Jan 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 citations over the past year, combined with the telephone calls and emails I receive, I can’t help but refer to the age-old method of continuous self-evaluation and improvement: the mock inspection.

Mock inspections are low-cost and can be high reward, provided operators conduct them in a way that prompts follow-up and correction. Having served as a state licensor in what seems like a previous life, I recommend following the Residential Care Services (RCS) licensing inspection process, step-by-step.

I’ve conducted mock inspections in many different assisted livings, including memory care arenas; using the state’s format has never steered me wrong. Using the State Operating Procedures (SOP) prepares the facility’s staff and residents for the real thing.

The state’s policy is available and clearly outlines not only the inspection process but the forms they use and the questions they ask residents and staff. A facility or company could opt to conduct an entire full inspection of all departments. Likewise, each assisted living facility department can apply the portion of the state inspection process to evaluate their systems and determine regulatory compliance.

No matter what process you use – the state’s inspection process, or one created by you or your company, there are some great insights into conducting and following up on a thorough mock inspection.

I asked a few WHCA assisted living members and leaders on their thoughts and insights surrounding mock inspections and have quoted highlights in the coming sections of this article.

Evaluate and Adjust Systems

Noelle Bickel, the Director of Quality and Document Governance for Aegis has overseen that company’s mock inspections (referred to as “quality assurance audits” by Aegis) for the past four years and has been in the mock inspection team for the past six years. She is a firm believer that mock inspections are beneficial to the community, as well as to the line staff and company leadership. “A good mock survey brings to light any processes that need to be tweaked or are missing…giving our communities time to correct any non-compliance that may be found.”

Monica Chopra, Vice President of Health and Wellness for Cascadia Senior Living and a WHCA board member, organizes and oversees the company’s mock inspections, which are done annually and are complete with plans of correction and follow-up. This process “has helped us identify deficiencies early and put plans into place before our friends [DSHS licensors] arrive.”

Staff Support

Mock inspections, when done correctly, can support facility staff. Bickel claims that mock inspection auditors for Aegis serve as “another point of contact at the home/corporate office…[they] can help [facility staff] to feel heard and can bring the community points of view to the leadership at the Home Office which can lead to change that benefits everyone.”

Using the DSHS SOP includes most of the questions licensors will ask your staff – from the kitchen inspection to medication delivery observations to mandatory reporting questions to questions about the facility’s disaster plans or infection prevention and control standards. These questions are all published and ready for your team apply during a mock inspection, well before DSHS licensors ask the questions. See forms for specifics.

• Attachment F: Staff Interview
• Attachment P: Food Preparation (observations and interviews)
• IPC Inspection Tool
• Attachment S: Medication Observation and Staff Interview

This view of readiness and support can prepare facility staff for the DSHS licensing team’s full inspection, setting up staff’s positive outlook rather than fearing the process and outcomes.

Resident-Driven Evaluation

Since the full licensing inspection was designed to evaluate three major areas of residents’ lives in the facility – quality of care, quality of life, and safety – it seems prudent to focus a mock inspection on the same.

The DSHS SOP includes forms with resident questions built in – specifically see Attachment G for the resident interview questions and Attachment E for the resident group meeting questions. These questions can be folded into a thorough mock inspection. I’ve used some of these questions outside the mock inspection process, particularly during re-assessments and care conferences, to gauge a resident’s overall satisfaction with the facility or determine concerns or grievances that have gone unaddressed. These interactions can prove helpful in improving services and communication and demonstrating to residents and their families of your commitment to quality care.

Timelines

A lot of citations focus on missed or late timelines. I call these “low-hanging fruit” citations because, aside from a delayed or missing date, there wouldn’t be a failed practice. Perhaps most frustrating with timeline citations is the fact that the citation isn’t resident outcome-focused as is required in RCW 18.20.110.

Using the DSHS SOP to determine internal facility systems adherence can be helpful, because consistency can keep the citations away. The DSHS forms used during a licensing inspection can find all kinds of timeline issues, including but not limited to:

• Outdated liability insurance policies
• Missed deadlines for staff records (TB tests, classes, background checks, CPR/first aid cards, food worker cards, continuing education, credentialing, respirator fit-testing upon hire and annually, for instance)
• Resident preadmission and 14-day assessments
• Resident 30-day negotiated service agreement completion, annual (semi-annual for Medicaid memory care and, in July 2026, all memory care residents)
• Monthly fire extinguisher checks
• Medication delivery timelines
• Food heating/cooling timelines, storage of leftovers

Linda Folkers, Regional Director of Health and Wellness for Cogir Management USA, finds the DSHS inspection forms especially helpful to the business office personnel; these forms enhance compliance with staff training and certification timelines.

Documents

Missing or incomplete documents are also of concern for the DSHS licensing team. Regular audits and mock inspections can pinpoint these missing or incomplete documents but perhaps more importantly can identify where facility systems lead to document-related noncompliance.

The DSHS process includes Attachment J, the resident record review. Using this form can provide an audit checklist to ensure a resident’s record is complete. Staff and pet records can also be audited using the DSHS Attachment K. Of course there are plenty of additional documents necessary for compliance.

Summary

Mock inspections can be conducted by internal facility staff, particularly by switching focus to a different department for fresh perspectives and to enhance understanding of each area’s roles and responsibilities. Alternatively, mock inspections might be conducted by sister facility staff or corporate staff to get completely new views on facility operations and compare one facility’s compliance and operations to another. Even taking pieces of the mock inspection process, for example the kitchen review, and using those tools to audit for quality improvement goals can prompt adherence to regulations and policies.

For questions about assisted living licensing processes, email me at [email protected].