Understanding DSHS Inspections & Compliance

License Conditions

Requirements the provider must correct within a set timeframe. Used for lower-level or first-time violations. The home may continue operating while corrections are made.

Civil Fines

Financial penalties, which by law become more severe for violations that are repeated, uncorrected, widespread, or a threat to residents: at least $100 per day per violation, up to $3,000 per incident, and up to $10,000 for a current or former provider operating an unlicensed home (RCW 70.128.160).

Stop Placement Order

The home cannot admit new residents until violations are corrected and stability is demonstrated. Used when there is significant risk if admissions continue.

License Suspension or Revocation

The most serious enforcement action. Used when violations are severe, repeated, or remain uncorrected. The home must cease operations until reinstated or permanently.

Medication system

How the home stores, assists with, gives, and tracks residents' medications. The single most-cited rule.

License annual fee

The fee is due each year in the month the home was first licensed. If it is not paid when due, DSHS imposes remedies.

Notice of resident rights and services

Residents must receive written notice of their rights and the home's services. Since September 20, 2026, the resident record must also hold a copy, with the resident's acknowledgement.

Medical devices

Devices that carry a safety risk, such as bed rails, cannot be used as a restraint or for staff convenience, and need an assessment, informed consent, and a place in the care plan first.

Background checks

The Washington name and date-of-birth check is valid for two years and must be kept current; the national fingerprint check is valid indefinitely.

Personnel records

Each staff member's file must hold the required records, such as background checks, training, and certification.

Emergency evacuation drills

Partial drills at least every two months on random staffing shifts (every sixty days before September 20, 2026), each resident in one each year, and a full drill every year, all documented.

Safety and maintenance

The home must be kept safe, clean, and in good repair.

Resident record content

What each resident's record must contain. Amended September 20, 2026: Social Security numbers are no longer required, and the notice of rights is now required.

Medication log

A daily log for each resident of every medication, dose, time, the staff member's initials, refusals, and any change with its written verification.

Focus on patterns, not isolated incidents.

A single citation during a staff transition or paperwork audit is very different from the same violation appearing repeatedly across multiple inspections.

Look for timely resolution.

Strong providers can clearly explain how an issue occurred and what steps they took to correct it. Unresolved or recurring citations are a more meaningful concern.

Context matters more than count.

Many citations address documentation or process issues rather than direct harm to residents. Civil fines and stop-placement orders are reserved for higher-risk situations.

Consider ownership and leadership stability.

Frequent ownership changes can reset the public record. Ask how long the current provider has operated this specific home and request disclosure of any ongoing limits or exemptions.

Use inspections as one tool among many.

Visit the home in person. Ask the seller about staffing levels, the current census and daily routines, and request the home's own copies of recent inspection reports and plans of correction. Public records alone rarely tell the complete story.