Washington State’s Oversight Could Better Ensure That Adult Family Homes Comply With Health and Safety and Administrative Requirements

Why OIG Did This Audit

• OIG has conducted audits of adult day care and foster care homes in various States. Those audits identified multiple health and safety issues that put vulnerable adults at risk.
• We conducted this audit to determine whether similar issues existed in adult family homes (family homes) that provide services under Washington’s Home and Community-Based Services, Residential Support Waiver program (the Program).
• This audit examined whether Washington’s oversight ensured that family homes serving vulnerable adults who received services through the Program complied with Federal waiver and State requirements.

What OIG Found

Washington’s oversight could better ensure that family homes comply with Federal waiver and State requirements. Of the 20 family homes we visited:

• 17 family homes did not comply with 1 or more health and safety requirements and
• 19 family homes did not comply with 1 or more administrative requirements.

In total, we found 214 instances of noncompliance with these requirements. Noncompliance occurred because the requirement to inspect family homes was suspended during the COVID-19 pandemic, and some homes had not been inspected for up to 3 years. In addition, family homes may have overlooked the requirement for a written succession plan because the requirement became effective during the pandemic.

What OIG Recommends

We recommend that Washington:

1. work with the 20 family homes to correct the 214 instances of noncompliance identified in this report;
2. reissue to all family homes the notification of the requirements for a written succession plan; and
3. improve its oversight of family homes to ensure that relicensing inspections are conducted within the required timeframes and evaluate all applicable compliance areas, including succession plans, resident assessments, and negotiated care plans.

Washington concurred with our first two recommendations, partially concurred with our third recommendation, and described actions it had taken or planned to take to address our recommendations.

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