Care-facility inspections
How nursing homes and care facilities in Washington are inspected, licensed, and held to account.
15 laws · 12 enforcement actions · 4 guides · 3 court decisions
See the details
The laws 15
- RCW 18.51.030, Nursing Homes chapter — License required: after July 1, 1951 no person may operate or maintain a nursing home in Washington without a license under chapter 18.51 RCW app.leg.wa.gov
- RCW 18.51.060, Nursing Homes chapter — Penalties—Grounds: authorizes the Department of Social and Health Services to suspend, revoke or refuse to renew a nursing home license, order stop placement, assess civil monetary penalties, deny medi… app.leg.wa.gov
- RCW 18.51.210, Nursing Homes chapter — Authority to enter and inspect nursing home—Advance notice—Defense: authorizes any duly authorized department officer/employee/agent to enter and inspect any nursing home (including interviewing reside… app.leg.wa.gov
- RCW 18.20.030, Assisted Living Facilities chapter — License required: after January 1, 1958 no person may operate or maintain an assisted living facility in Washington without a license under chapter 18.20 RCW, and defines when a license is… app.leg.wa.gov
- RCW 18.20.125, Assisted Living Facilities chapter — Inspections—Enforcement remedies—Screening—Limitations on unsupervised access to vulnerable adults: requires outcome-based, complaint-responsive inspections that interview an appropriate p… app.leg.wa.gov
- RCW 18.20.520, Assisted Living Facilities chapter — Stop placement orders and limited stop placement orders: requires an ALF under a stop placement or limited stop placement order to publicly post a standardized departmental notice (with th… app.leg.wa.gov
- RCW 70.128.060, Adult Family Homes chapter — License—Generally—Fees: sets the AFH licensing application/issuance process and bars the department from licensing an applicant with prior chapter violations resulting in revocation/suspension/no… app.leg.wa.gov
- RCW 70.128.160, Adult Family Homes chapter — Department authority to take actions in response to noncompliance or violations—Civil penalties—Adult family home account: the AFH enforcement-ladder statute, authorizing license denial/condition… app.leg.wa.gov
- RCW 70.128.100, Adult Family Homes chapter — Immediate suspension of license when conditions warrant: gives the department authority to immediately suspend an AFH license upon finding conditions that constitute an imminent danger to residen… app.leg.wa.gov
- RCW 70.129.005, Long-Term Care Resident Rights chapter — Intent—Basic rights: legislative intent extending the basic federally-guaranteed nursing-facility resident rights (42 U.S.C. 1396r, 42 C.F.R. app.leg.wa.gov
- RCW 70.129.020, Long-Term Care Resident Rights chapter — Exercise of rights: guarantees every long-term care facility resident a dignified existence, self-determination and communication access, freedom from facility interference/coercion/r… app.leg.wa.gov
- RCW 74.42.020, Nursing Facilities (resident care standards) chapter — Minimum standards: establishes RCW 74.42.030 through 74.42.570 as the minimum resident-care standards for facilities licensed under chapter 18.51 RCW (nursing homes), wit… app.leg.wa.gov
- RCW 74.42.600, Nursing Facilities chapter — Department inspections—Notice of noncompliance—Penalties—Coordination with department of health: requires the department to inspect nursing facilities for compliance with resident-rights and direc… app.leg.wa.gov
- RCW 74.34.020, Abuse of Vulnerable Adults chapter — Definitions: defines "abandonment," "abuse" (including sexual, physical and mental abuse) and related terms governing the state's vulnerable-adult protection system that covers residents o… app.leg.wa.gov
- RCW 74.34.035, Abuse of Vulnerable Adults chapter — Reports—Mandated and permissive—Contents—Confidentiality: requires mandated reporters (which includes facility staff) to immediately report reasonable-cause abandonment/abuse/financial exp… app.leg.wa.gov
Know your rights 4
- DSHS HCLA/RCS — Informal Dispute Resolution (IDR) program: RCS's own compliance guidance explaining how AFH/ALF/ESF/CCRSS/ICF-IID/NH providers can obtain an independent, centralized review of a citation or enforcement action (a right create… dshs.wa.gov
- DSHS HCLA/RCS — Enhanced Services Facilities (ESF) provider guidance page: explains new rules effective January 1, 2026 (implementing federal Home and Community-Based Settings requirements) that require AFH/ALF/ESF providers to use a writte… dshs.wa.gov
- RCS Management Bulletin R26-044, "Citation Without Plan of Correction" (issued 07/16/2026): internal compliance-procedure guidance clarifying that RCS surveyors may only select the STARS "citation without plan of correction" category for AL… fortress.wa.gov
- Washington State Department of Health (DOH) — Home Health Agencies licensing page: confirms DOH (not DSHS/RCS) licenses home health agencies (skilled nursing/therapy services delivered in a client's home) as a separate regulator from the DS… doh.wa.gov
Enforcement actions 4
- DSHS Home and Community Living Administration (HCLA, formerly ALTSA), Residential Care Services (RCS) — Nursing Home Locator for Professionals & Providers: a live, form-driven (POST) search of every licensed Washington nursing home by count… fortress.wa.gov
- DSHS HCLA/RCS — Assisted Living Facility Locator for Professionals & Providers: a live search of every licensed Washington ALF by county/city/zip/license#, with contract type, bed count, memory-care certification status and a "View Reports"… fortress.wa.gov
- DSHS HCLA/RCS — Adult Family Home Advanced Locator for Professionals & Providers: a live search of every licensed Washington AFH by county/specialty/contract, each row showing a named provider with a per-facility "Documents & Reports" statu… fortress.wa.gov
- DSHS HCLA/RCS — "Most Frequently Cited WACs and RCWs in Adult Family Home Inspections and Complaint Investigations" (CY2025 Q4, posted 01/2026): a statewide quarterly citation-frequency report drawn directly from RCS's own STARS enforcement… dshs.wa.gov
Orders & settlements 8
- WAC 388-97-4220, Nursing Homes rules — Reasons for denial, suspension, modification, revocation of, or refusal to renew a nursing home license: lists the department's grounds to deny/suspend/modify/revoke/refuse-to-renew a nursing home lice… app.leg.wa.gov
- WAC 388-97-4600, Nursing Homes rules — Civil penalty fund: requires civil penalties collected under chapters 18.51/74.42 RCW to be deposited into a special department fund used for resident relocation costs, maintaining a nursing home's ope… app.leg.wa.gov
- WAC 388-78A-3160, Assisted Living Facilities rules — Authorized enforcement remedies: the ALF enforcement-remedy menu under RCW 18.20.050/18.20.185/18.20.190, including license/memory-care-certification denial, suspension, revocation or non… app.leg.wa.gov
- WAC 388-78A-3181, Assisted Living Facilities rules — Remedies—Specific—Civil penalties: sets the ALF civil-penalty fine schedule (at least $100/day/violation, escalating to $3,000/day/violation by July 2020, $3,000 for ombuds interference o… app.leg.wa.gov
- WAC 388-76-10975, Adult Family Homes rules — Remedies—Specific—Civil penalties: the AFH civil-penalty fine schedule (at least $100/day/violation; up to $1,000 for ombuds interference under RCW 70.128.150; app.leg.wa.gov
- WAC 388-76-10910, Adult Family Homes rules — Inspections—Complaint investigations—Monitoring visits—General: requires the department to conduct unannounced inspections, complaint investigations and monitoring visits to determine AFH complia… app.leg.wa.gov
- WAC 388-107-1430, Enhanced Services Facilities rules — Enforcement authority—Penalties and sanctions: the ESF enforcement-remedy statute (license suspension/revocation/nonrenewal denial, stop placement, civil monetary penalties) for chapter… app.leg.wa.gov
- WAC 388-107-0001, Enhanced Services Facilities rules — Definitions: defines abandonment, abuse (mental, physical, sexual) and exploitation of residents in Washington's enhanced services facilities (ESFs, the highest-acuity behavioral/reside… app.leg.wa.gov
Court decisions 3
- Kim v. Lakeside Adult Family Home, Washington Supreme Court No. 91536-9 (filed May 12, 2016): a resident died of acute morphine intoxication at an adult family home; courts.wa.gov
- Turner v. Department of Social & Health Services, Washington Supreme Court No. 99243-6 (filed August 12, 2021): a long-term-care client with multiple sclerosis died in an apartment fire after DSHS/an Area Agency on Aging case-managed his tr… courts.wa.gov
- Schuster v. Prestige Senior Management, L.L.C., Washington Court of Appeals Div. III No. 33242-0-III (published, filed April 28, 2016): a resident's family sued the operators of Blossom Creek Senior Alzheimer Community (an assisted living/m… courts.wa.gov
Official notices 3
- DSHS HCLA/RCS Management Bulletins (2018-2026 archives): RCS's numbered bulletin series to its own regional/field survey staff on enforcement policy, rule changes and emergency guidance for nursing homes, ALFs, AFHs, ESFs and CCRSS provider… dshs.wa.gov
- RCS Management Bulletin R26-037 (issued 06/10/2026): notifies RCS adult-family-home field staff of 2026 legislative amendments (ESHB 2505) to RCW 70.128.030 creating a narrow AFH-licensure exemption, effective June 11, 2026, for certain for… fortress.wa.gov
- ALTSA/RCS Provider Letters portal: a searchable, filterable (by provider type NH/AFH/ALF/CCRSS/ESF/ETSS/ICFIID and year 2015-2026) archive of dated numbered letters sent directly TO Washington care-facility providers (distinct from the inte… dshs.wa.gov