Provider/Entity Representative Qualifications
- High school diploma or high school equivalency certificate per RCW 288.50.536
- Long-term care worker
- Documentation to show you are Exempt OR
- Non-exempt 75 hours plus Home Care Aid Certification
- Experience
- 1,000 hours Caregiving Experience Attestation (CEA) form – DSHS 10-417
- Adult Family Home Administrator Training Class
- CPR
- First Aid (Not required for licensed nurses)
- Food Safety
- The following trainings required only for homes admitting residents with the listed diagnosis or assessed need (Specialty Trainings):
- Dementia
- Mental Health
- Developmental Disabilities
- Nurse Delegation
- Basic
- Insulin
- Training Requirements for Adult Family Homes
- Resident Checklist
- Resident Information Sheet
- Adult Family Home Resident Personal Belongings Inventory
- Preliminary Service Plan Templates
- Negotiated Care Plan Templates
- Medicaid Supplementation
- Medical Devices
- Sample Policies, Additional Consents and Other Helpful Documents
- Resident Funds Policy
- AFH Resident Rights
- POA Notice of Electrical Panel in Resident Room
- Safety Policy For Electrical System in Residents Room
- Considerations When Admitting Residents with Previous Challenges
- Pet Policy and Requirements
- Visiting Pet Policy
- House Rules Acknowledgement Form
- Addressing Resident Smoking Needs (Things to Consider)
- Tobacco Use and Smoking Policy
- AFH Smoking and Vaping Evaluation
- Smoking Tracking Sheet
- Marijuana Evaluation Form
- Cannabis Use Not Permitted
- Photo and Video Consent
- Electronic Monitoring Consent
- Daily Quick Care Charting Log
- Meal Assessment & Nutrition Information
- Fall Risk Tool
- Healthcare Professional Sign In Log
- Quick Reference Guide Psychotropic Medication
- Nami Fact Sheet Mental Health Medication
- Quick Reference to Psychiatric Medication
- Medication Disposal Form
- Consent for Door Alarm
- Community Outing Policy
- Consent for Mobile Salon Services
- Co-Ed Shared Room Consent Form
Your Adult Family Home Annual Licensing fee is due on the 15th of the month you were licensed. The current licensing fee is $225/bed ($1350/ six bed AFH). If you did not receive an invoice or renewal form from the Department 60 days prior to your due date, you can contact Michael.Gardner@dshs.wa.gov or 360-725-2483 to update your mailing address.
Annual Licensing Fee Information-
- AFH Facility Training Information for Providers
- Secure Access Washington (SAW)
- Social Security Office
- Credentia
- Prometric
- Washington State Department of Health Fit Testing Information
- Request for Taxpayer Identification Number and Certification W-9
- Employee’s Withholding Certificate W-4
- Home Care Aide Licensing Information
- Online Application Video for Home Care Aide
- Home Care Aide Information
- Nursing Assistant Certified Information
- Nursing Assistant Certified Application Video
- Washington State's Board of Nursing-Nursing Care Quality Assurance Commission (NCQAC)
- Adult Family Home Caregiver Experience Attestation (CEA)
- Background Check Disclosure Statement
- Background Check Central Unit (BCCU)
- Background Check Authorization
- Employment Eligibility Verification
- Fact Sheet #25: Home Health Care and the Companionship Services Exemption Under the Fair Labor Standards Act (FLSA)
- Long Term Care Employment Verification Form
- Character, Competency & Suitability Review and Information
- Nursing Assistant Clinical Skills Checklist and Competency Evaluation
- Respiratory Program Template
- Caregiver Job Description
- Job Application
- Caregiver Etiquette Regarding Language Spoken in the AFH and on the Telephone & Cell Phone