Nursing Home Evaluation Checklist
Nursing Home: ______________________________________________________
Address: __________________________________________________________
Telephone: ___________________Email: _________________________________
Date of First Visit:_____________________ Second Visit: ___________________
Morning ____ Afternoon ____ Evening ____
Monday__ Tuesday__ Wednesday__ Thursday__ Friday__ Saturday__ Sunday__
THE BASICS
- Is the nursing home Medicare certified?
- Is the nursing home Medicaid certified?
- Has its license ever been revoked?
- Is it accepting new patients?
- Is there a waiting period for admission?
- Are background checks conducted on all of the staff?
- Does the nursing home have its own doctor?
- Is transportation available for visits to the resident’s personal physician?
- Are care planning meetings held at times easy for residents/family to attend?
- Does the nursing home have an active family council?
- How many licensed nurses are on duty at each shift?
RNs ___ LPNs ___
- What is the patient-to-staff ratio?______
Nurse-to-patient?______
Aide-to-patient? ______
- What is the visiting policy?
- What is the discharge policy?
Other:
SAFETY
- Are stairs and hallways well lighted? Exits well marked?
- Do the hallways have handrails?
- Do rooms and bathrooms have grab bars and call buttons?
- Are there safety locks on the doors and windows?
- Are there security and fire safety systems?
- Is there an emergency generators or alternate power source?
- Is the floor plan logical and easy to follow?
Other:
CARE ISSUES
- Are residents clean and well groomed?
- Do staff interact well with residents?
- Are residents participating in activities and exercise?
- Do the residents have the same caregivers on a daily basis?
- Does the staff respond quickly to calls for help?
- Is there fresh water available in the rooms?
- Does the food look and smell good?
- Are the residents offered choices of food at mealtimes?
- Are the residents who need assistance eating or drinking receiving it?
- Are there nutritious snacks available throughout the day and evening?
- Is physical therapy available for as long as the resident needs it?
- Does the staff have special training to deal with dementia?
- Are there special units or services for special needs, such as Alzheimer’s?
Other:
QUALITY OF LIFE
- Are resident’s rights posted?
- Does the staff knock before entering a resident’s room?
- Are the doors shut when a resident is being dressed or bathed?
- Is the location of facility convenient for family and friends to visit?
- Does the nursing home meet cultural, religious, or language needs?
- Does the nursing home have outdoor areas for residents and staff?
Other:
