Survey & Regulatory
September 25 | Is It Medication Assistance, Or Medication Administration?
The nuanced differences between medication assistance (called “self-administration with assistance” by the pharmacy board) and medication administration require looking at different Washington Administrative Codes (WACs) –... Read MoreAugust 27 2026 | Opioid Use Disorder-Discrimination Prohibited
While there are complex challenges to skilled nursing facilities in providing the necessary care and services to residents with a variety of medical conditions, treatment... Read MoreAugust 27 2026 | Medication Management Citations Top-Of-Mind for DSHS
In a recent meeting, Residential Care Services (RCS) leadership team members shared concerns with WHCA staff regarding the continued uptick of medication-related citations in assisted... Read MoreMedication Assistant Certification Endorsement (MACE) Survey
SNF | Please take 10-15 minutes to complete this important WABON (Washington Board of Nursing) survey by August 4 to better understand the barriers to employ, train, and certify Nursing Assistants to become Medication Assistant Certified Endorsed (MACE) in WA. Read MoreJuly 30 2026 | Limited Reasons to Issue a Discharge Notice
WHCA staff have received many questions this past month regarding discharge notices; specifically, in what circumstances a discharge notice can legally be issued. This article... Read MoreJuly 30, 2026 | In Case you Missed It: PBJ is Moving to iQIES
Effective August 17, 2026, all Payroll Based Journal (PBJ) staffing data submissions will transition to iQIES. It is important to note that this transition will... Read MoreJuly 2 2026 | CMS Releases Fact Sheet on OBRA Discharge MDS Assessments
In case you missed it, CMS released a new fact sheet to help skilled nursing facilities (SNF) determine when an OBRA Discharge assessment is required.... Read MoreJuly 2 2026 | Who Can Conduct Resident Assessments in Assisted Living?
This article was originally sent via an emailed Survey and Regulatory newsletter in 2023. While still accurate, questions surrounding assessments continue as the top inquiries to... Read MoreMay 29 2026 | Timeline For Change in Cost of Care and Services
There are regulatory requirements outlining formal notification to residents and their surrogate decision makers, specifically to charges for care and services. This article outlines the different... Read MoreMay 29 2026 | More Than You Want to Know on Federal Enforcement Remedies
The Centers for Medicare & Medicaid Services (CMS) has a variety of federal enforcement remedies at their discretion outlined in the State Operations Manual, Chapter... Read MoreApril 30 2026 | Denial of Payment for New Admissions vs. Stop Placement
Last month’s Survey & Regulatory Update gave an overview of state enforcement remedies. This article will discuss the federal enforcement remedy, Denial of Payment for New Admissions... Read MoreApril 30 2026 | Medicaid Pre-Admission Assessments and Intermittent Nursing Services
WHCA staff have received questions from members regarding the use of a potential resident’s Medicaid assessment (called a CARE assessment by DSHS) as the pre-admission... Read MoreMar 6 2026 | State of Washington SNF Enforcement Remedies: An Overview
When a skilled nursing facility (SNF) in Washington gets an enforcement notice from the Department of Social and Health Services (DSHS) or the Centers for... Read MoreMar 6 2026 | Resident Dementia Screening in Assisted Living
While all assisted living residents receive preadmission and ongoing assessments, those with symptoms of dementia require the facility staff to do some additional data collection. This... Read MoreFeb 20 2026 | Resident Dementia Screening in Assisted Living
While all assisted living residents receive preadmission and ongoing assessments, those with symptoms of dementia require the facility staff to do some additional data collection. ... Read MoreFeb 20 2026 | State of Washington SNF Enforcement Remedies: An Overview
When a skilled nursing facility (SNF) in Washington gets an enforcement notice from the Department of Social and Health Services (DSHS) or the Centers for... Read MoreJan 23 2026 | F684 - Quality of Care - The Basics
For those of you that may have missed the recent WHCA Top 10 citations for 2025, the number one federal citation in our state is... Read MoreJan 23 2026 | Mock Inspections in Assisted Living
Written by WHCA's Vicki McNealley Assisted living facilities incur demanding and rigorous annual DSHS inspections that cover all areas of the business. In viewing the top... Read MoreDec 18 2025 | Adverse Event Disclosure
Adverse events happen; while companies and their staff work hard to minimize the likelihood of an adverse event occurring, absolute avoidance is an unachievable goal.... Read MoreDec 18 2025 | Adverse Event Disclosure
Adverse events happen; while companies and their staff work hard to minimize the likelihood of an adverse event occurring, absolute avoidance is an unachievable goal.... Read MoreSept 10 2022 | Resident Discharge Notice Guidance for Assisted Living
Issuing a discharge notice to a resident and his/her surrogate decision maker is never an easy task. Not only is it emotionally difficult for all... Read MoreAug 20 2022 | Respite Care in Assisted Living
Assisted living facilities can legally provide short-term respite care in assisted-living licensed rooms. There is no additional application or approval process necessary for an assisted living... Read MoreJuly 17 2022 | Resident Move-In Process
The process of moving a new resident into an assisted living community can be daunting for the resident, their family members, staff, and the facility... Read MoreMay 30 2022 | Investigating Incidents in Assisted Living
Incident investigations can be time consuming. Getting to the root cause of an accident or incident, to implement workable prevention measures, can take much concentration and... Read MoreNov 20 2025 | Risk Management: Pressure Injuries
Allegations related to “facility-grown” pressure injuries remain a frequent cause for lawsuits and claims. This is particularly true as the frailness of residents continues to rise;... Read MoreNov 20 2025: Risk Management: Pressure Injuries
Allegations related to “facility-grown” pressure injuries remain a frequent cause for lawsuits and claims. This is particularly true as the frailness of residents continues to rise;... Read MoreOct 17 2025 | Resident Abuse
Allegations of resident abuse cause significant alarm for residents, staff, and families. First and foremost, acknowledging the trauma and effects of abuse to the victim... Read MoreOct 17 2025 | Resident Abuse
Allegations of resident abuse cause significant alarm for residents, staff, and families. First and foremost, acknowledging the trauma and effects of abuse to the victim... Read MoreUpdated Guidance for Melatonin Use in Skilled Nursing
SNF | DSHS has released a "Dear Provider" letter containing updated guidance for the use of melatonin in Skilled Nursing Facilities. Read MoreSept 22 2022 | Resident Falls
Resident falls can be devastating to the residents, their family, and facility staff. One out of every five falls results in serious injury such as... Read MoreSept. 22 2025 | Resident Falls
Resident falls can be devastating to the residents, their family, and facility staff. One out of every five falls results in serious injury such as... Read MoreAug 22 2025 | Elopement
A missing resident can be a scary and dangerous situation. Many long-term care facilities have developed and implemented systems to minimize the likelihood of resident... Read MoreAug 22 2025 | Elopement
A missing resident can be a scary and dangerous situation. Many long-term care facilities have developed and implemented systems to minimize the likelihood of resident... Read MoreJune 20 2025 | Transfer & Discharge Requirements – Notification of Ombudsman
As most of you are aware by now, the Centers for Medicare and Medicaid Services (CMS) made some key changes to Appendix PP of the State... Read MoreApr 17 2025 | The Benefits of Working Towards a National Quality Award
The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) has hosted a long-standing opportunity for WHCA member skilled nursing and assisted living providers to... Read MoreApr 17 2025 | The Benefits of Working Towards a National Quality Award
The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) has hosted a long-standing opportunity for WHCA member skilled nursing and assisted living providers to... Read MoreMar 21 2025 | Responsibilities of the Director of Nursing
On January 13, 2025, the Centers for Medicare & Medicaid Services (CMS) released a memo which identifies their 2025 Mission and Priorities. Contained within this document... Read MoreMar 21 2025 | Disclosure of Services
Every assisted living facility must disclose the scope of care and services it offers. This information must be completed on the Department of Social and Health... Read MoreFeb 20 2025 | Reporting of Crimes — F607 and F609
An often overlooked or misunderstood federal requirement is the result of section 1150B of the Social Security Act (SSA). On March 23, 2011, federal laws... Read MoreFeb 20 2025 | Requirements to Maintain Resident Contact Information
Resident contact information, along with aggregate data on residents’ care needs, must be made available to various agencies upon request. This article aims to clarify... Read MoreJan 23 2025 | Reporting Facility Investigation Outcome – 5 Day Requirement
There is a portion of the federal requirements related to facility investigations of abuse, neglect, exploitation, or mistreatment that has historically received little attention. However,... Read MoreJan 23 2025 | RN Delegation as a Relationship
RN delegation in Washington’s assisted living facilities has been around since 1996; while aspects of the regulations surrounding delegation have evolved over the years to... Read MoreNov 22 2024 | Every Long-Term Care Employee is a Resident Advocate
The ombuds program in Washington state is vital in holding up the rights of residents staying and living in assisted living and skilled nursing facilities.... Read MoreNov 22 2024 | Every Long-Term Care Employee is a Resident Advocate
6The ombuds program in Washington state is vital in holding up the rights of residents staying and living in assisted living and skilled nursing facilities.... Read MoreDec 13 2024 | Visitation
Imagine yourself in your own home, reading or watching TV. Someone you’ve known for years – or maybe, instead, a new acquaintance you met just last... Read MoreDec 13 2024 | Visitation
Imagine yourself in your own home, reading or watching TV. Someone you’ve known for years – or maybe, instead, a new acquaintance you met just... Read MoreOct 25 2024 | Ombuds Access to Residents and Resident Councils
Washington state is known for its robust advocacy channels for residents living or staying in long term care (LTC) facilities, including assisted living and skilled... Read MoreOct 25 2024 | Ombuds Access to Residents and Resident Councils
Washington state is known for its robust advocacy channels for residents living or staying in long term care (LTC) facilities, including assisted living and skilled... Read MoreSept 13 2024 | WHCA Members: Report on Your DSHS Survey/Inspection Experience
We encourage members who have experienced a recent survey or inspection who are interested in sharing their thoughts and ideas on the survey process to complete our quick informational Survey on Surveys. Read MoreSept 13 2024 | WHCA Welcomes Members to Report on Their DSHS Survey/Inspection Experience
We encourage members who have experienced a recent survey or inspection who are interested in sharing their thoughts and ideas on the survey process to complete our quick informational Survey on Surveys. Read MoreAug 26 2024 | Making the Most Recent Inspection Results Available
WHCA and Residential Care Services (RCS) headquarters staff recently met to discuss issues regarding recent assisted living facility members’ inspections. Of concern during this meeting... Read MoreAug 26 2024 | Overview of State & Federal CMPs
On July 31st the Centers for Medicare & Medicaid Services (CMS) issued the final rule for the skilled nursing facility (SNF) prospective payment system (PPS)... Read MoreJul 11 2024 | CMS Minimum Staffing Requirements - Waiver Criteria
When the minimum staffing rules take effect as referenced in June’s Survey & Regulatory article and in the Centers for Medicare and Medicaid Services (CMS)... Read MoreJul 11 2024 | Resident Smoking
Residents who smoke require careful consideration to promote safe habits while honoring Washington state’s smoking laws. Even if your building is a “no smoking” facility,... Read MoreJun 17 2024 | Reporting Concerns About a Statement of Deficiencies
Receiving a Statement of Deficiencies (SOD) report from Residential Care Services (RCS) can be a stressful time. To understand each component of a SOD, see... Read MoreJun 17, 2024 | CMS Minimum Staffing Rule-Requirements
As noted in last month’s Survey & Regulatory Update addressing the facility assessment requirements for minimum staffing, on April 22, 2024, the Centers for Medicare... Read MoreMay 31 2024 | CMS Minimum Staffing Rules-Facility Assessment Requirements Go into Effect Soon!
On April 22, 2024, the Centers for Medicare and Medicaid Services (CMS) released the anticipated final rule, Minimum Staffing Standards for Long-Term Care Facilities and... Read MoreMay 13 2024 | Sending Medications with Residents
It is common for assisted living residents to leave the facility to attend community events, go out to a restaurant with friends or family, or... Read MoreApr 12 2024 | What is a “Nonresident Individual” And What Services Can Assisted Living Facilities Offer Them?
Many assisted living facilities reserve several apartments for independent living residents, referred to in the assisted living regulations as “nonresident individuals.” The definition of a... Read MoreApr 12 2024 | Enhanced Barrier Precautions-Now Required in Skilled Nursing Facilities
On March 20, 2024, the Centers for Medicare & Medicaid Services (CMS) released QSO-24-08-NH in reference to Enhanced Barrier Precautions in Nursing Homes. The release... Read MoreFeb 28 2024 | Federal Arbitration Regulations - F847 & F848
Arbitration agreements have historically been a topic of confusion in our state that would garner the attention every few years with surveyors and facilities. With... Read MoreMarch 22 2024 | What is Required to Become an Assisted Living Administrator?
There are several different pathways to becoming a qualified assisted living administrator in Washington state. The regulations, though offered in a step-wise fashion based on... Read MoreFeb 13 2024 | Become Familiar with and Prepared for a DOSH Inspection
Washington State Labor and Industries’ Division of Occupational Safety and Health (DOSH) has instituted a Local Emphasis Program (LEP) for enforcement that targets industrial hygiene... Read MoreFeb 15 2024 | Become Familiar with and Prepared for a DOSH Inspection
Washington State Labor and Industries’ Division of Occupational Safety and Health (DOSH) has instituted a Local Emphasis Program (LEP) for enforcement that targets industrial hygiene... Read MoreJan 26 2024 | OIG Report - WA Failed to Ensure that Nursing Homes Complied with Federal Requirements
In the fall of 2022, twenty Washington skilled nursing facilities had unexpected visits from auditors representing the Office of Inspector General (OIG). These surprise visits... Read MoreJan 26 2024 | Coordination of Health Care Services
Assisted living residents will likely have outside health care service providers such as home health or hospice at some point during their stay in the... Read MoreDec 20 2023 | What’s Needed for A Compliance and Ethics Program?
19Not so long ago, in November of 2019, Phase 3 of the Requirements of Participation became effective. Part of those requirements expanded the expectations for... Read MoreDec 20 2023 | Cannabis in Assisted Living
Washington state was an early legalizer of both medical and recreational marijuana. The legalization of cannabis in the state prompted long term care providers to... Read MoreNov 15 2023 | E-Tags and Emergency Preparedness
In September 2016, CMS published the Emergency Preparedness final rule which established consistent emergency preparedness requirements for health care providers participating in Medicare and Medicaid. These requirements then went into effect in November of 2017. Read MoreNov 15 2023 | Nonavailability of Medications in Assisted Living
There are times when assisted living wellness staff experiences difficulties in obtaining residents’ necessary medications; there are various reasons for these difficulties and methods to address them. Read MoreOct 20 2023 | Room and Roommate Changes - What You Need to Know
October 2023 | As many of you know, a major focus on the regulatory changes contained within the Requirements of Participation (ROP) involve Resident Rights and the facility’s need to ensure each resident remains the locus of control regarding decision-making, their care and services, and discharge planning. An area to highlight is room/roommate changes, this was a Phase 1 requirement. Read MoreOct 20 2023 | What is an Oversight Nurse, and Do You Need One in Your Assisted Living?
October 2023 | While the term “oversight nurse” is not defined in statute or rule, many assisted livings employ or contract with a registered nurse (RN) to serve in this capacity. This article aims to clarify what the role of the “oversight RN” entails, to ensure intermittent nursing services are provided with the proper level of nursing care. Read MoreSept 29 2023 | Pharmacy Services-F758- Free from Unnecessary Psychotropic Medications/PRN Use
In 2017, the Centers for Medicare and Medicaid Services (CMS) expanded the category of antipsychotic medications to the new category of psychotropic medications. In doing... Read MoreSept 29 2023 | Intermittent Nursing Services
Nurses are a relatively new addition to assisted living in Washington. In the early 2000s, it was rare to see a nurse working full-time in an... Read MoreAug 22 2023 | Dining and Food Service-Phase 3 Requirements of Participation
The Centers for Medicare & Medicaid Services (CMS) made changes and clarifications to the food service and dining requirements in the Phase 3 implementation of the... Read MoreAug 22 2023 | Medication Assistance Via Accurately Directing Others
Residents must be assessed for the level of staff assistance they need with medications. Some residents (and in many instances some medications) warrant different levels of... Read MoreJul 24 2023 | Trauma Informed Care-Requirements Under F699 for Skilled Nursing Facilities
There is a continuing focus and pressure from regulatory agencies to ensure that facilities provide trauma informed and culturally competent care. The federal requirements outline... Read MoreJul 24 2023 | Caregiver Training and Certification Timelines after the Pandemic’s End
The Department of Social and Health Services (DSHS) training unit and the Department of Health (DOH) worked diligently with stakeholders, including WHCA, throughout the pandemic... Read MoreJun 12 2023 | F700 Guidance—Bedrails
The Phase 2 changes and Phase 3 Requirements of Participation (ROP) that took effect in October 2022 for all nursing homes included clarification and regulatory... Read MoreJun 12 2023 | Resident Dementia Screening in Assisted Living
While all assisted living residents receive preadmission and ongoing assessments, those with symptoms of dementia require the facility staff to do some additional data collection. This... Read MoreMay 8 2023 | Additions & Changes to Quality of Care FTags
Moving into 2023, it is important to note the changes the Centers for Medicare & Medicaid Services (CMS) made to the State Operations Manual (SOM)... Read MoreMay 5 2023 | Who Can Conduct Resident Assessments in Assisted Living?
This article was originally sent via an emailed Survey and Regulatory newsletter in March 2022. While still accurate, new updates have come from DSHS because... Read MoreMar 21 2023 | Psychosocial Outcome Severity Guide and Citations at F600-Abuse
The Centers for Medicare & Medicaid Services (CMS) released the psychosocial outcome and severity guide (POSG) in conjunction with the Phase 2 ROP (Requirements of... Read MoreMar 21 2023 | Medication Errors in Assisted Living
With the high average number of daily medications taken by residents in assisted living, medication error rates can be relatively high. Combine the high number of... Read MoreMar 1 2023 | CMS Requirements of Participation (ROP) Overview of Abuse and Neglect Changes
It is very important to keep in mind our specific Washington State requirements related to mandatory reporting (RCW 74.34), the WACs in Chapter 388-97, and the... Read MoreMar 1 2023 | Medication Administration and Nurse Delegation in Assisted Living
WHAT IS MEDICATION ADMINISTRATION? Legally, medication administration, accomplished by either a licensed nurse or a qualified credentialed caregiver, is the only medication service level that... Read MoreJan 5 2023 | ROP Phase 3-§483.15 Admission, Transfer, and Discharge
Like many other portions of the requirements of participation (ROP), CMS published changes to the requirements regarding resident admissions, transfers, and discharges, implementation of which... Read MoreJan 3 2023 | Pets in Assisted Living
Pets can be a benefit to residents in assisted living; dogs and cats (and other animals) offer companionship and attention and can enhance the homelike... Read MoreNov 15 2022 | Continuing Education Requirement
Washington State’s continuing education (CE) requirements vary, depending on the person’s job title as well as which (if any) credential they hold. This article is written... Read MoreNov 23 2022 | CMS Requirements of Participation (ROP) Changes - Residents Rights
As you are aware, on October 24, the changes to Phase 2 and the Phase 3 ROP became effective. Residential Care Services (RCS) will be... Read MoreNov 3 2022 | Transferring Residents to Other Settings
There seems to be ongoing confusion surrounding the intricacies of involuntarily discharging a resident. Clarity was attempted through this article, with cited rules and step-by-step instructions provided.... Read MoreNov 3 2022 | Transferring Residents to Other Settings
33There seems to be ongoing confusion surrounding the intricacies of involuntarily discharging a resident. Clarity was attempted through this article, with cited rules and step-by-step... Read MoreApr 23 2022 | Resident Rights - Visitation
Over the last two years, no topic has been more controversial and frequently altered than the guidance surrounding resident visitation. With the retirement of the... Read MoreApr 3 2022 | Inspection Process: Family Assistance with Medications and Treatment
The list of top citations over the past quarter shows family assistance with medications or treatments peaking at #2, the highest this WAC section has... Read MoreMar 3 2022 | Inspection Process: Writing a Plan of Correction
A plan of correction (POC) is required for every WAC violation noted in a Statement of Deficiencies (SOD) report. WAC 388-78A-3152 states that, by signing the attestation... Read MoreMar 17 2022 | Resident Smoking
Smoking is still a topic that is fraught with personal opinions, safety hazards, resident rights, and multiple regulations. Every facility needs to remain hypervigilant related... Read MoreFeb 3 2022 | Inspection Process: Enforcement Remedies
Residential Care Services (RCS) holds the authority to impose enforcement remedies on an assisted living licensee. While the entire list of remedies is listed in WAC 388-78A-3160,... Read MoreJan 3 2022 | Grievance System
Outlined in section CFR 483.10 Resident Rights in the Federal Register/Vol.81, No.192 are the requirements for all skilled nursing facilities related to management of grievances/complaints. While F585... Read MoreJan 3 2022 | Inspection Process: Resident Record Review
As part of the full inspection process, licensors will complete a full resident record review for each resident in the sample. While the record review is an important... Read MoreSept 3 2021 | State Enforcement Remedies for SNFs
Civil fines or Civil Monetary Penalties (CMP) are the most common state enforcement. Except as otherwise provided in statute, the range for a per-day civil fine is... Read MoreSept 3 2021 | Survey Process: Facilitating the Resident Group Meeting
Facility inspections include resident group meetings, conducted by your licensor. These meetings are ideally held relatively early in the full inspection process. This allows the licensors... Read MoreJul 3 2021 | Discharge Notice Guidance for Assisted Living and Skilled Nursing
Issuing a discharge notice to a resident and his/her surrogate decision maker is never an easy task. Not only is it emotionally difficult for all... Read MoreJul 3 2021 | Discharge Notice Guidance for Assisted Living and Skilled Nursing
Issuing a discharge notice to a resident and his/her surrogate decision maker is never an easy task. Not only is it emotionally difficult for all involved... Read MoreJun 1 2021 | Survey Information for Skilled Nursing Facilities
With the reimplementation of full recertification and re-licensure surveys by Residential Care Services (RCS), it is important for SNF staff to be familiar with the... Read MoreJun 1 2021 | New to Assisted Living? Learn What to Expect for Full DSHS Inspection
Many administrators and other assisted living leaders have entered the workforce during COVID-19. Because the licensing inspections were on hold for over a year, it is... Read More
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