Free Nursing Home Appraisal Checklist Template
Nursing Home Appraisal Checklist
Organization: [Your Company Name]
This Nursing Home Appraisal Checklist is developed to provide a comprehensive framework for evaluating the overall quality, safety, and regulatory compliance of nursing homes. It serves as an essential tool for ensuring that facilities meet the highest standards of care and operation.
Instructions for Use:
-
Comprehensive Review: This checklist should be used to conduct a thorough appraisal of each nursing home, covering all critical aspects from basic information and care services to regulations compliance and financial aspects.
-
Documentation: Accurately document findings against each checklist item. Use "Compliant," "Partially Compliant," or "Non-Compliant" to indicate the facility's status.
-
Action Plan: Develop an action plan for areas marked as "Partially Compliant" or "Non-Compliant" to address and rectify deficiencies.
-
Confidentiality: Maintain the confidentiality of the appraisal findings, accessible only to authorized personnel.
Checklist:
Section 1: Basic Information and Entrance Condition
|
Item |
Compliant |
Partially Compliant |
Non-Compliant |
|---|---|---|---|
|
Verify the official name and location |
|
|
|
|
Evaluate cleanliness and maintenance of entrance/reception |
|
|
|
|
Check security measures at the entryway |
|
|
|
|
Assess parking, accessibility ramps, and overall access |
|
|
|
|
Check for displayed certifications, awards, licenses |
|
|
|
Section 2: Staff and Care Services
|
Item |
Compliant |
Partially Compliant |
Non-Compliant |
|---|---|---|---|
|
Survey number and competency of staff members |
|
|
|
|
Examine staff responsiveness to needs and emergencies |
|
|
|
|
Verify available medical services and activities |
|
|
|
|
Assess hygiene care provided to residents |
|
|
|
|
Check for rehabilitation and therapy services |
|
|
|
Section 3: Living Conditions and Safety Measures
|
Item |
Compliant |
Partially Compliant |
Non-Compliant |
|---|---|---|---|
|
Evaluate cleanliness of rooms and common areas |
|
|
|
|
Check safety rails and non-slip flooring in hallways |
|
|
|
|
Conduct a fire safety inspection |
|
|
|
|
Check the quality and frequency of meals provided |
|
|
|
|
Assess residents' freedom to personalize their living space |
|
|
|
Section 4: Regulations Compliance and Patient Rights
|
Item |
Compliant |
Partially Compliant |
Non-Compliant |
|---|---|---|---|
|
Ensure compliance with local and federal health regulations |
|
|
|
|
Check for any history of violations or penalties |
|
|
|
|
Verify clear communication of residents' rights and responsibilities |
|
|
|
|
Review the complaint policy and resolution effectiveness |
|
|
|
|
Review residents' satisfaction surveys, if available |
|
|
|
Section 5: Financial Aspects and Contracts
|
Item |
Compliant |
Partially Compliant |
Non-Compliant |
|---|---|---|---|
|
Review fees structure and coverage |
|
|
|
|
Check availability and application process for financial aid |
|
|
|
|
Examine residential agreement for unfair terms |
|
|
|
|
Verify policy on refunds and contract termination |
|
|
|
|
Ensure fair and clear communication for rate changes |
|
|
|
This appraisal checklist is a critical component of [Your Company Name]'s commitment to ensuring high-quality care and safe living environments for nursing home residents. Through diligent application and review, we support ongoing improvements in nursing home standards, benefiting residents and their families.
