Checklist
For pdf copy of this form, please click here.
Use the following checklist when visiting residential are facilities. As you walk through the facility keep your eyes and ears open. Remember that this will be “home” to the person you are helping to place. If you don’t like what you see, hear, or smell, chances are that the person you represent will not be happy there. As a general rule, the most appropriate care facility is the one in which you have checked the most “yes” answers.
One of the most effective ways of reviewing a home is to drop in unannounced at meal times, keeping in mind that meals are important to the residents, and reveal much about the facility’s management and staff attitudes. This will allow you to see the quality and preparation of the food, how the staff relates to the residents, and see how the residents interact among themselves. Take this opportunity to talk to other residents -- how do they like where they are living? Could they be friends with your family member?.
| Yes | No | Yes | No |
General Atmosphere
Is the facility warm and hospitable?
Do the residents interact with one another?
Is the television on continuously?
Do the residents appear interested & involved in their lives?
Are there specific visiting hours? Yes No If so, what are they?
Is there a bed time requirement?
Food Service
Is the kitchen clean?
Are the menus posted for review?
Do the menus match what is being served?
If an individual has special dietary requirements will he/she be Accommodated?
Are there snacks provided between meals?
Are they healthy snacks?
Do the meals seem nutritious and provide variety?
Bedrooms and Bathrooms
Is there easy access to the beds?
Is there adequate lighting?
Is there adequate storage?
Is there a comfortable chair in the bedroom?
Is the bathroom clean and accessible?
Are there enough bathrooms?
Is there privacy for the resident?
Is there an adequate room where residents can visit with family or friends?
May the resident decorate his/her own room?
May the resident use his/her own furniture?
Social Activity / Rooms
Is there enough room available for the residents?
Is the telephone available where calls can be made in private?
Services/Activities
Will the facility provide transportation to medical services?
Will the facility help to arrange for transportation to medical services?
Will arrangements be made for a resident to worship as he/she pleases?
Are there group and individual activities provided inside the home?
Are there outside trips for those who choose to go?
Are there wheelchair vans?
Is special attention given to each resident’s interest?
Are there volunteers from the community to work with the residents?
Is the Ombudsman poster prominently displayed?
Staff
Can the staff speak and understand the resident’s language?
Is the staff courteous and kind to the residents?
Does the staff show interest in the resident’s welfare?
Is the staff familiar with the types of medications (dosages, side effects)?
Is the staff trained in CPR and First Aid?
How long has the current staff worked at the facility?_________________________
____________________________________________________________________
What is the training/certification of the people who care for the residents?________
____________________________________________________________________
Financial Business/Admissions
The admissions agreement is a legal contract and should be thoroughly read
before signing. If you have concerns about the contract ask either an attorney
or the local Ombudsman.
What services are covered by the basic monthly fee? (Ask for an itemized list)
____________________________________________________________________
If there is a hospital or nursing home stay, how long will the room be held?
____________________________________________________________________
Does the administrator handle a resident’s personal money?
Is he/she bonded?
Are the financial records kept current, and how often can they be reviewed?
What are the house rules? (Is smoking or alcohol allowed)?
Has the facility made provisions for safeguarding the resident’s personal property
and valuables? (Ask to see the theft and loss procedures)_____________________
_____________________________________________________________________
Emergencies
Who decides whether to call 911? ________________________________________
Are there written policies about how that decision is made?____________________
What kind of emergencies are staff expected to handle and how are they trained for
them?_______________________________________________________________
____________________________________________________________________
Medications
What safeguards are in place to ensure that I get the appropriate medications on
time and in the correct dosage?__________________________________________
____________________________________________________________________
How are prescriptions filled?_____________________________________________
Must I use the facility pharmacy?
What are the costs?___________________________________________________
Who gives out medications?_____________________________________________
If not a nurse, how are staff trained and supervised?__________________________
____________________________________________________________________