A Washington Adult Family Home negotiated care plan should translate the resident's assessment, preliminary service plan, needs, choices, and preferences into specific care and services the home will implement. It is not a generic template, task list, or copy of the assessment.
This checklist organizes WAC 388-76-10355 through 388-76-10385 into a practical documentation and review sequence. It was reviewed against official Washington sources on August 8, 2026. Providers should confirm the current rule text, DSHS guidance, and resident-specific requirements rather than treating this article as legal advice.
Start from the assessment and preliminary service plan
WAC 388-76-10355 states that the home uses the resident assessment and preliminary care plan to develop the written negotiated care plan.
Before drafting, confirm:
- Correct resident and facility
- Current written assessment
- Assessment date and qualified assessor
- Preliminary service plan
- Recent medical and medication information
- Resident strengths, needs, and preferences
- Refused or declined care and safety response
- Relevant practitioner, nurse, therapist, hospice, or case-manager information
- Changes since the source documents were completed
If sources conflict, resolve the discrepancy or document the review before finalizing the plan. Do not copy an old plan forward without comparing it with the current assessment.
The resident-assessment documentation guide provides a separate checklist for WAC 388-76-10330 through 10345.
Identify every care and service
The plan should list the care and services the home will provide. Use resident-specific descriptions rather than broad labels.
For each service, document:
- Assessed need, preference, or goal
- Specific care or service
- Person or role responsible
- When it occurs
- How it is provided
- Resident participation or choice
- Equipment or supplies
- Safety steps
- Documentation or follow-up
- Review trigger
“Assist with bathing” is incomplete if the resident's preferred schedule, level of assistance, equipment, privacy choices, and safe method matter to implementation.
Do not include a service the home cannot reliably staff or provide. Admission and continuation decisions require separate capability review.
State who will provide each service
Use a responsible role or qualified external provider rather than only a person's name, because employees and schedules change.
Examples include:
- Caregiver on assigned shift
- Provider or resident manager
- Delegating nurse
- Licensed nurse
- Hospice agency
- Home health or therapy provider
- Resident
- Resident representative or approved family participant
Where an individual has a special role, identify the person and effective period as appropriate. Do not assign clinical, delegated, or medication work solely because the name appears in the plan.
The staff schedule, credential status, and resident-specific authorization should support the plan without becoming part of the signed plan text unless required.
Document when services occur
Timing can include:
- Specific administration or care time
- Morning, evening, or shift window
- Frequency
- Days of week
- Before or after another activity
- As needed with defined condition
- Appointment or therapy schedule
- Review or monitoring interval
Avoid “as needed” without describing what need or resident request initiates the service and who responds.
The plan can state reasonable flexibility for resident preference while still giving staff enough direction. A software schedule should not replace the signed plan; it implements its reviewed timing.
When the resident is away from the home, explain how applicable services and medication management will be handled.
Explain how services will be provided
The method should reflect the resident's abilities, choices, communication, equipment, risks, and preferred approach.
Consider:
- Level of cueing, standby, partial, or full assistance
- Privacy and dignity
- Mobility and transfer method
- Adaptive equipment
- Communication approach
- Behavioral supports
- Infection-prevention steps
- Positioning or skin protection
- Nutrition and hydration preferences
- Monitoring and notification thresholds from authorized sources
Do not invent clinical thresholds or instructions. Link practitioner orders, delegation instructions, or other authoritative documents and preserve their versions.
The caregiver-facing task can summarize the action, but staff should be able to open the relevant plan section.
Document medication management
WAC 388-76-10355 includes how medications will be managed, including how the resident will receive medications when away from the home.
Checklist:
- Assessed medication-management ability
- Level of assistance or administration
- Responsible qualified role
- Current medication-order source
- Storage and access approach
- Routine and PRN administration workflow
- Refusal, hold, missed, or late-entry process
- Refill and pharmacy coordination
- Medication away from the home
- Nurse-delegation relationships where applicable
- Change and discontinuation review
The negotiated care plan describes management. The current medication order and MAR contain the medication-specific operational record.
Do not paste a static medication list into the plan and assume it stays current. Link to a controlled active list or identify the as-of date.
The eMAR guide for Adult Family Homes explains order, schedule, administration, correction, PRN, and reporting workflows.
Capture activity preferences
Document the resident's activity interests, routines, participation choices, and how the home will support them.
Review:
- Preferred individual and group activities
- Community participation
- Cultural, spiritual, and social preferences
- Rest and quiet time
- Interests, hobbies, and meaningful routines
- Mobility, transportation, communication, or sensory support
- Choice to decline or change participation
Avoid a generic list of facility activities. The plan should reflect the resident's choices and how staff will support access.
Document updates when interests or abilities change rather than treating a declined event as noncompliance by the resident.
Record other important preferences and choices
The rule lists examples including food, daily routine, and grooming. The plan can also address other resident-defined issues important to daily life.
Checklist:
- Food and meal preferences
- Daily wake, rest, and bedtime routine
- Grooming, clothing, and personal presentation
- Bathing preferences
- Room and personal-property choices
- Social contacts and privacy
- Communication and language
- Cultural or spiritual practices
- Preferred caregivers where feasible
- Technology, media, and telephone use
State how the home will accommodate each preference and any reviewed limitation. Do not reduce preferences to a checkbox without an implementation description.
The plan must remain centered on the resident, not the facility's default routine.
Add a foreseeable crisis plan when needed
If the assessment identifies a foreseeable crisis, document a resident-specific response.
Include:
- Identified situation or trigger
- Early indicators
- Prevention or de-escalation approach
- Staff response
- Environment modification
- Communication approach
- When to seek additional help
- People to notify
- Emergency boundary
- Documentation and follow-up
Do not copy a generic emergency policy into the resident's plan. The facility emergency plan and resident-specific foreseeable-crisis plan serve different purposes.
Use language staff can follow during the event while preserving resident dignity and rights.
Address tension, agitation, and behavior support when needed
The plan can describe strategies and environmental or staff approaches connected to assessed behaviors or symptoms.
Document:
- Objective behavior description
- Known triggers or context
- Communication or unmet-need indicators
- Preventive routine
- Preferred calming supports
- Environmental modification
- Staff response
- Practices to avoid
- Escalation and notification
- Outcome documentation
Avoid labels such as “difficult” without observable facts. Do not use software-generated predictions as a substitute for assessment and individualized planning.
Daily Behavior Tracker entries can support review, but isolated observations should not rewrite the plan automatically.
Cover medical devices and related safety plans
For devices or special needs, identify:
- Device and purpose
- Resident's ability and preference
- Assistance needed
- Responsible qualified person
- Routine care and cleaning
- Supplies
- Manufacturer or professional instructions
- Safety risks
- Failure or emergency response
- Monitoring and notification
- Documentation
Examples may include mobility devices, oxygen equipment, hearing or communication devices, glucose-related equipment, or other resident-specific items.
Do not place a device task on a caregiver schedule unless the person's role and instructions authorize it.
Plan for refusal of care or treatment
The plan should identify how staff respond when the resident refuses applicable care or treatment, including when the physician or practitioner should be notified.
Checklist:
- Specific care or treatment that may be refused
- Resident communication and decision support
- Immediate safety assessment
- Alternatives or later re-offer
- Respectful documentation
- Practitioner notification condition
- Representative or other notification when appropriate
- Significant-change or emergency threshold
- Plan review trigger
Do not use a refusal plan to coerce care or automatically label the resident incapable. Record the facts, response, and authorized follow-up.
Medication refusal also needs the medication administration record and applicable medication workflow.
Document communication barriers and strategies
Identify communication barriers and how staff will use behaviors, nonverbal gestures, devices, language support, or other approaches to communicate with the resident.
Include:
- Preferred language and communication mode
- Hearing, vision, speech, cognitive, or literacy needs
- Assistive devices
- Meaning of known gestures or behaviors
- How staff confirm understanding
- Interpreter or representative involvement
- Emergency communication
- Approaches to avoid
Use respectful, observable descriptions. Update the plan when the resident's communication ability or technology changes.
Caregivers need access to the relevant section during the shift without viewing unrelated sensitive plan content.
State whether and how long the resident may be left unattended
The plan should include a specific statement about the resident's ability to be left unattended for a defined length of time.
Document:
- Assessment basis
- Specific duration
- Conditions or time of day
- Emergency knowledge and ability
- Communication access
- Resident consent
- Staff contact method
- Environmental or mobility limits
- Review trigger
Avoid vague phrases such as “briefly” or “as tolerated.” A change in cognition, mobility, health, or emergency response ability can require immediate review.
The plan statement should align with current staffing and facility procedures.
Include hospice planning when applicable
When the resident receives hospice services from a licensed hospice agency, the negotiated care plan should connect with the hospice plan and clarify responsibilities.
Review:
- Hospice agency and contacts
- Current hospice plan reference
- Services provided by hospice
- Services provided by the AFH
- Medication and comfort coordination
- Equipment and supplies
- After-hours contact
- Change, crisis, and death procedures
- Family or representative communication
- Document versions and updates
Avoid copying clinical hospice material into an uncontrolled note. Link the authoritative plan and preserve access appropriate to staff duties.
Complete the plan within the required timing
WAC 388-76-10360 addresses development and completion within thirty days of admission.
The software can calculate a due date from a verified admission date and show:
- Admission date
- Plan due date
- Draft status
- Missing sections
- Participant review
- Signature status
- Completion date
An alert should clear only when the complete required plan is signed and dated, not when an empty template is created.
If the admission date changes through correction, recalculate transparently and preserve history.
Involve the required and resident-chosen people
WAC 388-76-10370 identifies people involved in plan development.
Participation record checklist:
- Resident involved to the greatest extent possible
- Family involved when approved by the resident
- Resident representative involved when applicable
- Professionals involved in care included as appropriate
- Other resident-chosen people included
- Department case manager included when services are department-paid
- Meeting dates and methods
- Input, disagreement, or clarification documented
Participation is not the same as signature. Record both accurately.
Do not invite a family member automatically because the person is in the contacts list.
Obtain required signatures and dates
WAC 388-76-10375 addresses agreement, signature, and date by the resident and Adult Family Home.
Checklist:
- Final version presented
- Resident signature and date
- Home signature and date
- Signer identity and capacity
- Electronic or paper method reviewed
- Decline, inability, or alternative process handled according to current requirements
- Signed version protected from ordinary editing
- Copy provided as required or appropriate
Electronic signature should bind identity and intent to the exact version. Do not paste a stored signature image onto a revised plan.
Implement the signed plan
WAC 388-76-10365 addresses implementation.
After signing:
- Mark the version effective
- Retire or supersede the prior plan
- Generate reviewed care schedules and tasks
- Make relevant sections available to assigned staff
- Confirm external-provider coordination
- Update medication or delegation workflows through their own controls
- Train or orient staff where needed
- Monitor unresolved implementation gaps
Do not mark implementation complete because the document was signed. Test whether staff can explain and carry out the current services.
Review and revise at the correct triggers
WAC 388-76-10380 addresses review and revision after an assessment for significant change, when the plan no longer addresses needs and preferences, at resident or representative request, and at least every twelve months.
Track:
- Current effective date
- Last review
- Next annual review
- Significant-change assessment
- Resident or representative request
- Service mismatch or implementation concern
- Review participants
- Decision and revision status
A review that results in no change still needs documentation. A revision creates a new version and repeats required agreement, signature, implementation, and distribution steps.
Do not edit the current signed document to reset the annual date.
Provide the case manager copy when required
WAC 388-76-10385 addresses providing a signed and dated copy to the department case manager when the resident's services are department-paid.
Record:
- Payer or program status
- Case manager and contact
- Plan version
- Signed date
- Copy delivery date and method
- Confirmation or follow-up
- User completing delivery
Email-sent status does not necessarily prove receipt. Use the facility's approved secure method and preserve the delivery evidence.
Run a complete plan audit
For each resident, verify:
- Current assessment and preliminary service plan.
- Every required plan content area.
- Specific care, provider, timing, and method.
- Medication and away-from-home management.
- Preferences, communication, safety, and refusal approaches.
- Required participation.
- Resident and home signatures and dates.
- Completion within the applicable timing.
- Implementation in staff workflows.
- Annual and event-triggered review.
- Case-manager copy when required.
- Version, access, retention, and report controls.
The AFH care-plan software evaluation guide helps providers test how a product supports this checklist.
Frequently asked questions
When must the negotiated care plan be completed?
The current WAC 388-76-10360 text states within thirty days of admission. Confirm the current rule and resident circumstances.
Who signs the negotiated care plan?
The current WAC 388-76-10375 text identifies the resident and Adult Family Home. Providers should review how current requirements apply when capacity, representation, or signature challenges arise.
How often is the plan reviewed?
WAC 388-76-10380 lists event-based triggers and at least a twelve-month review. A significant change or resident request may require earlier action.
Can the software generate the plan automatically?
It can organize assessment data and suggest structure. An authorized team must negotiate, review, finalize, sign, implement, and revise the resident-specific plan.
Does signing prove the plan is implemented?
No. Implementation requires staff access, scheduling, training, external coordination, and actual delivery of the agreed care and services.
Turn assessment into implemented resident choices
A complete negotiated care plan connects assessed needs and resident preferences to specific people, timing, methods, signatures, implementation, and review. Its value comes from daily use, not template completion.
AFH Manager can connect assessment, preliminary service planning, negotiated services, participant review, signatures, versions, caregiver tasks, medication workflows, review alerts, case-manager delivery, and formatted exports. Providers can test every checklist item with demonstration residents before rollout.