Fillable Printable Initial Inspection Preparation checklist Download

Initial Inspection Preparation checklist Download

ADULT FAMILY HOME INITIAL INSPECTION PREPARATION CHECKLIST



 !! !

"#$%&

'('#

INTERIOR PHYSICAL ENVIRONMENT

POSTINGS:)*((%

WAC 388-76-:

+,-.-/!01!02/

1

10525

-,    12

10525

+3#!1#+ #-#24566789:7:;6:

10525

+#4:

10585

+#

10585

<#=<.

10584

+##>

1)(%%2

10885/10890

COMMON AREA/S

?(%#

10705

/

10705

.*

10740

BEDROOM/S

!#@%%(

10575

A%#

10685

B>1564/4:6:2

NOTE:-&CD>E

10685 /10690

B"#

10715

.*

10740

-*((%(

10750

B%>#

10750

%#%#

10795

-%%%%

10685 /10750

%

10795

A

10765

BATHROOM/S WAC 388-76-

#((%See WAC 51-51-0325 Secon R325

10695

ADULT FAMILY HOME INITIAL INSPECTION PREPARATION CHECKLIST

-*@%%#

10750

(%/%"@1>5

10780

KITCHEN AND LAUNDRY AREA

#(#(%F

10410

G%/((%(

10750

G#

10735

MEDICATIONS

((

10485

OTHER ITEMS

AC !"

10720 /10725

# "%

10400 /10685

)'(#%#%'

10750

( H#%*



10805

-=%#%#

10825

7H4:6



=

10750

!95

=% 96

=

NOTE: -J,F

10775

@

10770

+H#

10750

%%>/%%%

10750 /10775

EXTERIOR PHYSICAL ENVIRONMENT

/H(

(%%#%#(%See WAC 51-51-325.4

388-76-10695

-H

10730

!44:5KL #

See WAC 51-51-325.9

10695

!M$$(( 7

10730/10745

3%#F(7'

10750

ADULT FAMILY HOME INITIAL INSPECTION PREPARATION CHECKLIST

WAC 388-76-:

37('

10750

$%&&%&&(

=<

10750(2)

)#%'K557;9746;5K(##

10783 /10784

SAMPLE RESIDENT RECORD REVIEW 

#&#

10315

YOUR SYSTEM MUST BE ORGANIZED SO THERE IS A PLACE FOR THE FOLLOWING DOCUMENTS:

10320

?.1388-76-104752 !)-1388-76-103202 =!G

10320

+)#-1388-76-103202 ?+,1388-76-103202 .3

10325

!1388-76-103352 +#-+1388-76-103202 J+

10355

J31388-76-103152 J31388-76-103152

ADMINISTRATION RECORDS

*

388-112-

10020/ 10035

##&@ 4



/+!1388-76-101302 see also [388-112]

10135

B12

10155

=#((MREQUIRED

10230

+#%#1+0B.)-AA!,!)J3A+AJ3AJ-ANA--A?2

NOTE: )##(discuss with licensor

10755

+#%#1PUBLIC OR PRIVATE WATER SUPPLY] NOTE: )#%(discuss with licensor

10790

POLICIES

%F#%%(O(#

10490

##

10250

#?#

10522

#(((/H#

10675

LOGS

/)/)$#.

10220

A#A3.

10900

?.C

10475

ADULT FAMILY HOME INITIAL INSPECTION PREPARATION CHECKLIST

EMERGENCY PREPAREDNESS

A##*

10740

5 pound 2A:10B-Crated &Hmounted12

%4#

10810

A#M72#%'

10840

A#%7M3 (*1AHMPQ:*R452

10845

A#&&

10850

MULTIPLE HOME PROVIDERS MUST HAVE:

E:P/;ES(1388-76-10036] #

10035

%##

10035

RESOURCES

!A=A!,<)-AB-)AMhttps://www.dshs.wa.gov/altsa/residential-care-services/information-adult-family-home-providers=,!<A=,..,)JNM

 !AN0.),J-

MK557;9 ()*+,(K55744:-(:P975P6./"(K55746876686*

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