washington State Department of Social and Health Services, did not provide and use safety devices, work practices, methods, and means that are reasonably adequate to make the workplace safe, and did not do everything reasonably necessary to protect employees of Western State Hospital from the recognized hazard of Workplace Violence. Cited for not developing and implementing technologically and economically feasible equipment, methods, and work practices to prevent all incidents of workplace assaults on Western State Hospital employees. Equipment and methods include, but are not limited to: 1. Develop and implement a policy that identifies staff work areas and tasks that require the presence of two or more employees with the goal of eliminating all workplace assaults. 2. Enclose all nurses' stations on all wards to ensure a secure location for duties not related to patient care. 3. Ensure floor staffing coverage that protects employees and prevents the hazard of workplace assaults on all wards and all shifts. 4. Create and implement a transition process for potentially assaultive patients being transferred from forensic wards to civil wards. (Note: This may entail use of a PICU, STAR, or other physical setting for transition purposes.) Employees who are exposed to workplace assaults can experience severe physical and emotional trauma, leading to serious injury, permanent disability, or death. Correct by: 4/24/2019 Assessed penalty: $4,900.00 Violation Type: General Violation 2 Item 1 WAC 296-27-031(3)(a) Employer did not report a work-related hospitalization to DOSH within 8 hours of the hospitalization. Cited for not reporting the hospitalization of an employee after a patient-to-staff assault incident on 2-Feb-2018. Correct by: 4/24/2019 Assessed penalty: $0.00 2 Post This Document Citation and Notice of Assessment Inspection: 317951354 Violation Type: General Violation 2 Item 2 WAC 296-800-14025 Employer did not enforce their Accident Prevention Program in a manner that is effective in practice. Cited for not ensuring that employees of Western State Hospital complete DSHS 03-133 (Employee Injury Report) forms after workplace assault incidents as required by the Accident Prevention Program. Without enforcement of an APP that is effective in practice, employees may not report assault incidents in a way that will capture the safety hazards of the workplace. Correct by: 4/24/2019 Assessed penalty: $0.00 3 Employer Certification of Abatement Instructions Inspection: 317951354 What you must do now: · · · · · Check the correction due date(s) shown on the enclosed Employer Certification of Abatement Form. You must fully correct the hazards by these dates. Describe on the form how you corrected each hazard, rather than what you intend to do in the future. Examples: Right: All staff have received the required training. Wrong: All staff will receive the required training next week. Use attachments if you need more space. Submit additional documentation of hazard correction if requested in the citation packet. Fill in the date you corrected the hazard and sign. Post a copy of the completed form for at least three working days, or until you have corrected all violations, whichever is longer. It must be posted near the hazard location or in a place that is readily accessible by affected employees and their representatives. Send your completed form to the address provided. Note: If we do not receive written confirmation you have corrected the hazards, we will take follow-up action, which may include additional penalties. If you provide us with false information, you may face criminal penalties. If you are unable to fix the hazard(s) by the correction due date(s): We must receive your written request for an extension before the correction due date(s) listed for the hazard(s). Correction due dates are shown on the enclosed Citation and Notice of Assessment and on your Employer Certification of Abatement Form(s). Extensions are not automatically granted. To be considered for an extension, you must provide the following: · · · · · · Inspection number, employer name, telephone number, and site address. Violation and Item number for each requested extension. Correction due date on the citation and additional time needed. Steps taken to fix the hazard by the correction due date. Why you cannot correct the hazard by the correction due date. How you will protect your employees until you fix the hazard. For more information, contact: Or call: (360) 902-5409 Lyndsey Banks, Compliance Supervisor Department of Labor and Industries PO Box 44810 Olympia, WA 98504-4810 You must post all documentation associated with your request for extension with your citation packet. All postings must remain until you have corrected all violations, or unless you have appealed and received and posted your hearing notice. 4 Employer Certification of Abatement Form Inspection: 317951354 UBI: 342007865 Legal Name: WA ST SOCIAL & HEALTH SERVICES Issued: March 22, 2019 DBA Name: WESTERN STATE HOSPITAL DEPT OF Site Address: 9601 Steilacoom Blvd, Lakewood, WA, 98498 You must complete this form and return it to: LISA VAN LOO, Department of Labor & Industries PO Box 44810, Olympia, WA 98504-4810 Or Fax to: Violation(s) are fully described in the Citation and Notice of Assessment section. Violation, Item & Group# Type of Violation WAC# Violated Correction Due Date 1-1 Serious WAC 296-800-11010 Violation Summary: Prevent workplace assaults. 4/24/2019 How you corrected the hazard è Date you corrected the hazard è 2-1 General WAC 296-27-031(3)(a) Violation Summary: Report all employee hospitalizations. 4/24/2019 How you corrected the hazard è Date you corrected the hazard è 2-2 General WAC 296-800-14025 Violation Summary: Enforce assault documentation per APP. 4/24/2019 How you corrected the hazard è Date you corrected the hazard è I certify that the hazards described in this Employer Certification of Abatement Form have been corrected as described above. Affected employees and their representatives have been informed of the correction activities. I am aware that knowingly providing false information may result in criminal penalties (RCW 49.17.190(2)). Signature Title Name Date Phone No. DOSH USE ONLY DOSH Reviewer's Signature Date 5 Post This Document Appeal Rights Inspection: 317951354 For Employers If you are cited for a violation of Occupational Safety and/or Health rules, you have the right to appeal the citation. You have 15 working days from the date you receive this citation to appeal. (RCW 49.17.140(1)) "Working day” means a calendar day, except Saturdays, Sundays and all legal state holidays. Your appeal must be in writing. It may be mailed, faxed, or personally delivered. For violations classified as serious, willful, repeat serious, or failure to abate serious, an employer must correct the violations by the date listed on the Citation and Notice / Employer’s Certification of Abatement form unless a stay of abatement date is requested in the appeal as described on this page. A stay of abatement date means the employer’s requirement to abate or correct the hazard is put on hold until the appeal is resolved. All general and repeat general violations under appeal automatically have stay of abatement dates until a final order on those violations has been issued. If you only need an extension of an abatement date, please see the above section entitled, “If you are unable to fix the hazard(s) by the correction due date(s)”. Your appeal must include: · Name, address, telephone number, and fax number if available of the employer who is appealing, and for the employer’s representative, if any, such as an attorney or interpreter. · Inspection Number (You will find this nine-digit number in the top right corner of this page.) · Statement explaining: 1. What you think is wrong with the citation and any related facts. 2. How you think the citation should be changed. 3. What relief you are seeking and why. If you are requesting a stay of abatement date for serious, willful, repeat serious or failure to abate serious, you must also include: · Each violation and item number for which a stay of abatement date is requested; and · The reason for the stay of abatement date request. Note: Employees and/or employee representatives may elect to participate in appeal hearings. Posting requirement: You must post your appeal documents (along with this citation packet) until the appeal is resolved. You must also post all other documents related to this appeal. For Employees or Their Representatives If your employer is cited, you may only appeal the correction due date(s). Your appeal must include: · · · Your name, address, telephone number, and fax number if available and the same information for anyone who is representing you, if any. Inspection number. Statement explaining why the correction due date should be changed. Send all appeals to: Assistant Director for DOSH Attn: Appeals Program PO Box 44604 Olympia, WA 98504-4604 Fax to: (360) 902-5581 or deliver to: Any L&I office Electronically to: DOSHAppeals@Lni.wa.gov For more information call the Appeals Program: (360) 902-5486. 6 WA ST SOCIAL & HEALTH SERVICES DEPT OF WESTERN STATE HOSPITAL Po Box 45882 Attn: Sandra Chakones Olympia, WA 98504-5882 WA ST SOCIAL & HEALTH SERVICES DEPT OF WESTERN STATE HOSPITAL Po Box 45882 Attn: Sandra Chakones Olympia, WA 98504-5882