Home Health Agencies

In-Home Services Survey Program

The Department of Health's Office of Investigation and Inspection (OII) is responsible for ensuring that licensed in-home services agencies comply with all applicable state and federal requirements. The OII survey and investigation teams conduct routine state and federal surveys as well as complaint investigations. Washington State licenses more than 400 in-home services agencies to provide home-based personal care and health services to clients and patients within the minimum health and safety standards established in chapter WAC 246-335. The OII survey team is required to survey applicants as part of the initial licensing process, and to survey licensees once during each licensure period. Initial surveys are scheduled and announced; on-going surveys are unannounced.

Our survey team consists of registered nurses who have experience and training in home care, home health, and hospice services. Initial licensure surveys focus primarily on reviewing and approving an applicant's policies and procedures, sample employee and client/patient files, and demonstrated knowledge of the in-home services rules and client/patient delivery of care. On-going surveys of licensed agencies focus primarily on the delivery of client/patient care, interviewing client/patients about the services they receive, interviewing agency employees about training and knowledge of agency policies and procedures, and a review of randomly selected client/patient and employee files.

After a survey is completed, the agency may be provided with documentation indicating non-compliance with chapter WAC 246-335 and chapter RCW 70.127. If so, the agency is required to submit an acceptable plan of correction addressing the areas of non-compliance.

How to prepare for your survey:
Surveyors use the following tools and checklists to systematically guide them through the survey process to determine an agency's compliance with the minimum health and safety standards in chapter WAC 246-335. Agencies are encouraged to review the below tools and checklists to help them prepare for their next survey.

Home care survey resources

Home health survey resources

Hospice and hospice care center survey resources

Policies and procedures

Chapter WAC 246-335 require agencies to develop and put into operation various policies and procedures (P&Ps) related to delivery of services. P&Ps provide framework and structure for the agency, the services it provides and its employees. Well-written P&Ps allow employees to clearly understand their roles and responsibilities within predefined limits. P&Ps allow agency administration to define and guide operations without constant management intervention. When consistently enforced, they contribute to the development of the company culture. P&Ps may not consist of the WAC or RCW copied word for word, nor may they refer to Medicare certification or accreditation prior to an agency officially gaining Medicare certification or accreditation. Agencies have the option to develop P&Ps themselves or to hire an industry consultant to create a P&P manual for them. Agencies that want to develop P&Ps themselves may find the below example helpful in regards to structure and wording:

Statement of deficiencies and plan of correction

If non-compliance with chapter WAC 246-335 is identified during the on-site survey process, surveyors will compile all areas of noncompliance and may issue a statement of deficiencies document. The statement of deficiencies will include brief statements of what is required for agencies to achieve compliance, the date by which the department requires compliance to be achieved, contact information for any technical assistance services the department provides, and the process to request an extension of time for good cause to achieve compliance.

Agencies that are not Medicare certified must submit a written plan of correction (POC) within 10 working days after receiving the statement of deficiencies to address deficiencies that are determined not to be significant, broadly systemic, or recurring. The POC must describe: How each deficiency will be or was corrected; what measures or monitors will be put in place to ensure the deficiencies do not recur; who is responsible for correcting each deficiency; and when each deficiency will be or has been corrected.

Agencies must complete all corrections within 60 days, unless the department authorizes a different time frame for correcting some of the deficiencies. Implementation of the plan of correction is subject to verification by the department. Agencies needing to submit a plan of correction may find the below resource helpful: