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 to meet the residents and provide an explanation on their purpose for being in the facility. During the meeting, residents can ask questions and share information on their experiences about living in the facility. This data-gathering exercise allows the licensors to focus on specific concerns voiced during the meeting and serves in the resident sample selection process for in-depth interviews and record reviews later in the inspection. While the resident group meeting generally occurs shortly following the facility tour, the timing is flexible and based on resident availability, activity schedules, and other factors.

Licensors will work with facility leadership in communicating with residents the time and location of the resident meeting. Facility staff might announce the time/day of the resident meeting during a meal or activity so residents are aware. Licensors will post signage throughout the building, notifying residents of the upcoming meeting.
Facility leadership plays a role in identifying a large enough space where licensors and residents can gather and, at the same time, speak freely without interruption. Facility staff are not invited to the meeting, but should ensure residents who wish to attend the meeting receive assistance needed to get there timely. If the facility has a secure memory care unit in addition to the assisted living, the licensors might hold two separate resident meetings so all residents have the opportunity to participate.

If the facility serves mixed populations of assisted living and nonresident individuals (independent residents/tenants), it is important to ensure that only assisted living residents participate in this meeting. There may be times when it is necessary to stand outside the door as assisted living residents enter, and let nonresidents know that this meeting is solely for those residents on assisted living services. Should a nonresident individual attend the meeting, advise the licensors so they are aware.

Licensors have scripted questions on certain topics (via Attachment E) to ask during the resident meeting. While there are plenty of questions included in the form, licensors might only ask a few of them or, in the event residents guide the discussion toward certain topics, licensors may focus on those areas during the meeting.
Licensors will follow up on any resident concerns that were not rectified during the group meeting. If the licensors have not done so already, they may choose some residents from this meeting to include in their resident sample, which guides the remainder of the resident-centered inspection process.

It is recommended that providers include similar questions as outlined in Attachment E when conducting formal and informal resident surveys; this way, any concerns or issues can surface before a full licensing inspection, and the facility’s staff can work with the resident to remedy any concerns and minimize the likelihood of any issues that may come to the attention of the licensors during the inspection process.

If you have questions about the resident group meeting or any other aspect of the assisted living inspection, contact Vicki McNealley at (800) 562-6170 extension 107 or via email.
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 $50 to $3,000 and the per-instance civil fine is $1,000 to $3,000. In the event of continued noncompliance, nothing prevents the Department from increasing a civil fine up to the maximum amount allowed by law.

Accrual of a per-day civil fine begins on the first date the Department verifies that the facility has or had a specific deficiency. Accrual of the per-day civil fine will end on the date the Department determines the facility corrected the deficiency. A per-instance fine may be assessed for a deficiency, regardless of whether the deficiency had been corrected by the time it was first identified by the Department.

Civil fine(s) are due 20 days after the facility is notified of the civil fine(s) if the facility does not request a hearing. If a hearing is requested, the civil fine(s), including interest if any, is due within 20 days after a hearing decision ordering payment of the fine(s) becomes final in accordance with chapter 388-02 WAC.

If a facility fails to pay a civil fine when due, the Department may withhold an amount equal to the fine plus interest, if any, from the facility's Medicaid payment, impose an additional fine, or suspend the nursing home license under WAC 388-97-570.

A state-issued Stop Placement order is often confused with the Federal enforcement action of Denial of Payment for New Admissions (DPNA). These actions are entirely different. DSHS must impose a stop placement when required by RCW 18.51.060 and WAC 388-97-4460 and may impose a stop placement as an optional remedy in accordance with WAC 388-97-4480. The Department's stop placement order becomes effective upon verbal or written notice.

The facility has the right to an Informal Department Review (IDR) to refute the state deficiencies cited as the basis for the stop placement. However, the Department will not delay or suspend a stop placement order because the facility requests an administrative hearing or IDR. The stop placement must remain in effect until the Department terminates the stop placement or the stop placement is terminated by a final agency following appeal.

According to the requirements, the Department must terminate the stop placement when:
  • The facility states in writing that the deficiencies necessitating the stop placement action have been corrected; and
  • Within 15 working days of the facility's notification of correction to the Department, the Department staff confirm by on-site revisit that:
  1. The deficiencies that necessitated the stop placement action have been corrected; and
  2. The facility exhibits the capacity to maintain adequate care and services and correction of deficiencies.

After the stop placement, the Department may continue to perform on-site monitoring visits to verify that the facility has maintained correction of deficiencies. 

Additional information and resources can be found on the ALTSA website, including the DSHS Operating Procedures, DSHS Request for Administrative Hearing Form, and a DSHS/RCS webinar recording regarding SNF Enforcement Remedies. If you have questions, please contact Elena Madrid.  
303 Cleveland Avenue SE, Suite 206 | Tumwater, Washington 98501
Tel (800) 562-6170