Initial Inspection Preparation checklist

ADULT FAMILY HOME INITIAL INSPECTION PREPARATION CHECKLIST

FOR ADDITIONAL INFORMATION, YOU MAY ALSO REFER TO: https://www.dshs.wa.gov/altsa/residential-care-services/information-afh-prospective-providers LAST UPDATED 1/27/2021

This checklist is designed to assist the applicant in preparation for the initial inspection. You are responsible for meeting the

requirements of the current Washington Administrative Code (WAC) & Revised Code of Washington (RCW). WAC’s are listed

for reference only and are subject to revision. The onsite initial inspection usually takes between three and five hours

depending on the size of the home, the organization of the applicant and any unforeseen onsite environmental challenges.

The home should be move in ready on the day of initial inspection. Please only schedule your initial inspection when you

have confirmed your home meets all minimum licensing requirements.

INTERIOR PHYSICAL ENVIRONMENT

WAC 388-76-

POSTINGS: In a visible location for staff, visitor, and residents to view

Post the ALTSA/Complaint Resolution Unit [CRU] hotline abuse/neglect contact information. [Use poster at link here.]

10525

Post the WA State Ombudsman contact information. [the above poster includes State Ombuds program toll free #]

10525

Post Disability Rights of Washington poster. [formerly Washington Protection & Advocacy System] to order poster call 1 800-562-2702

10525

Place in a visible location in common use area a copy of all complaint and inspection reports from the last 12 months.

10585

Post a statement that the past three years of annual inspection and complaint reports are available upon request.

10585

Have an area designated to post your AFH License.

10584

Post your emergency evacuation floor plan on each level of the house. *The floor plan for each level of the home should be specific to that

level.

[Indicate route from each bedroom out of home, the location of the doors, windows and the outdoor meeting place.]

10885/10890

COMMON AREA(S)

Must be homelike, with furnishings that each resident may use and large enough for all residents to use at the same time.

10705

Common area/s must not be used as a bedroom or sleeping area.

10705

Lighting must be adequate for each task a resident or staff does.

10740

Fireplaces that will be used must prevent the possibility of a resident being burned. A sturdy flame resistant barrier will need to be installed

that will prevent all access points to any hot surface of the fireplace. If fireplace will not be used, plan to provide residents with some type of

notice the home does not plan to utilize the fireplace. Also, plan to demonstrate for the Licensor how you plan to prevent usage of the

fireplace.

10825 /10750

BEDROOM(S)

Resident privacy must be maintained in the bedroom; i.e. curtains or blinds on windows, bedroom door that closes securely. Pocket, bi-fold,

side hinged and barn style doors are all acceptable provided the minimum door width opening is 27inches and the door allows for visual and

auditory privacy for residents.

10575

Each bedroom is an outside room and must have direct access to hallways and corridors and unrestricted access to common use area.

10685

ADULT FAMILY HOME INITIAL INSPECTION PREPARATION CHECKLIST

FOR ADDITIONAL INFORMATION, YOU MAY ALSO REFER TO: https://www.dshs.wa.gov/altsa/residential-care-services/information-afh-prospective-providers LAST UPDATED 1/27/2021

Bedrooms must meet minimum requirement of usable floor space.

[80 usable sq feet for 1 resident & at least 120 usable sq feet for 2 residents] NOTE: See WAC definition section – “usable floor

space”

10685 /10690

Every bedroom must have a closet or place to store resident clothing. Resident bedroom closets are not required to have doors, but if the

closet does have a door it must open easily from the inside and outside. Slider style closet doors must have a floor guide installed at the

bottom to ensure the slider doors stay securely in place while sliding each direction.

10715

Lighting must be adequate for each task a resident or staff does.

10740

Staff must have means of rapid access to locked bedrooms, toilet rooms, shower rooms, closet and other resident room. Please note: locks

are not required on resident bedroom and bathroom doors for initial inspection.

10750

Bedroom sliding closet doors must have a workable floor guide to ensure safety and rapid access.

10750

Windows must open easily and without a key or tool. Window egress must not be blocked from the inside or from outside. Please note:

resident bedroom windows must have a minimum opening area of 5.7 sq. ft. except a grade level floor window opening may have a

minimum clear opening of 5.0 sq. ft. Resident bedroom windows must also have a minimum opening height of 24 inches and a minimum

opening width of 20 inches. Resident bedroom window sills cannot exceed 44 inches from the bedroom floor.

10795

Screens must be intact on doors and window and installed securely in a way that will not allow the entry of insects. Window glass, window

tracks and sills must be clean and free from anything that could harbor bacteria.

10685/10750

Each resident bedroom must have adequate storage space for clothing and personal belongings. If the home will utilize an armoire, dresser or

something similar in lieu of a closet, the armoire/dresser must be in the resident bedroom at the time of inspection. The armoire/dresser or

similar item being used in lieu of the resident room having a closet will be measured and subtracted from the useable floor space of the

bedroom. Please note: Resident bedrooms do not otherwise need to be furnished at time of initial inspection.

10765

BATHROOM(S)

WAC 388-76-

There must be securely fastened grab bars at the toilet, and in bathing facilities, such as tubs and showers to be utilized by residents.

Bathrooms not intended for resident use will not be required to meet the toilet and bathing unit grab bar requirements. Applicants will need

to demonstrate during initial inspection the plan to ensure residents do not access bathrooms not meeting toilet and bathing unit grab bar

requirements. See WAC 51-51-0330 for specific grab bar requirements.

10695

Staff must have a means of rapid access to locked bathroom if door has a lock on it. Bathroom vanity drawers must not block door when they

are open.

10750

There must be access to a toilet, shower/tub without going through another resident’s bedroom; including 1 flushing toilet per 5 persons.

Please note: When calculating toilet to people ratio, any person living in the home to include residents, applicant, caregiver etc. will be

counted when determining how many toilets will be required.

10780

Every toilet must have a toilet paper holder.

10750

Residents must have visual and auditory privacy in the bathroom, with no gaps at the door and privacy coverings or glass at the windows.

10575

Bathrooms must have sufficient lighting.

10740

ADULT FAMILY HOME INITIAL INSPECTION PREPARATION CHECKLIST

FOR ADDITIONAL INFORMATION, YOU MAY ALSO REFER TO: https://www.dshs.wa.gov/altsa/residential-care-services/information-afh-prospective-providers LAST UPDATED 1/27/2021

EXTERIOR PHYSICAL ENVIRONMENT

WAC 388-76

The main entrance/exit door must have a lever handle that unlocks inside and outside mechanisms and opens the door, from inside of the

house, with a single press of the lever handle, and allows for reentry without the use of a key, tool or special knowledge. The door must also

have a lever handle on the outside. See WAC 51-51-330.4

10695

Step or stairs to be utilized by resident, must have handrails on both sides extending the full length of the step or stairs. If stairs will not be

10695

Bathroom water temperature may not exceed 120-degrees Fahrenheit.

10750

KITCHEN AND LAUNDRY AREA

A plan must be in place for providing laundry service as needed, if laundry passes through kitchen, must have written infection control plan

outlining how the home will prevent cross contamination.

10410

Kitchen must be stocked with pots/pans, dishes, silverware, and glasses. The kitchen should be stocked as if residents were moving in on

inspection day.

10750

Kitchen and equipment must be maintained in a clean and sanitary state.

10735

MEDICATIONS

All prescribed, over the counter, and refrigerated medications must be kept in locked storage.

10485

OTHER ITEMS

If using electronic monitoring equipment, review this WAC section carefully. Please note: Security style cameras can be utilized at entrances

and exits of the home, but may not show the view of any resident gathering area at the time of initial inspection.

10720/10725

Call bell system for residents to acquire care & services IF caregiver’s bedroom not within hearing distance.

10400/10685

If the garage contains hazards to the residents, you must have a plan as to how you will keep residents safe from these hazards.

10750

Working smoke detectors must be installed on each level of the home, in each resident bedroom & in proximity to where staff sleep. Smoke

detectors MUST be interconnected per the International Residential Code. Each resident bedroom smoke detector will be tested during

initial inspection to ensure the detector is working properly and interconnected.

10805

Space heaters must have an underwriters laboratories (UL) rating.

10825

If you have individual wall mounted (cadet) heaters, you need to follow manufactures instructions and safety information. If the heating unit

is hot to the touch, the hot surface will be required to be made inaccessible.

10750

Baseboard heaters must be made inaccessible if unit is hot to the touch and poses a burn risk to residents.

10750

Water temperature at resident-use sink(s) must not exceed 120

Fahrenheit (bathrooms and kitchen).

10750

Room temperature must be at least 68

◦

F during waking hours & not less than 60

◦

F at night.

10775

A telephone for resident(s) to use in private; must be activated and in service at time of inspection. This does not have to be a landline.

10770

Provide storage for toxic substances that is only accessible to residents under direct supervision.

10750

All windows that can be opened must have screens to prevent flies and/or bugs from entering the home when the window is open.

10750

ADULT FAMILY HOME INITIAL INSPECTION PREPARATION CHECKLIST

FOR ADDITIONAL INFORMATION, YOU MAY ALSO REFER TO: https://www.dshs.wa.gov/altsa/residential-care-services/information-afh-prospective-providers LAST UPDATED 1/27/2021

utilized by residents, applicant must show on day of inspection how they plan to make the steps inaccessible to residents.

See WAC 51-51-330.10

Ramps must have a safe slope (8.3% or less). All ramps must be inspected by building official. See WAC 51-51-330-9

10695

ADULT FAMILY HOME INITIAL INSPECTION PREPARATION CHECKLIST

FOR ADDITIONAL INFORMATION, YOU MAY ALSO REFER TO: https://www.dshs.wa.gov/altsa/residential-care-services/information-afh-prospective-providers LAST UPDATED 1/27/2021

Ramps must have graspable handrails on both sides extending the full length of ramp, 3x3 ft. landings at top, bottom and any change in

direction, a safe slope, & non- slip surface. Please note: Required ramp landing average measurements may not exceed 2% in slope.

10730/10745

Doorways must have smooth transitions on bottom of door threshold to maintain a safe, non-trip hazard.

10750

Decks must be safe including having a non-slip surface, sturdy barriers as required and edges cannot be a trip hazard.

10750

An outdoor resident area must be safe [from hazards, i.e. busy roads, trip hazards, yard tools, chemicals etc.], usable and accessible to

residents. This space must be large enough to accommodate all of the AFH residents at the same time. Please note: This area does not have

to be furnished on day of inspection.

10750

If you have water hazards as described in WAC 388-76-10783, you must ensure resident safety per this WAC.

10783 /10784

ADMINISTRATIVE RECORDS

WAC 388-

Provide a staff orientation checklist. This is the checklist the home will use to orient new staff to specific processes and requirements for

the home.

112A-0240

Have a process and system to ensure employees meet caregiver qualifications, including 1

Aid/CPR. see also [388-112A]

76-10130/10135

The adult family home must complete the department's disclosure of charges form and provide a copy to each resident admitted to the

home.

10540

For any pets, living or visiting, in the home: proof of updated rabies vaccination is REQUIRED.

10230

Provide proof of type of sewage disposal system [PUBLIC SEWER OR INDEPENDENT SEWAGE SYSTEM]. NOTE: If you have a septic system, please

be sure to obtain a document from your local health/inspecting authority showing the system has been inspected, approved, will be

utilized in an AFH how many people (not bedrooms) can be accommodated with the system. If you have questions about this

requirement please discuss with assigned Licensor, or call (360)725-2575

10755

Provide proof of your water system [PUBLIC OR PRIVATE WATER SUPPLY]. NOTE: If you have a private well, please be sure to obtain a

document from your local health/inspecting authority showing the system has been inspected, approved and what type water rating the

well has. If you have questions about this requirement please discuss with assigned Licensor, or call (360)725-2575

10790

SAMPLE RESIDENT RECORD REVIEW

You must have a system to maintain confidential resident records so you can provide the needed care to the residents

10315

YOUR SYSTEM MUST BE ORGANIZED SO THERE IS A PLACE FOR THE FOLLOWING DOCUMENTS:

10320

Medication Log [388-76-10475]

Resident Information Sheet [388-76-10320]

Financial Record Keeping

10320

Personal Inventory Sheet [388-76-10320]

Medical Professional Orders [388-76-10320]

Legal Documents

10325

Resident Assessment [388-76-10335]

Preliminary Service Plan [388-76-10320]

Negotiated Care Plan

10355

Nurse Delegation [388-76-10315]

Disclosure of Charges [388-76-10540]

ADULT FAMILY HOME INITIAL INSPECTION PREPARATION CHECKLIST

FOR ADDITIONAL INFORMATION, YOU MAY ALSO REFER TO: https://www.dshs.wa.gov/altsa/residential-care-services/information-afh-prospective-providers LAST UPDATED 1/27/2021

POLICIES

Must have notice of rights and services document. Please carefully review WAC Chapter 388-76 for the comprehensive requirements for

this document.

10520

Must have written disaster plan. Please specifically address the actions to be taken during and immediately following a natural or man-

made disaster to ensure resident safety in this plan.

10830/10835

Must have written policy on how the home will dispose of unused, left over, and any remaining medication.

10490

Must have policy for contacting emergency medical services.

10250

Must have policy about accepting Medicaid as a payment source. Please be sure to specifically address your homes policy and process for

accepting residents who are funded by Medicaid.

10522

Must have policy that prohibits abandonment, abuse, neglect, and/or exploitation of any resident. Please be sure to address the specific

action your home will take to ensure resident safety in the case of alleged abuse by a staff in your home in this plan.

10675

ADULT FAMILY HOME INITIAL INSPECTION PREPARATION CHECKLIST

FOR ADDITIONAL INFORMATION, YOU MAY ALSO REFER TO: https://www.dshs.wa.gov/altsa/residential-care-services/information-afh-prospective-providers LAST UPDATED 1/27/2021

LOGS

Must have accident / Incident / Injury Log.

10220

Must have emergency Evacuation Drill Log

10900

Must have medication Log – this log can be a separate log or contained in resident record

10475

MULTIPLE HOME PROVIDERS MUST HAVE: These plans must be provided for each home under the MHP management

A ”24/7” staffing plan, including a resident manager for each home [388-76-10036]

A daily operation plan for all homes

10035

A parking plan for each individual home which includes a plan for accessibility of emergency services

10035

RESOURCES

REFER TO THIS WEB SITE: https://www.dshs.wa.gov/altsa/residential-care-services/information-afh-prospective-providers FOR THE FOLLOWING:

 REGULATIONS

WACs: chapter 388-76 AFH Minimum Licensing Requirements, chapter 388-112A Training, chapter 246-840 Nurse Delegation, 388-105-0050 Medicaid

Supplementation…AND RCWs: chapter 70.128 Adult Family Homes, chapter 70.129 Resident Rights; chapter 74.34 Abuse of Vulnerable Adults

 Background Check Information

 Caregiving Experience Attestation [CEA] forms for Entity Representatives & Resident Managers

 Emergency Planning Information

REFER TO THIS WEB SITE: https://www.dshs.wa.gov/altsa/home-and-community-services/training-requirements-and-classes FOR THE FOLLOWING:

 Training Requirements for adult family

homes [AFH]

 Food Safety

 Finding community educators in your area

 Administrator Training Classes

 AFH Providers minimum instructor requirements

EMERGENCY PREPAREDNESS

Emergency lighting must be readily available for residents and staff. Please have enough emergency lighting available for each resident and ready

to demonstrate it is in good working condition.

10740

5 pound 2A:10B-C rated fire extinguisher mounted on each level of home [per manufactures instructions] including visible proof of purchase or

service within 1 year.

10810

Emergency medical supplies including first aid supplies and a first aid manual

10850