Directions: This checklist is intended for use when selecting an assisted living residence. Complete this for each facility you visit to keep track of and compare different facilities.
| Medical Care |
Yes |
No |
Comments |
| Are residents encouraged to be as independent as possible? |
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| What happens if the health care needs of a resident change? |
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| Can hospice care be provided? Will the facility help to coordinate with the physician and family? |
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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 Alzheimer's)? |
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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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| What is the policy on dispersing medications? Are there any limitations on how the staff will handle your loved one's medications? |
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| Can a resident take his/her medications on own? |
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| Does the facility use a particular pharmacy? If so, is the pharmacy participating in the resident's Medicare Part D prescription plan? |
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| Does the pharmacy provide a yearly review and consultation services? |
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| Are physical, occupational or speech therapists available or arranged? |
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| May residents still see their own doctors? |
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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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| Plan of Care |
Yes |
No |
Comments |
| How and by whom are residents' needs assessed and monitored? |
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| Are there special programs available (memory loss, dementia, limited mobility)? |
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| Does the facility prepare a written plan for how it will care for the resident? |
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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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| 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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| 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 plenty of community areas for residents to use? |
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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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| Is there a bank, beauty parlor or barber? |
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| Are there laundry services? Is there an extra cost? |
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| Staff |
Yes |
No |
Comments |
| Is the staff visible? |
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| Does the staff wear name tags? |
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| Does the relationship between staff and residents appear to be polite, warm and respectful? |
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| If residents or staff are not native English speakers, can they communicate effectively with each other? |
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| Can a private duty companion be hired? What is the procedure? |
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| Is training and continuing education programs available to all staff? Are there on-going programs? |
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| Does the staff receive abuse prevention training? |
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| Are background checks completed for all staff? |
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| Is there at least one full-time registered nurse (RN) on duty around the clock? If not, how does facility support resident in obtaining nursing care? |
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| Residents' Room |
Yes |
No |
Comments |
| Is the living space big enough? |
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| Are the rooms private? |
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| Do any rooms have kitchens or kitchenettes? |
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| Are rooms furnished? If so, can residents have personal belongings and/or furniture in their rooms? |
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| Is it well lit? |
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| How often is the room cleaned? |
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| Is there a window in each resident's room? |
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| Do residents have access to a personal telephone, Internet and television? |
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| Is there a cable TV connection in each room? |
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| Are linens and towels provided? |
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| Do policies and procedures exist to protect residents' personal possessions? |
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| What is the policy for visitors? Staying overnight? Are there guest rooms? |
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| Is there additional storage space available? |
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| Are there call systems in each room? |
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| Is there a private bathroom? If so, how often is it cleaned? |
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| Is there a call system in the bathroom? |
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| Menus and Food |
Yes |
No |
Comments |
| How often do the menus rotate? Are residents' suggestions taken into account? |
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| Do residents have a choice of food items at each meal? |
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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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| Activities |
Yes |
No |
Comments |
| Are residents encouraged, not pushed, to participate in activities? |
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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 his/her background? |
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| Does the facility have pleasant outdoor areas for resident use? Is there a place for residents to garden? |
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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)? Can residents use supplies outside of scheduled programs? |
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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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| Are pets allowed? If not, 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 |
| Does the facility offer security? 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? |
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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 residents with dementia or Alzheimer's prevented from wandering from the facility? How? |
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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 there an emergency generator or alternate power source? |
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| Are there written policies about emergencies, when 911 is called and who decides to call? |
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