ADULT FAMILY HOME INITIAL INSPECTION PREPARATION CHECKLIST

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.

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-
10525
2702
Place in a visible location in common use area a copy of all compliant 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.
10885/10890
[Indicate route from each bedroom out of home, the location of the doors, windows and the outdoor meeting place.]
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. 10750
BEDROOM(S)
Resident privacy must be maintained in the bedroom; i.e. curtains or blinds on windows, bedroom door that closes. 10575
Each bedroom is an outside room and must have direct access to hallways and corridors and unrestricted access to common use area. 10685
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 10685 /10690
space”
Every bedroom must have a closet or place to store resident clothing. Every closet door must open easily from the inside and outside. 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. 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. 10795
FOR ADDITIONAL INFORMATION, YOU MAY ALSO REFER TO: https://www.dshs.wa.gov/altsa/residential-care-services/information-adult-family-home-providers L AST U PDATED 6/11/2018
 ADULT FAMILY HOME INITIAL INSPECTION PREPARATION CHECKLIST
Screens must be intact on doors and window and the window sills are clean. 10685/10750
Each resident bedroom must have adequate storage space for clothing and personal belongings. 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. See WAC 51-51-0325 10695
Staff must have a means of rapid access to locked bathroom; 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. 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
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. 10410
Kitchen must be stocked with pots/pans, dishes, silverware, and glasses. 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. 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. 10805
Space heaters must not be used. For individual wall mounted heaters you need to follow manufactures instructions and safety information. 10825
Water temperature at resident-use sink(s) must not exceed 120 o 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. 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
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 10695
have a lever handle on the outside. See WAC 51-51-325.4
Step or stairs must have handrails on both sides extending the full length of the step or stairs. See WAC 51-51-325.10 10695
Ramps must have a safe slope (8.3% or less). All ramps must be inspected by building official. See WAC 51-51-325.9 10695

FOR ADDITIONAL INFORMATION, YOU MAY ALSO REFER TO: https://www.dshs.wa.gov/altsa/residential-care-services/information-adult-family-home-providers L AST U PDATED 6/11/2018
 ADULT FAMILY HOME INITIAL INSPECTION PREPARATION CHECKLIST
Ramps must have graspable handrails on both sides extending the full length of ramp, flat landings at top and bottom , a safe slope, & non-
10730/10745
slip surface.
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, 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
10750
residents. This space must be large enough to accommodate all of the AFH residents at the same time.
If you have water hazards as described in WAC 388-76-10783, you must ensure resident safety per this WAC. 10783 /10784

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]
ADMINISTRATIVE RECORDS WAC 388-
Provide a staff orientation checklist. 112A-0240
Have a process and system to ensure employees meet caregiver qualifications, including 1 st Aid/CPR. see also [388-112A] 76-10130/10135
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, discuss
10755
with licensor
Provide proof of your water system [PUBLIC OR PRIVATE WATER SUPPLY]. NOTE: If you have a private well, discuss with licensor 10790
POLICIES
Must have notice of rights and services document. 10520
Must have written disaster 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. 10522
Must have policy that prohibits abandonment, abuse, neglect, and/or exploitation of any resident. 10675

FOR ADDITIONAL INFORMATION, YOU MAY ALSO REFER TO: https://www.dshs.wa.gov/altsa/residential-care-services/information-adult-family-home-providers L AST U PDATED 6/11/2018
 ADULT FAMILY HOME INITIAL INSPECTION PREPARATION CHECKLIST
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

EMERGENCY PREPAREDNESS
Emergency lighting must be readily available for residents and staff 10740
5 pound 2A:10B-C rated fire extinguisher mounted on each level of home [per manufactures instructions] including visible proof of purchase or
10810
service within 1 year
Emergency medical supplies including first aid supplies and a first aid manual 10850

MULTIPLE HOME PROVIDERS MUST HAVE:

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-adult-family-home-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
 Food Safety  Finding community educators in your area
homes [AFH]
 Administrator Training Classes  AFH Providers minimum instructor requirements

FOR ADDITIONAL INFORMATION, YOU MAY ALSO REFER TO: https://www.dshs.wa.gov/altsa/residential-care-services/information-adult-family-home-providers L AST U PDATED 6/11/2018