What does WAC 388-76 require adult family homes to document?

This is a plain-language summary, not legal advice. Rules change, so check the current text at the links below. Chapter 388-76 WAC was last updated in August 2026.

The resident record

Each resident needs a record kept in the home where they live, with enough information to provide care, in a format useful to the home. It must be confidential, protected from loss, alteration or unauthorized use, and kept for three years after discharge or death (WAC 388-76-10315).

The record includes (WAC 388-76-10320):

• identifying information and contacts, including the resident's representative and health care providers
• medical history, assessment information, the preliminary service plan, the negotiated care plan and the medication list
• the resident's signed acknowledgment of their rights notice
• admission, absence and discharge dates
• a signed inventory of belongings
• financial records and, for Medicaid residents, the residency agreement

The assessment

A written assessment is required before admission, except in a genuine emergency (WAC 388-76-10330). Its topics include significant known behaviors or symptoms, refusal of care, mood or behavior symptoms in the past five years, cognitive status, and any history of depression, anxiety or mental illness (WAC 388-76-10335).

It's updated after a significant change, when the care plan no longer meets the resident's needs, when the resident asks, and at least every 12 months (WAC 388-76-10350).

The negotiated care plan

Built from the assessment, the plan says what services the resident gets, who provides them, and when and how. Where needed, it also covers a plan for foreseeable crises, steps to reduce tension, agitation and problem behaviors, and how staff respond when the resident refuses care (WAC 388-76-10355).

The medication log

A daily log with staff initials, refusals and the reasons for them, and documented medication changes (WAC 388-76-10475).

The incident log and reports

The home logs suspected abuse, neglect, abandonment or exploitation, accidents or incidents affecting a resident's welfare, and any injury to a resident (WAC 388-76-10220). Suspected abuse, neglect, exploitation and abandonment must also be reported to DSHS, and to law enforcement where the law requires (WAC 388-76-10225; RCW 74.34.035). After a significant change, serious injury, trauma or death, the home immediately notifies the family or representative, the health care provider and, for DSHS clients, the case manager. The DSHS complaint hotline is 1-800-562-6078 (WAC 388-76-10617).

Where daily behavior notes fit

The WAC doesn't use the phrase "behavior notes." But the care plan sets out how staff respond to problem behaviors, the home has to carry that plan out, and DSHS reviews the staff notes in the resident record alongside the assessment and the plan (RCS procedures, chapter 12). Daily notes are how you show the plan is being followed, and how you notice when it needs to change.