Login to your Account


After you login, please click on the link in the User Menu "Your Profile" which appears in the upper left corner of this page. THEN, click on "Log Into Your Account" to view your PSA files.

Facilities First Impression

Generated with MOOJ Proforms Basic 1.1
CLIENT NAME:
DATE:
FACILITY NAME:
 Do you like the facility's location and outward appearance?
 Is the facility convenient for frequent visits by family and friends?
 Are you welcomed with a warm greeting from the staff?
 Does the staff address residents by their names and interact with them during your tour?
 Do you notice the residents socializing with each other and do they appear content?
 Can you talk with residents about how they like living there and about the staff?
 Is the staff appropriately dressed, friendly and outgoing?
 Do the staff members treat each other in a professional manner?
 Are visits with the residents encouraged and welcome at any time?
 What percentage of the rooms/beds is available?
 Is there a waiting list? If so, how long do they estimate it will take to be admitted?
Living Area and Accommodations
 Is the floor plan well designed and easy to follow?
 Are doorways, hallways and rooms accommodating to wheelchairs and walkers?
 Are elevators available for those unable to use stairways and handrails to aid in walking?
 Are floors of a non-skid material and carpets conducive for safe walking?
 Does the residence have good lighting, sprinklers and clearly marked exits?
 Is the residence clean, free of odors and appropriately heated/cooled?
 What is the facility's means of security if a resident wanders?
 Are the common areas in general attractive, comfortable and clean?
 Is there an outside courtyard or patio for residents and visitors, and assistance getting there?
 Does the residence provide ample security and is there an emergency evacuation plan?
 Are private rooms available and/or double occupancy units for sharing with another person?
 Does residence have furnished/unfurnished rooms? What is provided or what can they bring?
 May they decorate their own rooms? Is there adequate storage space?
 Is a 24-hour emergency response system accessible from the unit?
 Are bathrooms private with handicapped accommodations for wheelchairs and walkers?
 Do all units have a telephone and cable TV and how is billing handled?
Moving In, Contracts, and Finances
 What's involved with the moving in/out process? How is the initial needs assessment done?
 Does assessment process include the resident, family, facility staff, along with the physician?
 Is there a written plan for the care of each resident?
Is there an ongoing process for assessing a resident's need for services and how often are those needs evaluated?
 Is there a written statement available of the resident rights and responsibilities?
 Is a contractual agreement available that clearly discloses healthcare, accommodations, personal care and supportive services, all fees, and admission and discharge provisions?
 What type of insurance is required/accepted? Medicare/Medicaid/Medigap/Long-term care/Private?
 What are the specific costs for various levels of care including skilled/unskilled beds?
 What additional services and staff are available if the resident's needs change?
 When may a contract be terminated and what are the policies for refunds and transfers? Is there an appeals process for dissatisfied residents?
 What happens if funds are depleted and full payments can no longer be made?
 Is there any government, private or corporate programs available to help cover the costs?
 Is there any government, private or corporate programs available to help cover the costs?
 Is there a procedure to pay for additional services such as skilled nursing care when the services are needed on a temporary basis?
 Do billing, payment and credit policies seem fair and reasonable?
May resident handle his/her own finances with staff assistance if able? Must a family member/outside party be designated?
Health/Personal Care/Services
 What type of healthcare and personal care services are available?
 What type of healthcare and personal care services are available?
Does the facility have both short and long-term services, such as routine physical and dental/vision examinations as well as skilled nursing?
 Can the facility provide a list of available services and are residents and families involved in developing the care plan/service agreement?
Who provides these services/what are their qualifications?
 Are physical, occupational, or speech therapy services available onsite?
Who coordinates these services and how are they billed to Medicare/Medicaid or other third party insurance?
 Is staff available to provide 24-hour assistance with activities of daily living (ADLs) if needed? ADLs include dressing eating, mobility, hygiene, grooming (bathing, toileting, incontinence)
 Does the residence have Alzheimer's programs, or other dementias and other specialized areas? How does staff safely manage residents who might wander?
 Is staff available to assist residents who experience memory, orientation, of judgment losses?
 How are medical emergencies handled?
Does the residence have a clearly stated procedure for responding to medical emergencies? Is there an arrangement with a nearby hospital?
 Are housekeeping, linen service and personal laundry included in the fees, or extra charges?
 Does the residence provide transportation to doctors' offices, the hairdresser, shopping and other activities desired by residents and can it be arranged on short notice?
 Are pharmacy, barber/beautician and/or physical therapy services offered on-site?
 How does staff safely administer, monitor, and assist a resident in taking medicine?
 Does the residence's pharmacy provide delivery, consultation and review of medicines?
 Does a staff physician visit the resident regularly for medical checkups or can resident his/her have own personal physician?
Social and Recreational
 What kinds of group/individual recreational activities are offered and who schedules them?
 Is there an organized activities program with a posted daily schedule of events?
 Do volunteers and family members come into the residence to participate/conduct programs?
 Does the facility schedule trips or go to other events off premises?
 Do residents participate in activities outside of the residence in the neighboring community?
 Are the resident activity (social) areas appropriate and desirable to the prospective resident?
 Are there supplies for social activities/hobbies (games, cards, crafts, computers, gardening)?
 Are religious services held on the premises or arrangements made for nearby services?
 Are there fitness facilities, as well as regularly scheduled exercise classes?
 Does the residence create a sense of community by allowing residents to participate in certain activities or perform simple chores for the group as a whole?
 Does facility have pets? Who is responsible for their care?
Staff
 Are nursing staff members courteous and friendly to residents and to other staff?
 Do nursing staff respond timely to residents requests for assistance such as help getting in and out of bed, dressing and going to the bathroom?
 Which nursing staff members are involved in planning the resident's individual care? Are they the same ones who give the care to residents?
 Ask questions about staff turnover. Is there frequent turnover among certified nursing assistants (CNAs)? What about turnover for nurses and supervisors, including the Director of Nursing and the Administrator?
 What is the nursing staff to resident ratio? How many registered nurses (RNs) and Licensed Practical Nurses (LPNs) are on staff? How many per shift? What is their training/education?
 What is the nursing assistant to resident ratio and how many are on staff? How many on each shift? What kind of training do certified nursing assistants (CNAs) receive?
 What is history of compliance with staffing ratios? Are there incentives to help with staffing?
 How does the nursing home ensure that all staff maintains licensure/certification, receives continuing education, and keeps their knowledge and skills up-to-date?
Food
 Does the residence provide three nutritionally balanced meals a day, seven days a week, and how does the menu vary from meal to meal?
 Observe meal times. Do all residents who need assistance with eating get help? Does staff give each resident enough time to chew food thoroughly and complete the meal?
 What about special diets; does a dietitian plan or approve menus? Are resident's weight routinely monitored?
 Are residents involved in menu planning? Can request special foods? Are snacks available?
 Does dining room environment encourage residents to relax, socialize, and enjoy their food?
 Are water pitchers/glasses accessible in rooms and does staff assist with drinking as needed?
 Are common dining areas available? Is tray service available when ill and staff to assist?  Are common dining areas available? Is tray service available when ill and staff to assist?
 May meals be provided at a time a resident would like or are there set times for meals?
 May residents have guests for meals in the dining room for an additional fee? Is there a private dining room for special events and occasions?
Licensure and Certification
 Is the facility Medicare certified and/or Medicaid certified?
 Is this a skilled nursing facility and is a skilled bed available?
 Is the facility accepting new patients? Is there a waiting period for admission?
 If the facility is sponsored by a nonprofit organization and managed under contract with a commercial firm, what are the conditions of that contract?
 Is there a resident council or organization through which resident/family have a means of voicing their views on the management of the community?
 Each state requires the residence to be licensed and/or certified. Does the facility have a current license/certification and is it displayed?
 Each state requires the administrator to be licensed/certified. Does she/he have current license/certification?
 What reputation does the facility have in the community? How long has it been in business? Is it in good financial health? Does the facility follow generally accepted accounting procedures?
 Has the facility corrected any Quality of Care deficiencies in their State inspection report?
mad4media user interface design

In the News