Directions: This checklist is intended for use when selecting a nursing home or skilled nursing facility. Complete this for each facility you visit to keep track of and compare different facilities.
| Basic Information |
Yes |
No |
Comments |
| Is facility Medicare-certified? |
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| Is facility Medicaid-certified? |
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| Is the valid license posted? |
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| Is the latest state survey or inspection report available for review? |
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| Has the facility corrected all deficiencies (failure to meet a federal or state requirement) on its last inspection report? |
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| Has the license ever been revoked? If so, why? |
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| Is there a waiting period for admission? |
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| Is the level of care (e.g., skilled, custodial) needed offered and a bed is available? |
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| Are special services (e.g., dementia, ventilator, rehabilitation) needed offered in a separate unit and a bed is available? |
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| Is facility located close enough to friends and family? |
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| Personal and Health Care |
Yes |
No |
Comments |
| Are residents encouraged to be as independent as possible? |
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| Are residents allowed to make choices about their daily routine? |
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| Are assessments performed on residents to assess needs? How often? |
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| Can the facility accommodate with a resident's changing needs? |
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| Does facility have the ability to determine the cause of confusion a resident may develop (medications versus diagnosis of dementia or Alzheimers')? |
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| Does the facility have the ability to deal with a resident's behavior that may change and become abusive? |
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| Are there any limitations on how the staff will handle your loved one's medications? |
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| Are there safeguards in place to ensure that medications are taken on time and in the correct dosage? |
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| Is a pharmacist available for individuals and staff? |
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| Are routine and emergency drugs available? How are prescriptions filled? What are the costs? |
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| Who dispenses medications? |
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| Who reviews medication procedures and how frequently? |
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| Do residents receive preventative care such as yearly flu shots? |
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| Does the facility monitor residents' health including routinely monitoring weight? |
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| Does the staff routinely check each resident thoroughly from head to toe to avoid bed sores? |
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| May residents still see their own doctors? |
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| How will physician and facility communicate about resident's care? |
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| Are there health care facilities available at the facility (physical therapy, occupational therapy, wound care, hospice care, social services, etc.)? |
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| Are there a variety of medical services available (dentists, podiatrists, optometrists)? |
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| Will the staff set up appointments for residents? |
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| Does the staff respond quickly when residents push the call buttons? |
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| Does the facility have an arrangement with a nearby hospital for emergencies? |
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| Does the facility call family or a personal doctor when emergencies arise? Under what circumstances? |
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| Does the facility use physical or chemical restraints? If so, under what circumstances and policy? |
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| Is there a beauty parlor or barber? |
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| Are there laundry services? Is there an extra cost? |
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| Plan of Care |
Yes |
No |
Comments |
| Does the facility prepare a written plan for how it will care for my loved one? |
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| Are Certified Nursing Assistants involved in care planning meetings? |
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| Are care plan meetings are held with residents and family at convenient times if possible? |
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| How will my family be involved in the plan? |
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| What if I don't agree with the plan? |
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| What involvement does a confused resident have? |
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| Does the plan cover all aspect of a resident's life? (physical, mental, social and medical) |
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| Is the plan and any medical records stored? If so, is confidentiality guaranteed? |
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| Does a pharmacist review individual drug treatment plans? |
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| Environment |
Yes |
No |
Comments |
| Are there any overwhelming unpleasant odors? |
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| Is the facility clean and well-kept? |
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| Is the temperature comfortable for residents? |
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| Is facility well lit? |
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| Are there quiet and/or private areas for visiting with friends and family? |
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| Are noise levels in common areas comfortable? |
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| Is smoking not allowed or is it restricted to certain sections of the facility? |
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| Are furnishings comfortable, sturdy and attractive? |
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| Are the building and grounds well cared for and attractive? |
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| Menus and Food |
Yes |
No |
Comments |
| Do residents have a choice of food items at each meal? |
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| Is there enough time to eat meals? |
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| Are favorite foods offered? |
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| Does the food look and smell good? |
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| Are special dietary needs accommodated? How? |
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| Are nutritious snacks available upon request? |
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| Can staff help residents eat and drink at mealtimes if needed? |
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| Is the meal schedule flexible? At what times are meals served? |
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| Does a nutritionist or dietician review meals and special diets? |
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| Can a meal tray be delivered to a resident's room? At what cost? |
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| Is the food preparation separated from the dishwashing and garbage areas? |
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| Is food requiring refrigeration properly stored? |
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| Do the kitchen workers observe sanitation rules? |
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| Activities |
Yes |
No |
Comments |
| Are residents, including those who are unable to leave their rooms, able to choose to take part in activities? Are residents encouraged, not pushed, to participate? |
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| Are activity schedules varied and include resident's interests? Do residents provide input? |
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| Is there someone who develops and supervises recreational activities? What is their background? |
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| Is reading assistance available? |
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| Does the facility have pleasant outdoor areas for resident use? Does the staff help residents go outside? |
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| Are there protected/enclosed areas for residents with dementia? |
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| Are residents involved in the community outside the facility? If so, how? How is staff involved? |
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| Are there recreation facilities on site (such as a game room)? |
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| Can residents exercise? What are the exercise facilities like? |
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| Does the facility have an active volunteer program? Are volunteers from the community? Are they screened? |
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| What is the visiting policy? |
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| Does the facility have pets? Or can family pets come with visitors? If yes, what are the restrictions? |
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| How does the facility accommodate religious or spiritual needs? |
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| Safety and Security |
Yes |
No |
Comments |
| Is there a security checkpoint at the entrance? |
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| Does the facility meet local, state and federal fire codes? |
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| Are emergency exits clearly marked, accessible and easily opened from the inside? |
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| Are there fire safety systems? (For example, smoke detectors, fire extinguishers and sprinklers are in each room.) |
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| Is there an emergency evacuation plan? Is it posted? |
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| Does the facility hold regular fire drills that include bed-bound residents? |
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| Are the facility's doors locked? When? How does a resident or family member get into the home when the doors are locked? Are exit doors alarmed? |
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| Are there safety locks on windows? |
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| Are there handrails in the hallways and grab bars in the bathrooms? |
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| Are stairway doors kept closed to prevent potential spread of fire? |
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| Is the facility wheelchair accessible? (Example: hallways are wide enough, there are wheelchair ramps) |
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| Is floor covering made of nonskid material? |
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| Is the building generally free of clutter? |
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| Are there safety measures in place to protect residents from wandering? |
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| Is there an emergency generator or alternate power source? |
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| Are there written policies about when 911 is called and who decides to call? |
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