Your Washington home care office, records and counties

Client records must be "accessible in the licensee’s office location for review by appropriate direct care personnel, volunteers, contractors, and the department" (WAC 246-335-450(2)(a)). They may be "written legibly in permanent ink or retrievable by electronic means" (WAC 246-335-450(2)(b)), and must be on your standard forms or templates, confidential, in date order, fastened together if on paper, kept current, and stored "in a safe and secure manner to prevent loss of information, to maintain the integrity of the record, and to protect against unauthorized use" (WAC 246-335-450(8)(a)).

How DOH reaches your records

• Any time. "The department may at any time conduct a survey of all records and operations of a licensee in order to determine compliance with this chapter." (RCW 70.127.180(1))
• Unannounced. DOH may survey unannounced at any time and at least once during each licensure period (WAC 246-335-340(1)). DOH says "Initial surveys are scheduled and announced; on-going surveys are unannounced." (DOH, Survey Program)
• In clients’ homes too. DOH may visit clients to observe care (RCW 70.127.180(1)), and the rule speaks of on-site visits with client consent (WAC 246-335-335(4)).
• Health information law. Client records are kept and released under chapter 70.02 RCW (RCW 70.02.020). That chapter lists disclosure "when needed to determine compliance with state or federal licensure, certification or registration rules or laws" among those a health care provider makes without the patient’s authorization (RCW 70.02.050(2)(a)). Whether a home care agency counts as a "health care provider" under that chapter is not settled in what we read; the DOH rule requires DOH access either way.

The rules do not say how quickly you must produce a record when a surveyor asks. Our suggestion: keep records where whoever is in the office can find them, and if they are electronic, make sure someone there can log in and print them. In CareRulebook’s manual, Policy 3.4 sets out how client records are kept, filed and released, and Policy 1.7 names the office where records are kept.

The 30-year rule for employee medical records

This one comes from the Department of Labor and Industries (L&I), not DOH. L&I’s bloodborne pathogens chapter applies if any of your employees have occupational exposure to blood or other potentially infectious materials (WAC 296-823-100), and DOH’s rule has you offer the Hepatitis B vaccine when your risk assessment finds that exposure (WAC 246-335-425(12)(e)). Then:

• "You must establish and maintain an accurate medical record for each employee with occupational exposure." It holds the person’s Hepatitis B vaccination status, any declination statement and post-exposure evaluation records, and is kept confidential (WAC 296-823-17005).
• That rule says "You need to follow additional requirements for medical records found in chapter 296-802 WAC" (WAC 296-823-17005, Reference), and chapter 296-802 WAC says "You must keep medical records for at least as long as the employee works for you plus thirty years." (WAC 296-802-20005(1)).
• An exemption: "If an employee works for you for less than one year and you provide the records to them when they leave employment, you do not have to keep their medical records." (WAC 296-802-20005)
• "You may keep information in any form as long as the information is retrievable." (WAC 296-802-200)

CareRulebook’s manual applies the 30 years to the bloodborne pathogens records, kept in a confidential health section of the personnel file (Policy 3.5). Whether other health records an agency holds, such as TB test results from a clinic, also count as employee medical records under chapter 296-802 WAC is a question for L&I; we have not settled it.

Personnel files and everything else

Chapter 246-335 WAC sets no retention period for personnel files, complaint logs or quality improvement records. CareRulebook’s manual keeps personnel files for three years after the person leaves, and sets its own periods for other agency records, mostly three years. Those are the manual’s choices (Policy 3.5). Other laws, such as tax and payroll rules, may set their own periods for some records; we did not review them.

If the agency closes

Your plan of operation must include "a plan for preserving records, including the process to preserve or dispose of records prior to ceasing operation according to WAC 246-335-450 (7) and (8)" (WAC 246-335-415(8)), and after closing the licensee must "retain or dispose of client records in a confidential manner" for the periods above (WAC 246-335-450(8)(c)). For employee medical records, L&I’s rule has you transfer them to any employer that continues the business, or, if none does, "notify affected current employees of their rights of access to records at least three months prior to the termination of your business" (WAC 296-802-60005).

DOH approves the area you serve as well as the agency. A service area "means the geographic area in which the department has given prior approval to a licensee to provide home health, hospice, or home care services" (WAC 246-335-310(39)), and the statute has every applicant "file with the department for approval a description of the service area in which the applicant will operate and a description of how the applicant intends to provide management and supervision of services throughout the service area." (RCW 70.127.080(1)(f)). DOH may not set service area criteria that "limit the number or type of agencies in any service area" (RCW 70.127.080(1)(f)(i)).

• You tick the counties. DOH’s application lists Washington’s 39 counties, each with a home care box (DOH 505-051; our count).
• DOH approves each one. "The department must approve the requested counties before an agency may provide services in those counties." "Approval of a county includes the expectation that agencies will strive to service all clients or patients within the county boundaries." (DOH 505-053, item 2C)
• Your plan covers every county. The plan of operation sets out how intake and plans of care, supervision, evaluations and quality improvement work throughout all approved service areas (WAC 246-335-415(6)), and the administrator provides management and supervision throughout them (WAC 246-335-415(11)(d)). The administrator and supervisor →
• Staffing counts per county. For renewal fees, "The department will assume a minimum of 2 FTE for each approved service area per service category." (WAC 246-335-990(4)). DOH’s FTE worksheet and application instructions still say a minimum of one FTE per service area per category (DOH 505-137; DOH 505-053). If you plan several counties with a small team, ask DOH how it will count you.
• Adding or dropping counties. "Licensees must receive department approval for service area expansion prior to providing services in the proposed expanded service area(s)." (WAC 246-335-335(6)(b)). Serving fewer counties needs written notice within 30 days (WAC 246-335-335(5)(d)).

By our arithmetic, an applicant asking for three counties pays DOH’s $5,000 initial fee (WAC 246-335-990(1)) plus a surcharge on the two counties after the first: $6,000 in all if both are urban, $5,200 if both are rural. This is our example, not a DOH quote.

What the rule leaves open. It does not say which counties are urban and which are rural, and we did not find a DOH list. It charges the surcharge to "an applicant or licensee" without saying whether it is charged again at each renewal or only when a county is added. Ask DOH’s home care program (360-236-2957) before you budget (DOH, Contact Information).

Chapter 246-335 WAC mentions branch offices once, in the display rule: the license goes in the main office, "including branch office locations if applicable" (WAC 246-335-335(3)). The home care rules do not define a branch office or set a distance from the main office. What DOH asks for:

• Each office on the application. Section 4, "Other Office Locations": "Enter the name, street address, mailing address, phone number, fax number, email address, and on-site manager or supervisor name." You also tick the service categories provided from each location (DOH 505-053, item 4). The section’s "Approved Medicare Branch Office" box is, by our reading, for Medicare-certified home health and hospice offices (DOH 505-053).
• Business licenses for each office location (DOH 505-109).
• Notice within 30 days of beginning or ceasing operation of any office location (WAC 246-335-335(5)(b)).

The rules do not say whether each office must hold its own records. The office rule asks for at least one office where records are kept, secured and accessible, and client records must be accessible "in the licensee’s office location" (WAC 246-335-450(2)(a)). Counties are approved for the agency: the application’s county table sits apart from the office section, which asks for categories but not counties (our reading of the form). CareRulebook’s manual lists each office with the counties it serves and its on-site manager or supervisor, and keeps every client’s record available at the office DOH has on file (Policy 1.1); ask DOH if you plan to keep records only at a second office.

The rules do not say. We read chapter 70.127 RCW, chapter 246-335 WAC, DOH’s application packet (DOH 505-052, April 2026, with the 505-051 application, 505-053 instructions and 505-109 license requirements), and DOH’s home care pages: the program page, license requirements, survey program, updated rules and orientation class. None of them says whether the in-state office may be in a residence. None says it must be commercial premises, and none says a home is allowed. We are not reading an answer into that silence either way.

Ask DOH’s home care program on 360-236-2957 before you sign a lease or set up at home (DOH, Contact Information). Our suggestion: ask for the answer in writing and keep it with your license papers.

What applies wherever your office is

These are rule duties for any office. They are not an answer to the home office question, but they are what to plan for:

• records kept, secured and accessible there (WAC 246-335-335(2));
• the license displayed where the public can see it (WAC 246-335-335(3));
• DOH may survey all records and operations at any time, unannounced (RCW 70.127.180(1); WAC 246-335-340(1));
• its physical street address goes on your application (DOH 505-053), with the business licenses for that location (DOH 505-109).

Your address may be published. DOH’s January 2025 list of licensed in-home services agencies in King, Kitsap, Pierce and Snohomish counties prints each agency’s site address, city, zip code and county (DOH list, January 2025). If your office is your home, plan on that address being public.