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Vulnerable Children & Adults Final 02-15-11 -   4.2 - Licensing Re-Inspections

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Vulnerable Children & Adults Final 02-15-11
1. Child Safety
2. Child Care Licensing
3. Mental Health
4. Aging & Disability
Action Plan

4.2 - Licensing Re-Inspections
Are we re-inspecting residential care facilities as frequently as required?

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Data Notes
Data Source: Facility Management System and Residential Care Services documentation
Measure Definition: Nursing home re-inspections required every 15 months; adult family home and boarding home re-inspections required every 18 months.
Target Rationale: Response times required by 42 CFR 488.308 (nursing home); RCW 18.20.110 (boarding home); RCW 70.128.070 (adult family home)
Link to Agency Strategic Plan: Goal #2 in the Aging and Disability Services Administration Strategic Plan 2009-2013: Continue Efforts to Enhance Quality of Services
Relevance: This measure is part of ADSA’s core business requirement to protect the health and safety of vulnerable adults.  Meeting the response times for inspections of residential care settings is crucial to the state’s safety net for vulnerable adults.
Notes: (optional) TBD
Also Available
Action Plan: Yes
Extended Analysis: Yes

 Drill Down Measures

 Summary Analysis

Aging and Disability Services Administration continues to meet statutory requirements for the re-inspection of residential care facilities, including nursing homes (NH), boarding homes (BH), and adult family homes (AFH). To maintain their license, all these facilities require inspection by DSHS, though the majority of facility residents are not DSHS clients. Those who are DSHS clients have case management oversight, and are seen more frequently by DSHS than private pay clients.

  • AFHs are the bulk of the licensing and inspection workload, growing faster, and turning over more often. While the number of BH and NH facilities have remained relatively constant over the past 10 years (2000 – 2010), AFHs have added more than 800 facilities during this same period.
  • There are now 30% more AFH facilities than there were in FY04 and AFH complaints to investigate have increased by more than 50% during the same period. These increases have added mandatory licensing and regulatory oversight requirements to the work required of existing staff resources. FTEs to conduct this work have increased less than 10 percent.
  • Because staff resources have not kept pace with expanding oversight requirements, the workload has been prioritized to address the most immediate investigation needs. Complaints are a high priority, and life threatening complaints are investigated sooner than the two-day priority timeline requires. This means licensing staff must be diverted to complaint investigations, which in turn has pushed AFH licensing re-inspections closer to statutory deadlines. More than 85% of all re-inspections now occur in the last six months of the 18-month inspection cycle (see Slide 3 of Supplemental Information on Adult Family Home Oversight). This makes inspections much more predictable to providers, and decreases the effectiveness associated with truly random, or “unanticipated” visits.
  • The number of AFH facilities with identified deficiencies has been steadily increasing. The department has increased its oversight by increasing the number of site visits that are follow ups to deficiencies found from inspections and complaintsThe Department has increased major enforcement actions against AFHs, all of which require stop placement of clients, and can result in license revocation, as well as summary suspension.  Intermediate enforcement actions on AFHs have also increased, these enforcements include conditional licenses or civil fines.

 Key Action Items:  See drill-down measure