Washington DSHS Licensing Standards for Adult Family Homes (AFHs)

Adult Family Homes (AFHs) in Washington play a vital role in providing residential care for older adults and adults with disabilities who require supervision or assistance with activities of daily living. These homes are licensed, monitored, and enforced by the Washington State Department of Social and Health Services (DSHS).

DSHS’s licensing standards for AFHs establish minimum requirements to ensure the health, safety, and welfare of residents. These standards affect everything from staffing and training to environmental safety, medication management, recordkeeping, resident rights, and incident reporting.

This guide provides a comprehensive overview of DSHS licensing standards for Adult Family Homes in Washington State — focusing on operational compliance and survey readiness.

Regulatory Authority

Washington State Adult Family Homes operate under:

• Chapter 388-76 WAC — Adult Family Home Licensing Requirements

• Chapter 388-112A WAC — Assisted Living Facility Licensing Requirements (when AFH elects ALA endorsement)

• Relevant sections of the Revised Code of Washington (RCW)

• DSHS policy and interpretive guidelines

DSHS enforces these standards through routine inspections, complaint investigations, and corrective action plans.

What Is an Adult Family Home?

An Adult Family Home is a:

• Residential living arrangement

• Typically located in a private home or adapted residence

• Serving up to six residents

• Providing supervision, personal care, and assistance with ADLs

• Offering a smaller, home-like setting compared to larger facilities

AFHs may serve a wide range of adult populations, including older adults, individuals with developmental disabilities, and those with physical limitations.

Licensing Categories

Washington DSHS issues Adult Family Home licenses under different categories based on services provided:

1. Basic AFH License — standard care

2. Enhanced Services AFH — additional behavioral or medical needs

3. Specialty Endorsements — such as dementia care (ALA) or specialized developmental care

Licensing categories determine training requirements, staffing capabilities, and survey expectations.

Admission and Retention Standards

DSHS licensing standards emphasize that AFH residents must be appropriate for the home’s care scope.

Resident Screening

Prior to admission, AFHs must:

• Conduct a pre-admission assessment

• Evaluate care needs (mobility, cognition, medication, behavior)

• Document clinical history and support requirements

• Determine whether the home’s staffing and physical setup can safely meet needs

Residents requiring care outside the home’s licensed scope may not be admitted or must be discharged.

Retention Criteria

DSHS expects ongoing evaluation. Residents must remain appropriate for the level of care. If acuity increases beyond AFH capability, transfer to a more suitable setting must occur.

Staffing Standards and Ratios

Washington AFHs must maintain sufficient staffing to:

• Provide resident supervision

• Assist with ADLs

• Administer medications

• Respond to emergencies

• Support resident rights and dignity

Minimum Staff Availability

DSHS does not prescribe rigid numeric ratios but requires staffing levels appropriate to resident acuity. Key expectations include:

• Direct caregivers on duty at all times

• Awake staff when residents are present

• Additional staff or services if resident needs increase

• Documented staffing plans tied to resident assessments

In AFHs providing Enhanced Services or serving residents with complex needs, staffing must increase accordingly.

Staff Training and Competency Requirements

DSHS licensing standards include training expectations for all staff.

Required Training Topics

Staff must complete training in:

• Resident rights and dignity

• Infection prevention

• Safe transfer and mobility assistance

• Medication assistance competence

• Recognizing and reporting abuse/neglect

• Communication and behavioral supports

• Emergency procedures and disaster planning

• Documentation and recordkeeping

Additional topics apply when serving residents with specific needs (e.g., dementia, developmental disabilities).

Timeframes

Training must be completed within defined periods after hire, typically:

• Initial orientation training prior to duty assignment

• Continued competency training within 60–120 days

• Ongoing in-service/annual training

Training records must be maintained in personnel files.

Medication Management Standards

Administration and assistance with medications must comply with DSHS standards:

• Policies and procedures governing medication assistance and supervision

• Clear documentation requirements

• Secure storage of medications

• Observation of self-administration when appropriate

• Preventing medication errors

• Reporting and documenting medication incidents

Medication logs must include:

• Resident name

• Date/time administered

• Dosage

• Staff initials/signature

• Documentation of refusals and omissions

• Physician orders

Infection Control and Safety Procedures

DSHS AFH licensing standards require facilities to adopt:

• Infection prevention policies

• Cleaning and sanitation protocols

• Outbreak response procedures

• Staff training on infection control

• PPE use where appropriate

• Resident screenings

Safety also includes:

• Fire safety compliance

• Environmental hazard prevention

• Emergency drills

• Documentation of safety checks

Personal Care and Activities of Daily Living

AFH staff must assist residents with activities such as:

• Bathing and grooming

• Dressing and feeding

• Toileting

• Ambulation and mobility supports

• Continence care

Assistance must respect resident dignity and preference, and staff must document these supports.

Resident Rights and Confidentiality

DSHS licensing standards strongly emphasize resident rights.

AFHs must:

• Respect dignity and privacy

• Promote autonomy and decision-making

• Provide access to appropriate medical care

• Ensure freedom from abuse and neglect

• Maintain confidentiality of records

• Allow family and resident access to grievance procedures

Providers must post rights notices and distribute them to residents and responsible parties.

Recordkeeping Standards

DSHS requires detailed recordkeeping, including:

• Resident files

• Assessments and service plans

• Medication logs

• Incident reports

• Staff training records

• Staffing schedules

• Communication logs

• Grievance records

Records must be current, accurate, and readily available for inspection.

Incident Reporting and Risk Management

Washington AFHs must implement risk management and incident reporting systems.

Reportable Incidents

Examples include:

• Serious injury

• Resident elopement

• Medication errors with harm

• Abuse or neglect

• Death associated with care factors

• Safety hazards

Reporting Requirements

AFHs must:

• Document internal incident reports promptly

• Notify responsible parties and guardians when required

• Report certain incidents to DSHS within defined timeframes

• Maintain incident records for audit and survey

Corrective actions and root cause analysis should be documented.

Behavioral Supports and Dementia Care

When serving residents with cognitive impairment:

• Staff must be trained in dementia supports

• Behavior support plans must be developed

• Environment must be dementia-friendly

• Incidents of behavioral escalation must be documented

Special endorsements (e.g., assisted living endorsement) impose additional training and care planning requirements.

Physical Environment and Safety Standards

AFHs must maintain a safe, clean, and resident-friendly environment:

• Accessible exits and emergency pathways

• Functional smoke detectors

• Fire extinguishers

• Safe room layouts

• Adequate lighting

• Safe flooring

• Climate control

• Resident accommodations for mobility devices

Facilities must correct hazards promptly.

Resident Assessment and Service Planning

Each resident must receive:

• An initial functional assessment

• Identification of care needs

• Service plan development with measurable goals

• Updates upon condition changes

• Documentation tied to care delivery

Assessments inform staffing plans, medication supervision, mobility supports, and risk mitigation.

Surveillance, Inspections, and Compliance Monitoring

DSHS conducts regular licensing inspections and complaint investigations to verify:

• Policy adherence

• Documentation accuracy

• Staff competency

• Resident outcomes

• Safety practices

• Regulatory compliance

Surveyors review records, observe care delivery, and interview residents and staff.

Corrective Action Plans

When non-compliance is identified, DSHS may issue a Corrective Action Plan (CAP) requiring:

• Root cause analysis

• Remedial training

• Policy revision

• Enhanced supervision

• Documentation corrections

Facilities must implement CAPs in defined timelines and demonstrate ongoing compliance.

Training on Abuse Prevention and Reporting

DSHS standards require staff to be trained on:

• Recognizing abuse, neglect, exploitation

• Mandatory reporting procedures

• Documentation expectations

• Resident protection measures

Failure to report suspected abuse is a compliance violation.

Emergency Preparedness and Disaster Planning

AFHs must have:

• Written emergency plans

• Evacuation procedures

• Communication plans

• Drills and documentation

• Natural disaster readiness

• Contingency staffing plans

Surveyors assess readiness and staff understanding of emergency roles.

Transportation Safety Standards

When providing resident transport, AFHs must:

• Maintain vehicle safety

• Verify driver qualifications

• Adhere to transportation policies

• Monitor resident safety during transport

Documentation of transportation policies and logs is required.

Quality Assurance and Continuous Improvement

Best practices include:

• Internal audits

• Trend analysis

• Staff competency assessments

• Policy review cycles

• Resident satisfaction surveys

Quality programs reduce risk and enhance care.

Common AFH Deficiencies

Frequent survey citations relate to:

• Incomplete assessments

• Poor documentation

• Inadequate staff training

• Medication logs errors

• Incident reporting delays

• Environmental hazards

• Resident rights violations

Effective compliance systems prevent these issues.

Conclusion

Washington State DSHS licensing standards for Adult Family Homes establish comprehensive rules to ensure safe, respectful, and quality care for residents. Successful AFH operators implement structured compliance systems encompassing training, documentation, risk management, resident rights, safety, and continuous quality improvement.

Facilities that prioritize compliance and readiness are better positioned to withstand inspections, prevent adverse incidents, and provide high-quality care.

URL:

Washington Administrative Code — Adult Family Home Licensing
https://apps.leg.wa.gov/WAC/default.aspx?cite=388-76

Washington Administrative Code — Assisted Living Endorsement
https://apps.leg.wa.gov/WAC/default.aspx?cite=388-112A

DSHS Adult Family Home Licensing Overview
https://www.dshs.wa.gov/altsa/residential-care-services/adult-family-homes-afhs