Washington home care policies and procedures: what DOH reviews

Plan of operation: organizational structure

Describe how the agency is organized (an organizational chart or narrative of key positions).

"The applicant or licensee must develop and implement a plan of operation which includes: (1) A description of the organizational structure;"

Plan of operation: job descriptions

Include personnel job descriptions that meet WAC 246-335-425(2).

"Personnel job descriptions according to WAC 246-335-425(2);"

Plan of operation: contractor and volunteer responsibilities

State what contractors and volunteers are responsible for (or that the agency uses none).

"Responsibilities of contractors and volunteers;"

Plan of operation: services

List the services the agency provides.

"Services to be provided;"

Plan of operation: days and hours

State the agency’s days and hours of operation.

"The days and hours of agency operation; and"

Management across service areas: intake and plan of care

Describe how intake and the plan of care are completed in every approved county.

"How the initial intake and development of the plan of care will be completed per WAC 246-335-440;"

Management across service areas: supervision

Describe how staff and volunteers are supervised and contractors monitored in every approved county.

"How supervision of personnel and volunteers and monitoring of services provided by contractors will occur which meet the requirements of WAC 246-335-445;"

Management across service areas: evaluations

Describe how performance evaluations and contractor evaluations are done in every approved county.

"How performance evaluations for personnel and volunteers and evaluation of services provided by contractors will be conducted per WAC 246-335-425 (13) and (14); and"

Management across service areas: quality improvement

Describe how the quality improvement program applies in every approved county.

"How the quality improvement program required in WAC 246-335-455 will be applied throughout all approved service areas."

Informing clients of alternatives

Have a process to tell clients about alternative services before closing, or when the agency cannot meet their needs.

"A process to inform clients of alternative services prior to ceasing operation or when the licensee is unable to meet the client’s needs;"

Preserving records on closure

Plan how records are preserved, or disposed of, before the agency ceases operation.

"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);"

Time frames for filing client documents

Set how soon visit notes and other documents are filed in client records.

"Time frames for filing documents in the client records;"

Emergency preparedness

Plan service delivery when disasters, man-made incidents or public health emergencies stop normal operation: risk assessment and planning, a communication plan, coordination with emergency personnel for clients’ urgent needs, and staff training.

"Include, at minimum: Risk assessment and emergency planning, communication plan, coordination of service delivery with emergency personnel to meet emergent needs of clients, and staff training;"

Administrator qualifications

Name an administrator who is a home care employee, and set in policy the education and experience the role needs.

"The applicant or licensee must identify an administrator. The administrator must be a home care employee and possess education and experience required by the agency’s policies."

Administrator: day-to-day operation

The administrator oversees daily operation and fiscal affairs, implements the plan of operation, arranges necessary services and is the liaison between the licensee, staff, contractors and volunteers.

"Oversee the day-to-day operation and fiscal affairs of the agency; ... Arrange for necessary services; ... Serve as a liaison between the licensee, personnel, contractors and volunteers;"

Administrator: written alternate

Designate in writing who acts when the administrator is absent.

"Designate in writing an alternate to act in the administrator’s absence;"

Administrator: management across service areas

The administrator manages and supervises services throughout all approved counties.

"Provide management and supervision of services throughout all approved service areas according to subsection (6) of this section;"

Administrator: contracts current

Keep contractor contracts current and consistent with the contracting policy.

"Keep contracts current and consistent with WAC 246-335-425(4);"

Administrator: current Washington credentials

Make sure staff, contractors and volunteers hold current Washington credentials where their work needs one.

"Ensure personnel, contractors and volunteers are currently credentialed by the state of Washington, when appropriate, according to applicable practice acts and consistent with WAC 246-335-425(5);"

Administrator: policy compliance, quality and records

Make sure everyone follows the agency’s policies, implement quality improvement and manage recordkeeping.

"Ensure personnel, contractors and volunteers comply with the licensee’s policies and procedures;"

Supplies and equipment

Make sure supplies and equipment needed for client care are available, maintained and working.

"Ensure supplies and equipment necessary to client care are available, maintained, and in working order;"

Accurate public information

Make sure brochures, websites and adverts are accurate (and use "home care" only as licensed).

"Ensure the accuracy of public information materials; and"

Policies accessible to staff

Keep current written policies accessible to staff, contractors and volunteers during operating hours.

"Ensure current written policies and procedures are accessible to personnel, contractors, and volunteers during hours of operation."

Keep the plan of operation current

Update the plan of operation as practice, services and laws change.

"The licensee must continue to update its plan of operation to reflect current practice, services provided by the agency, and state and local laws."

Admission, transfer, discharge and referral

Write and follow procedures for admitting, transferring, discharging and referring clients.

"The applicant or licensee must develop and operationalize delivery of services policies and procedures that describe: (1) Admission, transfer, discharge, and referral processes:"

48-hour discharge notice

Give at least 48 hours’ written or verbal notice before discharge and document it in the client record.

"In order to minimize the possibility of client abandonment, clients must be given at least a forty-eight hour written or verbal notice prior to discharge that will be documented in the client record;"

When 48 hours’ notice is not needed

No 48-hour notice is required where worker safety, significant client noncompliance or non-payment is the reason.

"Forty-eight hour notice is not required if home care agency worker safety, significant client noncompliance, or client’s failure to pay for services rendered are the reason(s) for the discharge;"

Self-report on a concerning dischargeif the agency discharges a client whose ongoing care and safety concern it

When discharging a client whose ongoing care and safety concern the agency, it may self-report to the appropriate state agencies with the reasons and the steps taken.

"A home care agency discharging a client that is concerned about their ongoing care and safety may submit a self-report to appropriate state agencies"

DSHS or AAA contract time framesif the agency has a DSHS or AAA contract

Agencies with a DSHS or AAA contract may follow the contract’s discharge notice and start-of-service time frames.

"Home care agencies under contract with DSHS or the AAA may follow different time frames for notice of discharge as established in the terms of the contract."

Nonmedical services available

Describe the specific nonmedical services available to meet client or family needs in the plan of care.

"Specific nonmedical services available to meet client, or family needs as identified in the plan of care;"

Start services within seven days

Start services within seven calendar days of accepting a referral; a longer time is allowed only when requested or agreed (for example to hire the right caregiver) or the agency could not reach the client, and the reason is documented.

"Home care services starting within seven calendar days of receiving and accepting a referral for services. Longer time frames are permitted when one or more of the following is documented:"

Medication self-administration with assistance

Describe what staff, contractors and volunteers may and may not do when helping clients take their own medications.

"Agency personnel, contractor, and volunteer roles and responsibilities related to medication self-administration with assistance;"

Medication assistance scope

Medication help is limited to reminding, handing, opening, enablers (no hand-over-hand), placing in the hand, setting up diabetic devices and handing injectables; transferring between containers and altering medication only on a practitioner’s direction; no IV or injectable administration.

"A nonpractitioner shall only perform the medication assistance described in subsection (1)(h) and (i) of this section, where a practitioner has determined and communicated orally or by written direction that such medication preparation assistance is necessary and appropriate."

Medication assistance restrictions

Help only clients cognitively aware they are taking medication, immediately before they take it; otherwise it must be administered by someone legally authorized.

"If an individual is not able to administer a medication to themselves independently or with assistance, then the medication must be administered to the individual by a person legally authorized to do so."

Coordination of care

Describe coordination with the agency’s own home health or hospice services (if licensed for them) and with other agencies when care affects the client’s health.

"Coordination of care, including: (a) Coordination among services being provided by a licensee having an additional home health or hospice service category; and (b) Coordination with other agencies when the care being provided impacts client health;"

Communication needs

Describe how the agency meets client and family communication needs (language, hearing, vision, cognition).

"Actions to address client, or family communication needs;"

Emergency care of the client

Describe what staff do in a client medical emergency.

"Emergency care of the client;"

Back-up care

Describe how substitute care is provided when scheduled care cannot be; ADL help only by credentialed or exempt workers, non-credentialed staff only for IADLs or emergencies.

"Providing back-up care to the client when services cannot be provided as scheduled. Back-up care which requires assistance with client ADLs must be provided by staff with minimum credentialing or workers who meet the exemption criteria in chapter 246-980 WAC."

Death of a client

Describe what staff do when a client dies or is found dead.

"Actions to be taken upon death of a client;"

Advance directives

Describe what the agency does when a client has a signed advance directive.

"Actions to be taken when client has a signed advanced directive;"

POLST

Describe what staff do when a client has a signed POLST, including giving it to emergency personnel in a medical emergency; an incomplete section means full treatment.

"Actions to be taken if a client has a signed POLST form. Any section of the POLST form not completed implies full treatment for that section."

Vital signs: informational helpif the agency offers help with taking vital signs

If offered, workers only assist clients to take their own vital signs, for information, with electronic digital devices, and pass readings to the client or representative.

"Home care agency workers may only assist clients in the process of taking their own vital signs."

Vital signs that guide medicationif the agency helps take vital signs that decide medication

If readings decide whether or how much medication to take, contract an RN to decide if nurse delegation is appropriate and to train workers.

"Agencies must contract with a registered nurse to determine if nurse delegation is appropriate and train agency worker(s) on taking specific vital signs and to understand how the readings relate to the medications that the client needs to take;"

Range of motion: therapist’s planif the agency offers passive range of motion

If offered, get a copy of the client’s passive range of motion plan from a PT, OT or qualified RN, dated within 12 months and stating maintenance only; otherwise direct the client to get a new plan. The client gives the agency an updated plan at least yearly.

"The plan must clearly state that the passive range of motion is for maintenance purposes only. Passive range of motion for purposes of restoring joint function is outside the scope of a home care agency to provide;"

Range of motion: skills checkif the agency offers passive range of motion

Verify and document assigned workers’ range of motion skills before they start.

"Ensure and document passive range of motion skills verification of assigned agency workers, consistent with WAC 246-335-425(9), prior to the provision of these services"

Nurse delegationif the agency provides nurse delegation

If offered: only for stable and predictable clients, through a contracted RN delegator (or DSHS/AAA for Medicaid clients), with workers holding DSHS core delegation training. Agencies that do not offer it need no policy.

"A licensee with an approved home care service category only may provide nurse delegation in the following ways: (i) Contract with a registered nurse for any client needing nurse delegation;"

Nurse delegation trainingif the agency provides nurse delegation

Credentialed workers complete DSHS core delegation training before taking part in delegation.

"Home care agency credentialed workers must complete the core delegation training from DSHS prior to participating in the delegation process."

Delegated tasks: consent and exclusionsif the agency provides nurse delegation

Delegated tasks are done only for that client, with consent, never injections other than insulin, sterile procedures, central lines or nursing judgment.

"Only for the specific patient for whom those tasks are delegated;"

Non-discrimination in employment

Set employment criteria consistent with the Washington Law Against Discrimination (chapter 49.60 RCW).

"The applicant or licensee must develop and operationalize personnel, contractor, and volunteer policies and procedures that describe: (1) Employment criteria regarding discrimination consistent with chapter 49.60 RCW;"

Job descriptions

Write job descriptions with responsibilities that fit each credential’s scope of practice.

"Job descriptions that contain responsibilities and are consistent with health care professional credentialing and scope of practice as defined in relevant practice acts and rules;"

References

Check references for staff, contractors and volunteers.

"References for personnel, contractors and volunteers;"

Contractingif the agency uses contractors

If contractors are used: a contract describing their duties and stating the contractor withholds their own taxes; contractors meet the same rules as staff.

"The contract should include, at minimum, a description of the duties the contractor will perform, and a statement indicating that the contractor, not the employer, is responsible for withholding any necessary taxes."

Credentials current

Verify health care professionals’ credentials are current and in good standing.

"Credentials of health care professionals that are current and in good standing;"

Background checks and disclosure statements

Run Washington State Patrol checks and get DOH-approved disclosure statements for everyone associated with the agency who has contact with children under 16, people with developmental disabilities or vulnerable persons; renew every two years.

"Criminal history background checks and disclosure statements for personnel, contractors, volunteers, students, and any other individual associated with the licensee having direct contact with children under sixteen years of age, people with developmental disabilities or vulnerable persons according to RCW 43.43.830 through 43.43.842"

WSP processing, DOH disclosure form, two-year renewal

Checks go through the Washington State Patrol, disclosure statements are on DOH’s approved form, and both are renewed within two years.

"Criminal history background checks must be processed through the Washington state patrol (WSP); (b) Disclosure statements must be approved by the department"

Initial checks through DSHS BCCU

DOH says home care agencies run initial hiring checks through DSHS BCCU (which satisfies -425(6)) and two-year rechecks through WSP.

"Processing background checks through the BCCU satisfies the requirement in WAC 246-335-425(6)."

Fingerprint checks for caregivers

Long-term care workers need a state and FBI fingerprint check at initial hire; a worker cleared on the name check may work up to 120 days while fingerprints are pending.

"All long-term care workers shall be screened through state and federal background checks in a uniform and timely manner to verify that they do not have a history that would disqualify them from working with vulnerable persons."

Fingerprint results within 120 days

If fingerprint results have not arrived within 120 days of hire the worker cannot keep working unsupervised.

"The applicant’s fingerprint results MUST be received by the HCA within 120-days of hire- no exceptions."

Give workers a copy of results

Tell the applicant of the Washington State Patrol response within 10 days of receiving it and give them a copy (RCW 43.43.834(4), which covers the two-year WSP rechecks). DSHS’s instructions say the same for BCCU result notifications: keep a copy and give the applicant a copy within 10 days.

"The business or organization shall notify the applicant of the state patrol’s response within ten days after receipt by the business or organization. The employer shall provide a copy of the response to the applicant and shall notify the applicant of such availability."

Conditional employment pending checks

Where the law requires a state or national check, a person may be engaged on a conditional basis pending completion.

"persons may be employed or engaged as volunteers or independent contractors on a conditional basis pending completion of the state background investigation"

Disqualifying history

People with unsupervised access may not have disqualifying convictions or findings, or be the respondent in an active vulnerable adult protection order; they disclose in writing under penalty of perjury.

"These additional requirements shall ensure that any person associated with a licensed agency or facility having unsupervised access with a vulnerable adult shall not be the respondent in an active vulnerable adult protection order"

Registry and findings bar

Do not employ in care with unsupervised access anyone on the vulnerable adult abuse registry or with a qualifying founded finding.

"A provider may not be employed in the care of and have unsupervised access to vulnerable adults if:"

Character, competence and suitability

Make and document a determination for anyone whose check shows non-disqualifying convictions, pending charges or negative actions, weighing ability to meet care needs, client vulnerability, behavior since, patterns, time elapsed, self-disclosure and other safety concerns.

"Factors to consider when making a determination include, but are not limited to: (a) Whether there is a reasonable, good faith belief that they would be unable to meet the care needs of the client;"

Reporting noncompliance to DOH

Staff report failures to comply with the rules or statute to DOH on DOH’s forms within 14 calendar days.

"Mandatory reporters shall report failure to comply with the requirements of chapters 246-335 WAC and 70.127 RCW to the department. The report must be submitted on department forms."

Reporting abuse, neglect and exploitation

Staff report suspected abandonment, abuse, financial exploitation or neglect immediately to DSHS and to law enforcement.

"Mandatory reporters shall report suspected abandonment, abuse, financial exploitation, or neglect of a person in violation of RCW 74.34.020 or 26.44.030 to the department of social and health services and the proper law enforcement agency."

Sexual and physical assault reports

Suspected sexual assault goes immediately to law enforcement and DSHS; physical assault or acts causing fear of imminent harm go immediately to DSHS and law enforcement.

"When there is reason to suspect that sexual assault has occurred, mandated reporters shall immediately report to the appropriate law enforcement agency and to the department."

Suspicious death

If abuse, neglect or abandonment is suspected in a death, report to the medical examiner or coroner, DSHS and local law enforcement.

"When there is reason to suspect that the death of a vulnerable adult was caused by abuse, neglect, or abandonment by another person, mandated reporters shall"

What a report contains

Reports give as much as possible of: reporter, the vulnerable adult and the agency, guardian, what happened, history, alleged perpetrator and other helpful information.

"Each report, oral or written, must contain as much as possible of the following information:"

No policy may block reporting

Agency policies may not interfere with staff’s direct duty to report (for example, by requiring permission first).

"may develop policies or procedures that interfere with the reporting requirements of this chapter"

No retaliation

Whistleblowers who report in good faith have remedies against reprisal, and retaliation against clients who complain is presumed within a year.

"An employee or contractor who is a whistleblower and who as a result of being a whistleblower has been subjected to workplace reprisal or retaliatory action, has the remedies provided under chapter 49.60 RCW."

In-person orientation and skills verification

Give in-person orientation to current policies and verify skills or training (written test, observation, prior training) before anyone gives care independently.

"In-person orientation to current agency policies and procedures and verification of skills or training prior to independently providing client care."

Ongoing training

Provide ongoing training relevant to clients’ care needs.

"Ongoing training pertinent to client care needs;"

Food safety

Safe food storage, preparation and handling following the FDA’s "food safety at home" guidance, and no homemade food for clients.

"Safe food storage, preparation and handling practices consistent with the United States Food and Drug Administration’s recommendations for "food safety at home""

Standard precautions

Hand hygiene, respiratory hygiene and cough etiquette, and personal protective equipment.

"Standard precautions such as hand hygiene, respiratory hygiene and cough etiquette, and personal protective equipment;"

PPE available

Make PPE and other equipment needed for each plan of care available.

"Availability of personal protective equipment and other equipment necessary to implement client plans of care;"

TB risk assessment at hire

Assess every new employee with DOH’s TB risk assessment form and test as the form recommends.

"Conducting a TB risk assessment for all new employees upon hire. Agencies must use a tuberculosis risk assessment form provided by the department."

Annual TB risk assessment

Reassess all employees for new TB risk factors every year on DOH’s form; retest only those who tested negative and have new risks.

"Conducting an annual assessment of new TB risk factors for all employees."

TB training

Train workers on TB at hire or orientation using DOH’s TB program materials.

"Ensuring workers receive TB related training and education at the time of hire or during new employee orientation."

Use DOH’s Adult TB Risk Assessment

DOH says to use its Adult TB Risk Assessment form and test if any of the three boxes is checked.

"Agencies must use the department’s Adult TB Risk Assessment form (PDF) and conduct TB testing if any of the three boxes are checked."

Communicable disease

Say what to do when staff or clients show or report symptoms of a communicable disease in an infectious stage, following chapters 246-100 and 246-101 WAC.

"Actions to take when personnel, volunteers, contractors, or clients exhibit or report symptoms of a communicable disease in an infectious stage"

Bloodborne pathogens risk assessment

Assess occupational exposure risk in staff’s working environments (per L&I chapter 296-823 WAC), let it shape policy and training, and check yearly whether a new assessment is needed.

"Conducting an initial risk assessment of the environment in which personnel, volunteers, and contractors perform their assigned duties to determine occupational exposure."

Hepatitis B vaccine offer

If exposure is reasonably anticipated, offer the Hepatitis B series at the agency’s expense; workers may decline.

"If the risk assessment concludes that workers have a reasonably anticipated risk of occupational exposure to blood and other potentially infectious materials, agencies must offer workers the Hepatitis B vaccine series at the agency’s expense."

Annual infection control review

Document a yearly review of state and federal health authority guidance on infection control, testing and vaccination, and update training and policies.

"Agencies must document an annual review of applicable state and federal health authority recommendations related to infection control practices, communicable disease testing, and vaccinations and update trainings and policies and procedures as necessary."

Annual performance evaluations

Evaluate every staff member and volunteer who gives direct care each year, including on-site observation of care and skills.

"Annual performance evaluations of all personnel and volunteers providing direct client care, including on-site observation of care and skills specific to the care needs of clients"

Annual contractor evaluationsif the agency uses direct care contractors

Evaluate direct care contractors’ services each year.

"Annual evaluations of services provided by contractors providing direct client care."

Records: credential or exemption

Keep each worker’s current credential, or documentation that a non-credentialed long-term care worker meets a chapter 246-980 WAC exemption.

"Current practice certification, credential, licensure, or documentation that noncredentialed long-term care workers meet the exemption criteria in chapter 246-980 WAC, as applicable;"

Records: references, orientation, contracts, skills

Keep reference checks, evidence of orientation, contracts and skills or training verification.

"Documentation of references; (3) Evidence of orientation to current agency policies and procedures; (4) Contracts when using contractors; (5) Verification of personnel, contractor, and volunteer skills or training specific to meeting the care needs of clients;"

Records: background checks

Keep evidence of initial and later background checks and disclosure statements.

"Evidence of initial and subsequent criminal history background checks and disclosure statements according to RCW 43.43.830 through 43.43.842 and this chapter;"

Records: policy training

Keep records of training on current and revised policies, including client care issues.

"Training on current and revised agency policies and procedures, including client care issues;"

Records: food handlingif staff prepare food for clients independently

For staff who prepare food for clients independently: food worker card, equivalent FDA training, or home care aide certification.

"Documentation for personnel, contractors, and volunteers who prepare food for the client independent of the client’s assistance, including:"

Records: testing and vaccination

Keep communicable disease testing and vaccination records as current health authority guidance recommends.

"Communicable disease testing and vaccination according to current state and federal health authority recommendations; and"

Records: evaluations

Keep documentation of performance and contractor evaluations.

"Documentation of performance evaluations of personnel and volunteers providing direct client care and evaluations of services provided by contractors providing direct client care"

Entry-level training within 120 days

Non-exempt long-term care workers complete 75 hours of DSHS-approved training within 120 days of hire, 5 hours (orientation and safety) before giving any care.

"all persons hired as long-term care workers must meet the minimum training requirements in this section within one hundred twenty calendar days after the date of being hired."

Home care aide certification

Non-exempt direct care employees apply for certification within 14 days of hire and must stop giving care if training is not done in 120 days or certification in 365 days (425 provisional), the 2025 to 2027 timelines.

"A long-term care worker is no longer eligible to provide care without a credential under the following circumstances:"

Documenting exemptions

Know which workers are exempt (nurses, CNAs, limited-hour, family-only, pre-2012 workers, CNA trainees) and document the basis.

"Long-term care workers who are exempt from obtaining a home care aide certification may be required to complete minimum training requirements under RCW 74.39A.074 or 74.39A.076."

Continuing education

Track 12 hours of continuing education a year for long-term care workers; home care aides need it to renew.

"A home care aide shall demonstrate completion of 12 hours of continuing education per year as required by RCW 74.39A.341."

Verify training and certification before hiring

DSHS’s rule says the employer reviews and verifies a worker’s highest training or certification (and continuing education for the hiring year) before hiring. It cites a "home care agency" definition no longer in RCW 74.39A.009, so whether it binds private-pay agencies is unclear; treat as good practice.

"must review and verify the highest level of training or certification achieved by the individual."

Keep training certificates

DSHS’s rule says a home care agency keeps a copy of each worker’s training certificate or transcript on file.

"A home care agency must keep a copy of the proof of completion as specified in subsection (1) of this section on file."

Rehiring workers who never finished training

Do not employ a former long-term care worker who never completed required training or certification unless their date of hire is reset under DSHS’s rule.

"a home care agency or consumer directed employer must not employ the individual to work as a LTC worker until the individual has completed the required training certification unless the date of hire has been reset"

Caregiver standards of practice

Long-term care workers may not borrow from or solicit clients, accept gifts above twice the hourly minimum wage, take client drugs or alcohol, work impaired, hold power over client finances or decisions, be the client’s landlord, or photograph clients without written permission. These bind each worker; the manual should say so.

"A long-term care worker must demonstrate behavior which maintains and respects client or resident rights and safety."

No power of attorney for clients

No owner, contractor or employee may hold a durable power of attorney for a client.

"No licensee, contractee, or employee may hold a durable power of attorney on behalf of any individual who is receiving care from the licensee."

Written bill of rights at admission

Give each client (or family member or legal representative) a written bill of rights at admission.

"A home care agency at the time of admission must provide each client, designated family member, or legal representative with a written bill of rights affirming each client’s right to:"

Rights: quality care and planning

Quality services under the plan of care, appropriately trained or credentialed staff, and ongoing participation in developing the plan of care.

"Receive quality services from the home care agency for services identified in the plan of care; (2) Be cared for by appropriately trained or credentialed personnel, contractors and volunteers with coordination of services;"

Rights: choice of agency

Access to DOH’s list of licensed home care agencies and the right to choose any licensee, subject to payment arrangements.

"A statement advising of the right to have access to the department’s listing of licensed home care agencies and to select any licensee to provide care"

Rights: services, refusal, supervisor

A list of all services offered and those provided, the right to refuse specific services, and the name and contact details of the person supervising the client’s care.

"The name of the individual within the home care agency responsible for supervising the client’s care and the manner in which that individual may be contacted;"

Rights: respect, safety, property, privacy

Courtesy, respect and privacy; freedom from abuse, neglect, exploitation and discrimination; respect for property; confidentiality of personal and health information.

"Be free from verbal, mental, sexual, and physical abuse, neglect, exploitation, and discrimination;"

Rights: charges and billing

What the agency charges, what insurance or public programs may pay, what the client pays, and an itemized bill on request (not required for managed care plans).

"Be informed of what the home care agency charges for services, to what extent payment may be expected from care insurance, public programs, or other sources, and what charges the client may be responsible for paying;"

Rights: advance directives and POLST

Information about advance directives and POLST and the agency’s scope of responsibility.

"Be informed about advanced directives and POLST, and the agency’s scope of responsibility;"

Rights: discharge and back-up care policies

The agency’s policies on when it may discharge a client and on back-up care.

"Be informed of the agency’s policies and procedures regarding the circumstances that may cause the agency to discharge a client;"

Rights: complaint process

How clients and family complain to the agency and have complaints addressed without retaliation.

"A description of the agency’s process for clients and family to submit complaints to the home care agency about the services and care they are receiving and to have those complaints addressed without retaliation;"

Rights: DOH and End Harm hotlines

DOH’s complaint hotline number and DSHS’s End Harm hotline number.

"Be informed of the department’s complaint hotline number to report complaints about the licensed agency or credentialed health care professionals; and (19) Be informed of the DSHS end harm hotline number"

Rights implemented and updated

Make sure the rights are carried out and the document kept up to date.

"The home care agency must ensure that the client rights under this section are implemented and updated as appropriate."

Written plan of care

Develop and follow a written plan of care for each client, with the client’s (or family’s or representative’s) input and written approval.

"Develop and implement a written home care plan of care for each client with input and written approval by the client, designated family member, or legal representative;"

Plan from an on-site visit

Plans are developed by trained or credentialed staff, list requested or recommended services, and are based on an on-site visit, following agency policy.

"Ensure each plan of care is developed by appropriately trained or credentialed agency personnel, lists services requested or recommended to meet client needs, and is based on an on-site visit and according to agency policies and procedures;"

Plan of care contents

Functional limitations; nutrition needs and food allergies; relevant equipment and supplies; whether there is a signed advance directive or POLST; nurse delegation tasks if any; the specific nonmedical services and how often.

"Ensure the home care plan of care includes: (a) The client’s functional limitations; (b) Nutritional needs and food allergies for meal preparation;"

Plan of care: equipment, directives, delegation, services

The plan also lists equipment, directive or POLST status, delegated tasks and the services with their frequency.

"Specific nonmedical services to be provided and their frequency."

Review every 12 months

Review the plan on-site, update it and get it signed by staff and the client every 12 months and whenever care needs change significantly.

"Ensure the plan of care is reviewed on-site, updated, approved and signed by appropriate agency personnel and the client, designated family member, or legal representative every twelve months"

Reporting condition changes

Have a system so the supervisor learns of changes in a client’s condition that need a plan update.

"Inform the supervisor of direct care services regarding changes in the client’s condition that indicate a need to update the plan of care."

One-time visitsif the agency provides one-time visits

For a one-time visit, record name, age, address and phone, confirmation the bill of rights was given, consent, and services provided, instead of a full plan.

"Home care agencies providing a one-time visit for a client may provide the following written documentation in lieu of the home care plan of care requirements"

DSHS CARE assessment as the planif the agency has an AAA contract for Medicaid clients

AAA-contracted agencies may use the DSHS CARE assessment details and service summary as the plan of care if it covers every required item.

"may use the DSHS CARE assessment details and service summary, or successor assessment tool, as the plan of care if it covers all items in subsection (3) of this section"

Supervisor and alternate

Employ a supervisor of direct care services, who names a similarly qualified alternate in writing.

"The supervisor of direct care services must designate in writing a similarly qualified alternate to act in the supervisor’s absence;"

Supervisor: 10 hours training a year

The supervisor and alternate each complete and document at least ten hours of relevant training a year (in-services, classes, conferences, emergency duties).

"Training must be documented and maintained in the personnel files."

Supervisor available during care hours

The supervisor or designee is available whenever clients are receiving care.

"The supervisor or designee must be available during all hours of client care;"

Supervisor duties

Supervise all care by staff and volunteers, evaluate contractors, coordinate and revise written client care policies, coordinate with other providers, and ensure care follows the plan.

"Coordination, development, and revision of written client care policies;"

Workers report changes

All direct care workers observe and report changes in a client’s condition and needs to the supervisor or designee.

"All direct care personnel, contractors, and volunteers observe and recognize changes in the client’s condition and needs, and report any changes to the supervisor of direct care services or the designee;"

Workers start emergency procedures

All direct care workers initiate emergency procedures under agency policy.

"All direct care personnel, contractors, and volunteers initiate emergency procedures according to agency policy;"

Workers read the plan first

Each worker reviews the plan of care and any written instructions before giving care and whenever the plan changes.

"Each home care agency worker reviews the plan of care and any additional written instructions for the care of each client prior to providing home care services and whenever there is a change in the plan of care"

Medication help follows policy

Each worker assists with medications only as agency policy and the rules allow.

"Each home care agency worker assists with medications according to agency policy and this chapter."

Six-monthly client contact

The supervisor contacts each client by phone or visit every six months to check the plan is followed and the client is satisfied, and documents it.

"The supervisor of direct care services must conduct and document client contact by phone or visit every six months to evaluate compliance with the plan of care and to assess client satisfaction with care."

A current record for each client

Keep a current record for each client consistent with the health care information law (chapter 70.02 RCW).

"Maintain a current record for each client consistent with chapter 70.02 RCW;"

How records are kept

Accessible at the office to staff and DOH, legible in permanent ink or electronic, on standard forms, legally acceptable, confidential, chronological, and fastened together if on paper.

"Accessible in the licensee’s office location for review by appropriate direct care personnel, volunteers, contractors, and the department;"

Records kept current per policy

File documents within the time frames the agency’s policy sets.

"Kept current with all documents filed according to agency time frames per agency policies and procedures."

Record contents

Name, age, address and phone; consent; payment source and client responsibility; plan of care; signed, dated visit notes for every contact; supervision records; anything else the chapter requires.

"Signed or electronically authenticated and dated notes documenting and describing services provided during each client contact;"

Client access to records

Records belong to the agency, but clients may access their own.

"Consider the records as property of the licensee and allow the client access to his or her own record; and"

Information on transfer

On request and under agency policy, give client information or a care summary when a client transfers or is discharged to another provider.

"Upon request and according to agency policy and procedure, provide client information or a summary of care when the client is transferred or discharged to another agency or facility."

Retention periods

Adults: three years after services end; minors: three years after age 18 or five years after discharge, whichever is longer; deceased clients: three years.

"Minors - Three years after attaining age eighteen, or five years following discharge, whichever is longer"

Security, release and closure

Store records securely against loss and unauthorized use, release them only under chapter 70.02 RCW, and after closing keep or dispose of them confidentially for the retention period.

"Store client records in a safe and secure manner to prevent loss of information, to maintain the integrity of the record, and to protect against unauthorized use;"

Quality improvement program

Run a quality improvement program across all approved counties.

"Every home care licensee must develop and operationalize a quality improvement program to ensure the quality of care and services provided throughout all approved service areas"

Complaint procedure

A procedure for receiving, investigating and resolving complaints about services.

"A complaint process that includes a procedure for the receipt, investigation, and disposition of complaints regarding services provided;"

Finding and fixing problems

A method to identify, monitor, evaluate and correct problems raised by clients, families, staff, contractors or volunteers.

"A method to identify, monitor, evaluate, and correct problems identified by clients, families, personnel, contractors, or volunteers; and"

Client satisfaction

A system to assess client satisfaction with the agency’s overall services.

"A system to assess client satisfaction with the overall services provided by the agency."

Policies demonstrate compliance

Policies cover the chapter for the home care category and clearly show compliance; no Medicare references.

"Policies and procedures addressing the content of this chapter for the service category(ies) to be provided."

Policies in the agency’s own words

DOH says policies may not be the WAC or RCW copied word for word.

"P&Ps may not consist of the WAC or RCW copied word for word"

Review templates before submission

Applicants who used AI or templates review the documents thoroughly for legal accuracy, WAC applicability and fit with their actual workflows before submitting.

"This includes verifying legal and regulatory accuracy, Washington Administrative Code provisions and applicability, and ensuring the facility’s workflows and staff responsibilities reflect the current practice."

In-state office and license display

Keep at least one Washington office holding the records, and display the license there.

"Maintain at least one in-state office location where records are kept, secured, and accessible;"

Cooperate with surveys

Cooperate with DOH surveys, including record review and home visits with client consent.

"Cooperate with the department during surveys which may include reviewing licensee records and conducting on-site visits with client or patient consent;"

Notify DOH within 30 days

Tell DOH in writing within 30 days of a new administrator or supervisor, opening or closing an office, ceasing home care, or reducing service areas.

"Changes of administrator, director of clinical services, or supervisor of direct care services;"

Approval before serving new counties

File an amended application and get approval before serving a new county.

"Request approval to expand state licensing home care, home health, or hospice service areas, by submitting an amended application"

Renewal package

At least 30 days before expiry: renewal application, insurance evidence, FTE worksheet, current checks and disclosure statements for the administrator and supervisor (renewed within two years), organizational structure and fee.

"Copies of the most current criminal history background checks and disclosure statements for the administrator, director of clinical services, or supervisor of direct care services"

Insurance kept in force

Keep commercial general liability cover of $1 million per occurrence or $2 million combined, with evidence at renewal.

"Evidence of continuing insurance coverage according to WAC 246-335-320 (2)(b);"

Change of ownership noticeif ownership changes

At least 30 days before the change, the current licensee files DOH’s change of ownership form, and the prospective new owner files a change of ownership application with DOH’s change of ownership fee ($500 per licensed service category, a state fee set in WAC 246-335-990).

"At least thirty days prior to changing ownership of an in-home services agency, the licensee must submit to the department a change of ownership form as provided by the department."

Plan of correctionif DOH issues a statement of deficiencies

Submit a signed plan of correction within ten working days of a statement of deficiencies and finish corrections within 60 days.

"The licensee shall sign and return the completed plan of correction or directed plan of correction to the department on or before the required date."

Keep approved exemptionsif DOH has granted an exemption

Keep a copy of any DOH-approved exemption available at all times.

"The licensee must retain a copy of each approved exemption and have them available at all times."

Use of "home care" in names and adverts

Use "home care" or "in-home services" in the name or advertising only for licensed services; do not advertise home health or hospice without those categories.

""Home care agency," "home care services," or "home care" in its corporate or business name, or advertise using such words unless licensed to provide those services under this chapter"