The negotiated care plan for an adult family home is the second-most-cited area in WAC 388-76, right behind the medication rules. It is also one of the easiest places to clean up, because the rule is specific. This guide walks the care-plan cluster section by section, names what surveyors actually check, and shows you the patterns that turn into deficiencies.
Key takeaways
- The negotiated care plan is required for every AFH resident and lives under WAC 388-76-10345 through 10385.
- Surveyors cite three patterns most often: missing required content, missing signatures, and overdue annual reviews.
- The plan must be reviewed at least every 12 months AND after every significant change in the resident's condition.
- Medication management, evacuation capability, activity preferences, and crisis plans all have to appear in the plan.
- For publicly funded residents, a copy goes to the DSHS case manager.
The care-plan cluster at a glance
The chapter spreads the care-plan rules across eight sections. Read this map first, then walk a sample chart.
| WAC section | Topic | Plain-language take |
|---|---|---|
| 388-76-10345 | Qualified assessor | The person who completes the assessment that anchors the plan has to meet the qualifications in the rule. |
| 388-76-10355 | Care plan content | The plan lists services, who provides them, when and how, medications including off-site doses, activity preferences, and other resident preferences. |
| 388-76-10360 | Timing of development | The plan has to be developed within a defined window after admission. |
| 388-76-10365 | Implementation | The home actually has to provide the services the plan describes. |
| 388-76-10370 | Persons involved in development | The resident, representative if appointed, and others involved in care help shape the plan. |
| 388-76-10375 | Signatures | The plan is signed and dated by the resident or representative and the home. |
| 388-76-10380 | Reviews and revisions | Reviewed at least every 12 months AND after every significant change. |
| 388-76-10385 | Case manager copy | For publicly funded residents, a copy goes to the DSHS case manager. |
What has to be in the plan
WAC 388-76-10355 is the content rule. It lists the elements every plan has to contain. Surveyors run a checklist down this list. If something is missing, the plan is incomplete, even if the resident is well cared for.
WAC 388-76-10355 (care plan content)
The home uses the resident assessment to develop a written negotiated care plan. The plan has to include: (1) a list of the care and services to be provided; (2) identification of who will provide them; (3) when and how they will be provided; (4) how medications will be managed, including how the resident will get their medications when not in the home; (5) the resident's activity preferences and how they will be met; and (6) other preferences and choices important to the resident. Plain-language summary, not legal advice.
Two pieces inside the content rule trip up new operators. First, the off-site medication piece. If a resident leaves the home for a day with family, the plan has to spell out how the medication still happens. Second, the activity preferences piece. A blanket "watches TV" line is not enough. Surveyors want a sentence that ties to the resident's actual choices.
Who signs and when
The signature rule is where many homes lose ground. The plan has to be signed and dated by the resident or representative and by the home. The annual review needs a fresh signature too.
WAC 388-76-10375 (signatures)
The negotiated care plan is signed and dated by the resident, or the resident's representative when one is appointed, and by the adult family home. Plain-language summary, not legal advice.
A signature without a date is a deficiency. A signed plan from admission with no fresh signature on the most recent annual review is a deficiency. A revised plan with the old signature still on the front page is a deficiency. Keep a signature page on the cover of every plan with admission date, every annual-review date, and every significant-change revision date in one place.
The review cadence
The plan is a living document. WAC 388-76-10380 requires reviews on a fixed cadence and after every meaningful change.
WAC 388-76-10380 (reviews and revisions)
The home has to ensure that each resident's negotiated care plan is reviewed and revised after an assessment for a significant change in the resident's physical or mental condition, and when the plan no longer addresses the resident's needs. The plan also has to be reviewed at least every 12 months, signed and dated. Plain-language summary, not legal advice.
The annual review is the most-missed obligation in the cluster. The first year is usually fine. The second year, busy operators forget, and the third year a surveyor pulls the chart and sees a plan with a signed date 14 months ago. That is a clean tag under 388-76-10380.
Three patterns that lead to citations
Pattern 1. Missing required content
The plan lists services and medications but does not name who provides them, or it skips the off-site medication piece, or activity preferences are a single line. Surveyors expect every element of -10355 on every plan.
Pattern 2. Missing or undated signatures
The plan exists. The signature page is incomplete, or the date is missing, or the family member who actually has authority is not the one who signed. Build a one-page signature tracker per resident and audit it monthly.
Pattern 3. Overdue annual review
The plan from 13 months ago is the current plan. The annual review never got scheduled. Set a recurring task on the calendar 30 days before the anniversary of every plan, every year.
Two operator scenarios
Tasha runs a 6-bed AFH in Bellevue. Her 2024 inspection found one tag under 388-76-10380: a plan reviewed 11 days after the 12-month anniversary. The plan itself was clean, but the date was late. Her fix was a 30-day pre-review reminder on each plan, plus a Sunday-afternoon calendar check at the start of each month for any upcoming anniversary. Her 2025 inspection closed with zero care-plan tags.
Doris runs a 6-bed AFH in Spokane. Her 2024 deficiency was under 388-76-10355: the plan for one resident did not name how medications would be handled during weekend visits with family. The fix was a sentence on every plan that explicitly addressed off-site medication, even for residents who never left the home. The standardized sentence template costs nothing to add and closes a recurring gap.
For publicly funded residents
If the resident is on a Medicaid waiver or another publicly funded program, WAC 388-76-10385 requires a copy of the negotiated care plan to go to the DSHS case manager. The mechanism is usually email or the state's case-management system. Skipping this step is a quiet deficiency that surveyors find when they cross-check with the case manager.
The annual-review checklist
| Step | What to confirm |
|---|---|
| 1 | The plan covers every element of WAC 388-76-10355. |
| 2 | Medications match the current MAR. Off-site medication is addressed. |
| 3 | Activity and other preferences match what staff actually do. |
| 4 | The resident or representative has signed and dated the review. |
| 5 | The home has signed and dated the review. |
| 6 | For publicly funded residents, the case manager has a current copy. |
How Marpass keeps care plans surveyor-ready
Marpass stores the negotiated care plan next to the medication log and the chart. The plan template includes every required element from 388-76-10355, including the off-site medication section. Signature blocks include date fields. The system flags any plan that will hit its 12-month anniversary in the next 30 days, so the annual review never slips. For publicly funded residents, the plan can be exported with one tap for the DSHS case manager. Pricing is flat per home and posted on the site.
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