Assisted Living (AL) food service operations are included as part of the full inspection process. Evaluating the operations of the dining and kitchen processes includes two major areas of focus: (1) foodborne illness mitigation practices, and (2) resident preference and choice.

Assisted living food service is touched upon in WAC 388-78A-2300 and -2305; the remainder of regulatory expectations on kitchen practices reside in WAC 246-215, which is the same WAC that restaurants must follow. If the AL is part of a Continuing Care Retirement Community or otherwise shares a kitchen with an attached nursing home, the nursing home surveyor will complete the inspection of the primary kitchen during the skilled nursing facility’s full survey rather than during the full AL inspection.

DSHS licensors will observe food preparation and dining on at least one occasion during the full inspection. An initial tour of the kitchen and food storage areas will take place at the first opportunity following the start of a full inspection. This initial tour focuses primarily on proper food handling and handwashing, with subsequent visits during the inspection focusing more in-depth.

Each assisted living facility must have a PIC who can answer licensor questions specific to food safety. Areas of focus for PIC interviews include:
  • Proper dishwashing methods
  • Systems in place for staff to report illnesses (and procedures used when an ill food worker reports an illness)
  • Descriptions of how food contact surfaces are thoroughly cleaned, rinsed, and sanitized
  • Methods used to check food temperatures, and steps taken in the event temperatures are not to a safe level
  • Descriptions of proper cooking times and temperatures for potentially hazardous foods
  • Descriptions of how foods are properly heated, cooled, and stored

Formal observation of the food services areas is included in Attachment P and focuses on high risk factors such as cross-contamination, handwashing, and proper temperature controls. During formal observations in the food preparation area, the licensor should wear a hairnet/restraint per regulation and facility policy. Observations include:
  • Overall kitchen cleanliness
  • Proper hand hygiene and glove use
  • Staff cleanliness, hair restraint usage
  • Food stored and held at proper temperatures
  • Refrigerators and freezers should all have operable thermometers with temperature logs to demonstrate consistently at or less than 41° F
  • Food in the freezer is frozen (no temperature requirement)
  • Frozen meat should not be thawed at room temperature
  • Hot foods at more than 135° F prior to serving
  • Cold foods held at less than 41° F prior to serving
  • Potentially hazardous foods properly cooled following WAC 246-215-03515
  • Food from approved sources (no items prepared at home, for example)
  • No ill food workers present
  • Chemicals labeled and stored away from food preparation areas
  • Food handler cards current for each kitchen employee
  • No bare-hand contact with ready-to-eat foods
  • Fruits and vegetables are properly rinsed
  • Storage rooms free of pests/rodents
  • Raw meats stored in refrigerator below and away from ready-to-eat foods

Menus must be made available to residents and provide a variety of different items. Meals must be nutritious, palatable, and served at proper temperature. Alternate choices to entrees must be available. Prescribed diets are honored following a diet manual.

DSHS licensors will watch meal delivery and residents dining. Of note, the following will be observed:
  • Residents who need assistance eating will receive that assistance in a respectful and dignified manner
  • Meals are delivered timely
  • Residents’ special needs are addressed and provided for
  • Tables are adjusted for residents in wheelchairs
  • Residents are prepared for the meal – glasses/hearing aids in place, dentures in, etc.
  • Adaptive equipment is available based on resident need
  • Residents sitting at the same table are served concurrently
  • Sufficient staff to deliver meals and assist as needed
  • Enough time is offered to eat the meal; dining environment is pleasant and calm
  • Meals served match what is on the menu
  • Meals served to residents in their apartments are prompt and at correct temperature

Besides formal interviews with the PIC, licensors will interview residents to learn of any concerns regarding meals, meal preferences, and meal delivery. Follow up interviews with staff may be necessary to confirm the facility has a formalized method of receiving input on meals and meal delivery, and following up on those concerns. Sample residents who have special dietary needs may warrant interviews with other staff to determine if these needs are being met.

Licensors will review sample resident records, to ensure special diet orders are present as necessary, and needs for additional assistance with meals are included in the assessment and negotiated service agreement.

If you have questions about the inspection process in assisted living facilities, please contact Vicki McNealley via email, or call her at (800) 562-6170 extension 107.
As skilled nursing facilities struggle through the staffing crises, it is apparent that not only front line and nursing staff are affected. In recent months, WHCA has received many questions regarding the process for a change in nursing home administrator and the training requirements. Hopefully, this article will answer some of those frequently asked questions.

How and when must a facility notify the department of an administrator change? According to WAC 388-97-1640, the facility must notify, in writing, the department's aging and disability services administration and each resident, of a loss of, or change in, the nursing home's administrator or director of nursing services at the time the loss or change occurs. Residential Care Services Dear Administrator letter 018-004.pdf dated March 8, 2018, explains the process for notification of the department using this form.

How long can a skilled nursing facility be without an administrator?
WAC 388-97-1620 states that nursing facilities temporarily without an administrator may operate up to four continuous weeks under a responsible individual authorized to function as nursing home administrator designee. The designee must be qualified by experience to assume designated duties. The director of nursing or other appropriately qualified department head usually serves in this role. When the facility is temporarily without an administrator and a designee has assumed the duties, the facility must have a written agreement with a nursing home administrator, licensed in the state of Washington, who must be readily available to consult with the designee. If needed, the facility may make a written request to the department's designated aging and disability services administration field office for an extension of the four weeks by stating why an extension is needed, how a resident's safety or well-being is maintained during an extension and giving the estimated date by which a full-time, qualified nursing home administrator will be on-site. A facility can find the local field office here.
What are the training requirements in Washington for Nursing Home Administrator?
The Code of Federal Regulation CFR 483.75 (d) requires the facility’s governing body to appoint an administrator who is licensed by the State and responsible for the management of each facility. The Washington Administrative Code (WAC) Chapter 388-97-1620-General administration, requires the governing body of the nursing facility to appoint an administrator who:
·        Is licensed by the state.
·        Is responsible for management of the nursing home.
·        Keeps the licensee informed of all surveys and notices of noncompliance.
·        Complies with all requirements of chapter 18.52 RCW, and all regulations adopted under that chapter.
·        Is an on-site, full-time individual in active administrative charge at the premises of only one nursing home, a minimum of four days and an average of forty hours per week except as provided in WAC 246-843-010.

It is important for all nursing facility administrators to know and comply with chapter 18.52 RCW. Administrators must fulfill the continuing education requirements per the Department of Health (DOH) rules. A licensed nursing home administrator must demonstrate completion of thirty-six hours of continuing education every two years. Specific criteria for continuing education is outlined in WAC 246-843-130.
The DOH Nursing Home Administrators Board recently made WHCA representatives aware of concerns regarding WAC 246-843-130. The Department’s databases regarding the requirement outlined below revealed a number of administrators did not have this required training and/or may not be aware of the training.
Within one hundred eighty days of becoming licensed, a licensed skilled nursing facility administrator must attend a board-approved course on laws relating to nursing homes in Washington. The state law training course must consist of a minimum of six hours of training with formal training objectives that cover the requirements of chapter 18.52 RCW and essential areas of laws that apply to nursing facilities regulated by the Department of Social and Health Services (DSHS) under chapter 388-97 WAC.
The DOH has coordinated with DSHS Residential Care Services, as well as WHCA to provide this required training. The DSHS training opportunity is a one-day state law course that meets the WAC 246-843-130(6) requirements for continuing education. DSHS typically holds these classes three or four times each year. Currently, there is no charge for this class, and it is being held virtually. For the DSHS training, ONLY licensed skilled nursing administrators, or those currently participating in the DOH “Administrator-in-Training” (AIT) program may attend. The training dates planned for 2022 are as follows:
  • March 17, 2022
  • June 15, 2022
  • September 1, 2022
  • December 1, 2022

This schedule is subject to change. 

To register for the one-day continuing education class, please email [email protected]. In the email, please include the date you wish to attend the class, your name, home mailing address, and phone number. Also, include the name of any skilled nursing facility and/or corporation with which you are affiliated. 
WHCA also has a DOH-approved training that meets the required elements. WHCA’s administrator training is pre-recorded and can be completed independently to meet this requirement. Please contact the WHCA office at (360) 352-3304 for more information. If you have questions, please email Elena Madrid or call her at (800) 562-6170, extension 105. 
303 Cleveland Avenue SE, Suite 206 | Tumwater, Washington 98501
Tel (800) 562-6170