What do DSHS inspectors look at in an adult family home's behavior documentation?

This summarizes DSHS's published procedures. It isn't legal advice.

How often inspections happen

DSHS inspects adult family homes at least every 18 months, averaging about 15 months statewide, and may make unannounced inspections at any time (RCW 70.128.070). Homes with three clean consecutive inspections can go up to two years.

What the record review covers

DSHS's procedures for adult family home inspections say record review covers (RCS procedures, chapter 12):

• the resident assessment
• the preliminary service plan and negotiated care plan
• the staff notes included in the resident record

The purpose, in DSHS's words, is to confirm the records are consistent with the resident's care and service needs: accurate, current and supporting their care. Concerns from records are followed up with interviews and observation. Records are reviewed for a sample of residents, and for at least one closed record if the home has no current residents.

What that means for behavior notes

• Notes match the plan. If the plan says staff offer a quiet space, the notes should show that, in the plan's words.
• Notes are current. Gaps of days or weeks are hard to explain.
• Changes lead somewhere. Repeated new behaviors should show up in a reassessment or plan review.
• Notes match what staff say. Inspectors interview staff and residents, so notes should describe what really happens.

Have records ready

DSHS can see residents' records, including former residents' (WAC 388-76-10915). Records can be paper or electronic. Anything not provided during the visit should be sent electronically within 24 hours (DSHS letter AFH #2024-011).