ࡱ> A 0bjbj\\ ?>h>hn >>>>>RRR8||RTn"P*: + + +,>.\p.0smumumumumumum$psm->.,,"..m>> + +mRB6B6B6.R> +> +smB6.smB6B6_Db +0$F.*W`&_mn<Tn}`ht0:htLbht>b ..B6.....mmV3...Tn....ht......... X : 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). WACs 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 ENVIRONMENTWAC 388-76-: Postings: In a visible location for staff, visitor, and residents to viewPost the ALTSA/Complaint Resolution Unit [CRU] hotline abuse/neglect contact information. [Use poster at link  HYPERLINK "https://www.dshs.wa.gov/sites/default/files/ALTSA/rcs/documents/Hotline%20Poster.pdf" here.]HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10525"10525Post the WA State Ombudsman contact information. [the above poster includes State Ombuds program toll free #]HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10525"10525Post Disability Rights of Washington poster. [formerly Washington Protection & Advocacy System] to order poster call 1 800-562-2702HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10525"10525Place in a visible location in common use area a copy of all complaint and inspection reports, follow-up reports and related cover letters from the last 12 months. For purposes of initial inspection, its only required to provide a location where these reports will be kept. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10585" 10585 Post a statement that the past three years of annual inspection and complaint reports are available upon request. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10585" 10585 Have an area designated to post your AFH License. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10584" 10584Post 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.] HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10885" 10885/ HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10890" 10890Common Area(s)Must be homelike, with furnishings that each resident may use and large enough for all residents to use at the same time. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10705" 10705Common area/s must not be used as a bedroom or sleeping area. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10705" 10705Must be large enough for all residents to use at the same time. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10705" 10705Lighting must be adequate for each task a resident or staff does. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10740" 10740Fireplaces 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. HYPERLINK "https://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10825"10825 /HYPERLINK "https://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10750"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 27 inches and the door allows for visual and auditory privacy for residents.  HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10575" 10575 Each bedroom is an outside room that allows natural light and must have direct access to hallways and corridors and unrestricted access to common use area. All resident bedrooms must have a window or a door that leads directly to the outside that allows for emergency evacuation. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10685" 10685Bedrooms 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 HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10685" 10685 / HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10690" 10690Every 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. Slider style closet doors must allow enough space when closed to allow for a resident to get their fingers in to slide the door open from the inside or the outside, or graspable handles must be placed on the inside and the outside of each slider closet door. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10715" 10715Lighting must be adequate for each task a resident or staff does. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10740" 10740Staff 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. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Windows 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 windowsills cannot exceed 44 inches from the bedroom floor. *Please be aware the minimum listed height of 24 inches and the minimum listed width of 20 inches will only result in a 3.33 sq. ft. opening and will not meet the minimum required 5.7 and 5.0 sq. ft. opening. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10795" 10795Windows must not have any obstructions blocking the window opening from the inside or the outside. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10795" 10795Windows must have some form of privacy such as curtains or blinds. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10795" 10795Screens 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.  HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10685" 10685/ HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Resident bedroom doorway widths must be a minimum of 27 inches. *This is a requirement by Residential Care Services and cannot be found in regulation. If you choose to add locks to resident bedroom doors, you must have an unlocking device nearby to demonstrate the lock can be quickly opened. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10715" 10715Each 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. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10765" 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. *Effective August 1, 2022, the local building official will be solely responsible for measuring the placement of toilet and tub/shower grab bars. Residential Care Services initial inspection Licensors will be responsible for ensuring grab bars that are installed are secure and safe. Licensors will also inspect and address any safety issues such as a toilet and/or shower/tub requiring additional grab bars to ensure resident safety. 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  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=51-51-0325" WAC 51-51-0330 for specific grab bar requirements. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10695" 10695/ HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=51-51-0325" WAC 51-51-0330Tub and/or showers intended for resident use must have a non-slip surface. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Staff 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. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750There must be access to a toilet, shower/tub without going through another residents 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.  HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10780" 10780Every toilet must have a toilet paper holder. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Residents must have visual and auditory privacy in the bathroom, with no gaps at the door and privacy coverings or glass at the windows. HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10575" 10575Bathrooms must have sufficient lighting. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10740" 10740Bathroom water temperature must not be less than 105-degress and must not exceed 120-degrees Fahrenheit. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Bathroom lighting must be adequate. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Bathrooms must be free from toxins HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Kitchen and Laundry AreaA 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.  HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10410" 10410Kitchen must be stocked with pots/pans, dishes, silverware, and glasses. The kitchen should be stocked as if residents were moving in on inspection day.  HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Kitchen and equipment must be maintained in a clean and sanitary state.  HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10735" 10735Kitchen sink temperature must not be less than 105-degress and must not exceed 120-degrees Fahrenheit HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Kitchen lighting must be adequate HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750MedicationsAll prescribed, over the counter, and refrigerated medications must be kept in locked storage. Be sure to consider a storage method that ensures resident medications are kept separate.  HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10485" 10485Other 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. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10720" 10720/ HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10725" 10725Call bell system for residents to acquire care & services IF caregivers bedroom not within hearing distance.  HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10400" 10400/ HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10685" 10685If the garage contains hazards to the residents, you must have a plan as to how you will keep residents safe from these hazards. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Working 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.  HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10805" 10805Space heaters must be certified by an organization listed as a nationally recognized testing laboratory. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10825" 10825If 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. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Baseboard heaters must be made inaccessible if unit is hot to the touch and poses a burn risk to residents. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Ensure hot water temperature is at least one hundred five degrees and does not exceed one hundred twenty degrees Fahrenheit at all fixtures used by or accessible to residents (bathrooms and kitchen). HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Room temperature must be at least 68%F during waking hours & not less than 60%F at night.  HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10775" 10775A 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. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10770" 10770Provide storage for toxic substances that is only accessible to residents under direct supervision. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750All windows that can be opened must have screens to prevent flies and/or bugs from entering the home when the window is open. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750 EXTERIOR PHYSICAL ENVIRONMENTWAC 388-76The 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 HYPERLINK "https://apps.leg.wa.gov/wac/default.aspx?cite=51-51-0330"WAC 51-51-0330.4 HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10695"10695Step 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 utilized by residents, applicant must show on day of inspection how they plan to make the steps inaccessible to residents. See HYPERLINK "https://apps.leg.wa.gov/wac/default.aspx?cite=51-51-0330"WAC 51-51-0330.10 HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10695"10695Ramps must have a safe slope (8.3% or less). All ramps must be inspected by building official. *Effective August 1, 2022, the local building official will be solely responsible for measuring ramp and landing slopes. Residential Care Services initial inspection Licensors will be responsible for ensuring all ramps have graspable handrails that extend the full length of the ramp slope and that they are securely installed. Licensors will also inspect and address any safety issues such as uneven or abrupt edges and drop off areas that may pose a trip/fall risk to residents. See HYPERLINK "https://apps.leg.wa.gov/wac/default.aspx?cite=51-51-0330"WAC 51-51-0330-9 HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10695"10695 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. Effective *Effective August 1, 2022, the local building official will be solely responsible for measuring ramp and landing slopes. Residential Care Services initial inspection Licensors will be responsible for ensuring all ramps have graspable handrails that extend the full length of the ramp slope and that they are securely installed. Licensors will also inspect and address any safety issues such as uneven or abrupt edges and drop off areas that may pose a trip/fall risk to residents. HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10730" 10730/ HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10745" 10745Doorways must have smooth transitions on bottom of door threshold to maintain a safe, non-trip hazard. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Decks must be safe including having a non-slip surface, sturdy barriers as required, and edges cannot be a trip hazard. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750An 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.  HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750If you have water hazards as described in WAC 388-76-10783, you must ensure resident safety per this WAC. Water hazards over twenty-four inches deep must be enclosed by fences and gates at least forty-eight inches high, equipped with an audible alarm that sounds when any door, screen or gate that directly leads to or surrounds the water hazard is opened and secured by locking any doors, screens or gates that lead directly to or surround the water hazard. HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10783" 10783 / HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10784" 10784If home is located on a busy street, you must be able to demonstrate a plan to ensure resident safety. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750If residents will have access to any drop off areas such as rock walls, a barrier must be in place to prevent residents from accessing the fall hazard. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Front, back and side yards accessible to residents must be free from hazards and toxic materials. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Yard must be maintained. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750Outdoor buildings will need to accessed to ensure safety. HYPERLINK "https://app.leg.wa.gov/wac/default.aspx?cite=388-76&full=true" \l "388-76-10750" 10750If the home has window wells in a resident bedroom, please review the window well requirements located in the International Residential Code sections R310.2.3 and R310.2.3.1. International Residential Code  SAMPLE RESIDENT RECORD REVIEWYou must have a system to maintain confidential resident records so you can provide the needed care to the residents. During initial inspection, you will be required to demonstrate you have a location (i.e., binder) to house all the areas listed below. The only actual documents listed below you will be required to have at time of inspection is the Personal Inventory Sheet, Resident Information Sheet, Disclosure of Charges and Medication Log. HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10315" 10315Your system must be organized so there is a place for the following documents: HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10320" 10320Medication Log [ HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10475" 388-76-10475]Resident Information Sheet [ HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10320" 388-76-10320]Financial Record Keeping  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10320" 10320Personal Inventory Sheet [ HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10320" 388-76-10320]Medical Professional Orders [ HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10320" 388-76-10320]Legal Documents HYPERLINK "D:\\AFH Reference Folder\\388-76-10335"10325Resident Assessment [ HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10335" 388-76-10335]Preliminary Service Plan [ HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10320" 388-76-10320]Negotiated Care Plan HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10355"10355Nurse Delegation [HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10315"388-76-10315]Disclosure of Charges [ HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10540" 388-76-10540] ADMINISTRATIVE RECORDSWAC 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. Please note this is not a checklist of all required staff trainings.112A- HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-112A&full=true" \l "388-112A-0240" 0240Have a process and system to ensure employees meet caregiver qualifications, including 1st Aid/CPR. see also [ HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10135" 388-112A]76- HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10130" 10130/ HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10135" 10135The adult family home must complete the department's disclosure of charges form and provide a copy to each resident admitted to the home.HYPERLINK "https://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10540"10540 For any pets, living or visiting, in the home: proof of updated rabies vaccination is Required. HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10135" 10230Provide 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 HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10755" 10755Provide 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 of water rating the well has. If you have questions about this requirement please discuss with assigned Licensor, or call (360)725-2575 HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10790" 10790PoliciesMust have notice of rights and services (admission agreement) document. Please carefully review WAC Chapter 388-76 for the comprehensive requirements for this document. HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10520" 10520Must 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. HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10830" 10830/ HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10835" 10835Must have written policy on how the home will dispose of unused, left over, and any remaining medication. HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10490" 10490Must have policy for contacting emergency medical services.  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10250" 10250Must 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.  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10522" 10522Must 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.  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10675" 10675 LogsMust have accident / Incident / Injury Log.  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10220" 10220Must have emergency Evacuation Drill Log  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10900" 10900Must have medication Log this log can be a separate log or contained in resident record HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10475" 10475 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. HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10740" 107405-pound 2A:10B-C rated fire extinguisher mounted on each level of home. Must be mounted or securely fastened in a stationary position at a minimum of four inches from the floor and a maximum of sixty inches from the floor; including visible proof of purchase or service within 1 year. When measuring the mounted fire extinguisher, it will be measured 4 inches from the bottom and 60 inches from the top. HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10810" 10810Emergency medical supplies including first aid supplies and a first aid manual HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10850" 10850 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 [ HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10036" 388-76-10036]A daily operation plan for all homes  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10035" 10035A parking plan for each individual home which includes a plan for accessibility of emergency services HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true" \l "388-76-10035" 10035RESOURCES Refer to this web site:  HYPERLINK "https://www.dshs.wa.gov/altsa/residential-care-services/information-afh-prospective-providers" 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 Supplementationand RCWs: chapter 70.128 Adult Family Homes, chapter 70.129 Resident Rights; chapter 74.34 Abuse of Vulnerable AdultsBackground Check InformationCaregiving Experience Attestation [CEA] forms for Entity Representatives & Resident ManagersEmergency Planning InformationRefer to this web site:  HYPERLINK "https://www.dshs.wa.gov/altsa/home-and-community-services/training-requirements-and-classes" 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 SafetyFinding community educators in your areaAdministrator Training ClassesAFH Providers minimum instructor requirementsCalculations: for Door Swings Door Width in inches = Sq Ft for of circle swing Dr Width Sq Ft swing Dr Width Sq Ft swing 25 3.41 sq ft 33 5.94 sq ft 26 3.69 sq ft 34 6.30 sq ft 27 3.98 sq ft 35 6.68 sq ft 28 4.28 sq ft 36 7.07 sq ft 29 4.59 sq ft 37 7.47 sq ft 30 4.91 sq ft 38 7.88 sq ft 31 5.24 sq ft 39 8.30 sq ft 32 5.59 sq ft 40 8.73 sq ft       INCLUDEPICTURE "cid:image001.jpg@01D05D91.AB072E40" \* MERGEFORMAT  Adult Family Home Initial Inspection Preparation Checklist  PAGE 1 for additional information, you may also refer to:  HYPERLINK "https://www.dshs.wa.gov/altsa/residential-care-services/information-afh-prospective-providers" https://www.dshs.wa.gov/altsa/residential-care-services/information-afh-prospective-providers Last Updated 2/21/2023    * . 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You are responsible for meeting                                  2  0  2  0the    52 * 0requirements of the current         ;2   0Washington Administrative Code (          2  0WAC   2 4 0)  2 : 0  2 ? 0&  52 Q 0Revised Code of Washington (         2 7 0RCW   2 \ 0) 2 b 0.   2 k 0  2 o 0WACs   2  0  2   0are listed     2 * 0for ref   #2 _ 0erence only and       2  0are   ,2  0subject to revision.       2  0The  12  0onsite initial inspection         2  0  2  0usually    @2 # 0takes between three and five hours           y2 *I 0depending on the size of the home, the organization of the applicant and                    2 q 0any  &2  0unforeseen onsite        2 ! 0environmental     2   0challenges.    @"Calibri--------- )2 * 0The home should be m       R2 / 0ove in ready on the day of initial inspection.            --- \2 <6 0Please only schedule your initial inspection when you               @ Calibri---- @ !<- --- p2 *C 0have confirmed your home meets all minimum licensing requirements.                 2 V 0   2 Z 0 - @ !)*- @"Calibri---  2 #* 0  I(% 72 =l%(IINTERIOR PHYSICAL ENVIRONMENT         2 =G%(I  ' - @ !!S(- I(--- - @ !R(-  2 5(IWAC   2 5(I388  2 5(I- 2 5(I76  2 5(I-  - @ !R9-   2 F(I:  2 F(I  '- @ !'#-- @ !'#-- @ !k'$- - @ !'-- @ !S'- - @ !'-- @ !'- - @ !!(#- - @ !!(- - @ !!(- [J%@"Calibri------------@"Calibri---@"Calibri--------------------- 2 W+%J[ ---  2 W0%J[P--- 2 W8%J[OSTINGS---  2 We%J[:---  2 Wi%J[ ---  2 Wk%J[  52 Wn%J[In a visible location for st @2 W#%J[aff, visitor, and residents to view ---  2 W%J[  '- @ !I#-- @ !kI$- - @ !I-- @ !SI- - @ !I- - @ !J#- - @ !J-  - @ !\%- n5\% - @ !\%- ---  2 j%%\5n  'n\5---@"Calibri------------ 2 j;5\nPost  2 jV5\n  2 jX5\nthe A  2 jy5\nLTS 52 j5\nA/Complaint Resolution Unit     2 j;5\n[ 2 j@5\nCRU   2 jZ5\n]  2 j_5\n  I2 ja)5\nhotline abuse/neglect contact information   2 j^5\n.  2 jb5\n  I2 jd)5\n --- )2 j5\n[Use poster at link   2 jZ5\nhere  2 ju5\n.  2 jy5\n]---  2 j~5\n @ Calibri---- @ !lZ- ' - @ !S\- n\@"Calibri--- - @ !R]-  2 j\n10525  2 j\n @ Calibri---- @ !#k- '- @ ![#-- @ ![$- - @ ![4-- @ !Z[5- - @ ![-- @ !S[- - @ ![- - @ !\#- - @ !\4- - @ !\- - @ !\-  - @ !n%- 5n% - @ !n%- ---  2 |%%n5  'n5--------------------------- 2 |; 5nPost the WA   2 |5n   2 |5nS 2 |5ntate   2 |5nO  52 |5nmbudsman contact information     2 |s5n.--- 2 |w 5n ---  2 |5n   2 |5n --- 2 |5n ---  2 |5n --- 2 |5n ---  2 |5n  2 | 5n  2 | 5n[the above   2 |X5np 2 |` 5noster includ A2 |$5nes State Ombuds program toll free #]  ---  2 |5n  n5''' - @ !Sn- n--- - @ !Ro-  2 |n10525  2 |n - @ !#}- '- @ !n#-- @ !n$- - @ !n4-- @ !Zn5- - @ !n-- @ !Sn- - @ !n- - @ !o#- - @ !o4- - @ !o- - @ !o-  - @ !%- 5% - @ !%- ---  2 %%5  '5--------------------- A2 ;$5Post Disability Rights of Washington    2 5  2 5poster. 2 A 5  L2 j+5[formerly Washington Protection & Advocacy      2 | 5System]  --- 2 5to o 2 5rde 2  5r poster call---  2 "5   2 &51---  2 -5 --- 2 05800  2 E5- 2 J5562  2 _5- 2 d52702  2 5  ' - @ !S- --- - @ !R-  2 10525  2  - @ !#- '- @ !#-- @ !$- - @ !4-- @ !Z5- - @ !-- @ !S- - @ !- - @ !#- - @ !4- - @ !- - @ !-  - @ !#%- 5% - @ !%- ---  2 %%5  '5---  2 ;5P _2 C85lace in a visible location in common use area a copy of   2  5all complaint   2 5  ,2 5and inspection reports 2 a5, follow   2 5- 2  5up reports  2 5  2  5and related  2 5  2  5cover letters  2 f5  2 h5from    (2 ;5the last 12 months.   2 5  2  5For purpose 2 5s of  F2 '5initial inspection, its only required t \2 65o provide a location where these reports will be kept.    2 %5  ' - @ !#S- --- - @ !R-  2 10585  2  - @ !#- '- @ !#-- @ !$- - @ !4-- @ !Z5- - @ !-- @ !S- - @ !- - @ !##- - @ !#4- - @ !#- - @ !#-  - @ !%- 5% - @ !%- ---  2 %%5  '5---  2 65  A2 9$5Post a statement that the past three   2 5  2 5years of  2 F5  n2 HB5annual inspection and complaint reports are available upon request   2 5.  2 5  ' - @ !S- --- - @ !R-  2 10585  2  - @ !#- '- @ !#-- @ !$- - @ !4-- @ !Z5- - @ !-- @ !S- - @ !- - @ !#- - @ !4- - @ !- - @ !-  - @ !%- 5% - @ !%- ---  2 %%5  '5---  2 65  A2 9$5Have an area designated to post your   2 5  2  5AFH License    2 d5.  2 h5  ' - @ !S- --- - @ !R-  2 10584  2  - @ !#- '- @ !#-- @ !$- - @ !4-- @ !Z5- - @ !-- @ !S- - @ !- - @ !#- - @ !4- - @ !- - @ !-  - @ !%- 5% - @ !%- ---  2 %%5  '5--- 2 ; 5Post your  2 t5  ,2 w5emergency evacuation f  2  5loor plan  42 >5on each level of the house.  2 5  p2 C5*The floor plan for each level of the home should be specific to th  2 i5at   2 ;5level.  2 \5   2 ;5[I m2 DA5ndicate route from each bedroom out of home, the location of the     2 5doors,  C2 %5windows and the outdoor meeting place    2 5.]  2 5  ' - @ !6S- --- - @ !R-  2 10885  2 / 2 10890  2  - @ !#-- @ !#- '- @ !#-- @ !$- - @ !4-- @ !Z5- - @ !-- @ !S- - @ !- - @ !#- - @ !4- - @ !- - @ !-  - @ !$%- 5% - @ !%- ---  2 %%5  '- @ !$#- - @ !$4- - @ !$- - @ !$- (%---------------------------------  2 $0%(C--- 2 $8%(OMMON  ---  2 $h%(A --- 2 $q%(REA---  2 $%((---  2 $%(S---  2 $%()  2 $%(  '- @ !#-- @ !$- - @ !4-- @ !Z5- - @ !-- @ !S- - @ !- - @ !#- - @ !-  - @ !(%- :5(% - @ !(%- ---  2 6%%(5:  ':(5--- ^2 6;75(:Must be homelike, with furnishings that each resident m     2 65(:ay use  2 65(:and  2 65(:  \2 665(:large enough for all residents to use at the same time    2 65(:.  2 65(:  ' - @ !S(- :(--- - @ !R)-  2 6(:10705  2 6(: - @ !#7- '- @ !(#-- @ !($- - @ !(4-- @ !Z(5- - @ !(-- @ !S(- - @ !(- - @ !)#- - @ !)4- - @ !)- - @ !)-  - @ !;%- M5;% - @ !;%- ---  2 I%%;5M  'M;5--- 2 I; 5;MCommon area  2 I5;M/s  2 I5;M  P2 I.5;Mmust not be used as a bedroom or sleeping area    2 I5;M.  2 I5;M  ' - @ !S;- M;--- - @ !R<-  2 I;M10705  2 I;M - @ !#J- '- @ !:#-- @ !:$- - @ !:4-- @ !Z:5- - @ !:-- @ !S:- - @ !:- - @ !;#- - @ !;4- - @ !;- - @ !;-  - @ !M%- _5M% - @ !M%- ---  2 [%%M5_  '_M5--- 2 [;5M_Must be  2 [p5M_large  2 [5M_enough  2 [5M_   2 [5M_f 2 [ 5M_or all res 2 [ 5M_idents to  2 [/5M_  )2 [15M_use at the same time    2 [5M_.  2 [5M_  ' - @ !SM- _M--- - @ !RN-  2 [M_10705  2 [M_ - @ !#\- '- @ !M#-- @ !M$- - @ !M4-- @ !ZM5- - @ !M-- @ !SM- - @ !M- - @ !N#- - @ !N4- - @ !N- - @ !N-  - @ !`%- r5`% - @ !`%- ---  2 n%%`5r  'r`5--- ,2 n;5`rLighting must be adequ  J2 n*5`rate for each task a resident or staff does  2 n5`r.  2 n5`r  ' - @ !S`- r`--- - @ !Ra-  2 n`r10740  2 n`r - @ !#o- '- @ !_#-- @ !_$- - @ !_4-- @ !Z_5- - @ !_-- @ !S_- - @ !_- - @ !`#- - @ !`4- - @ !`- - @ !`-  - @ !Hr%- 5r% - @ !r%- ---  2 %%r5  'r5--- 2 ;5rFi 2 ES5rreplaces that will be used must prevent the possibility of a resident being burned.    2 .5r  2 0 5rA sturdy  2 d5rflame   2 5r- 2 5rresist 2 5rant  2 5r  >2 "5rbarrier will need to be installed    U2 ;15rthat will prevent all access points to any hot su  k2 R@5rrface of the fireplace. If fireplace will not be used, plan to p  @2 #5rrovide residents with some type of     t2 ;F5rnotice the home does not plan to utilize the fireplace. Also, plan to    n2 B5rdemonstrate for the Licensor how you plan to prevent usage of the     2 ; 5rfireplace.   2 v5r  ' - @ !HSr- r--- - @ !R-  2 r10825  2 r   2 r/ 2 r10750  2 r   2 r - @ !"-- @ !#- '- @ !r#-- @ !r$- - @ !r4-- @ !Zr5- - @ !r-- @ !Sr- - @ !r- - @ !Gs#- - @ !Gs4- - @ !Gs- - @ !Gs- %---------------------  2 0%B--- 2 8%EDROOM ---  2 h%(---  2 m%S---  2 s%)  2 x%  '- @ !#-- @ !$- - @ !4-- @ !Z5- - @ !-- @ !S- - @ !- - @ !#- - @ !-  - @ !1%- 5% - @ !%- ---  2 %%5  '5--- 2 ;5Re I2 K)5sident privacy must be maintained in the    2 A5bedroom,   2 ~5  2 5i.e.,  2 5  72 5curtains or blinds on windows   2 L5,  /2 R5bedroom door that closes   2 5  )2 5securely. Pocket, bi  2 b5- 2 g5fold,  5'' 2 ;5side  2 T5- 2 Y5hinged  2 5and barn  2 5- }2 L5style doors are all acceptable provided the minimum door width opening is 27      2 5  (2 5inches and the door  2  5  ,2  5allows for visual and   5''' - @ !1S- --- - @ !R-  2 10575  2  - @ !#- '' - @ !R- ---  2    - @ !R-   2   '- @ !#-- @ !$- - @ !4-- @ !Z5- - @ !-- @ !S- - @ !- - @ !0#- - @ !#-- @ !#-- @ !$- - @ !04- - @ !4-- @ !Z5- - @ !0- - @ !-- @ !S- - @ !0- - @ !-- @ !- "Arial--00  //..D/FG[ ՜.+,D՜.+,X hp  DSHSA- )Initial Inspection Preparation checklist TitleZ 8@ _PID_HLINKSAZe8_\https://www.dshs.wa.gov/altsa/home-and-community-services/training-requirements-and-classesV^\^https://www.dshs.wa.gov/altsa/residential-care-services/information-afh-prospective-providersEY>http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true 388-76-10035EV>http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true 388-76-10035E S>http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76&full=true 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