Assisted Living Citation Trends January Through July 2025
WHCA tracks citation trends in assisted living facilities, to inform educational content development and delivery. In reviewing the top citations for 2025 so far, the major issues can be summed up into two topics: medications and staff files.
MEDICATIONS
So far this year, 51 assisted livings have been cited for failure to develop and implement systems that support and promote safe medication service for each resident (WAC 388-78A-2210 (1)(b)). This section of WAC is broad, and could mean any number of concerns including but not limited to timely prescriber order updates, ordering and delivery of medications to the facility, medication storage, medication delivery to the resident (including timeliness, appropriate and safe processes, and/or honoring privacy), accurate documentation and follow-up, appropriate monitoring and response to side effects, and staff knowledge.
41 assisted livings were cited for failure to ensure residents who require medication assistance services received their medications as prescribed (WAC 388-78A-2210 (2)(a)). This generally boils down to medication errors including missed medications, incorrect dosage and/or time, or medications delivered to the wrong resident.
A strong medication training program for all staff who handle medications is essential, along with consistent oversight and just-in-time retraining to maintain competency. Policies and procedures not only need to be developed but also implemented by all staff who manage medications. A prompt team debrief following every medication error, as well as a near-miss, can help strengthen systems and promote safer medication management strategies.
STAFF
46 facilities have been cited for not developing and implementing a system to ensure each staff person is screened for tuberculosis within three days of employment (WAC 388-78A-2480 (1)). While most facilities have a developed system for accomplishing TB screening for staff, any outliers beyond the first three days of work result in a citation highlighting the idea that the facility failed to implement that system.
43 facilities have been cited for failure to ensure caregivers and administrators, or their designees had completed specialty training for dementia, mental health, and/or developmental disabilities when serving residents with any of these primary special needs (WAC 388-78A-2474 (2)(c)). This training must be accomplished within 120 days of starting work. Staying in the same area of regulation, 45 facilities were cited for caregivers and administrators or their designees not having completed CPR and first aid training (WAC 388-78A-2474 (2)(d)). And finally, 43 facilities were cited because caregivers and the administrator or their designee could not demonstrate the completion of 12 hours of DSHS-approved continuing education classes (WAC 388-78A-2474 (2)(e)).
Routine audits of employee files, along with checklists to ensure timely completion of each required item, can prevent future citations.
Please note, repeat citations can result in facility sanctions including fines, stop placement of admission/readmission, and/or conditions placed on a facility’s license.
For questions about state inspections or citation trends, please email Vicki McNealley at the WHCA office.
