First Impressions
|
| What is your initial impression of the facility as you enter? |
| Your observation: |
| Is it well lighted and attractive in appearance? |
| Your observation: |
| Doe the facility feel "under control" or
"disorganized"? |
| Your observation: |
| Is the facility noisy? Is there background music? |
| Your observation: |
Food and Services - ask to eat a meal and observe:
|
| What type of dishes and tableware are used? Is the table set attractively?
How is the service? Is temperature of the food appropriately hot or cold? |
| Your observation: |
| Are the portions adequate? If not family style, may you have second
helpings or decline a portion of the menu? |
| Your observation: |
| Are there provisions for special diets, and will staff consider special
requests or additions to the menu? |
| Your observation: |
| Is the atmosphere pleasant and conducive to conversation? |
| Your observation: |
| Where are those who need assistance with eating served? |
| Your observation: |
Dignity and Decor
|
| What kind of schedules for meals, curfews and scheduled services are in
place - and enforced? |
| Your observation: |
| May friends and family visit at will? Are there visiting hours? |
| Your observation: |
| What is the temperature of the common areas? Will you have individual
temperature controls in our living space? |
| Your observation: |
| May you decorate your personal space as you wish? |
| Your observation: |
| Are bathrooms wheelchair accessible, and are grab bars installed. Are the
bathrooms clean and odor free? |
| Your observation: |
| What kind of activities are offered and how are residents encouraged to
participate? |
| Your observation: |
| Do residents greet staff in passing and do you see impromptu conversations
between them? |
| Your observation: |
| If considering a semi private room, how is the space shared by the two
individuals? Is there an adequate sound barrier between private living spaces? |
| Your observation: |
| Interpersonal Relations |
| During your visit was the administrator visible and involved in the
organizaton? |
| Your observation: |
| Did the staff communicate with each other in a courteous and professional
manner and seem happy to be working at the facility? |
| Your observation: |
| How did the staff address the residents? Did they engage in coversation
while performing tasks? |
| Your observation: |
| Were staff members neatly dressed and easily identified? Did they seem
approachable? |
| Your observation: |
| Did you sense individuality was encouraged? |
| Your observation: |
| Other Considerations |
| What provisions are there for special needs? Does the facility provide for
physician visits? May you use your own physician? |
| Your observation: |
| Does the facility host community activities? Is there a chapel and/or do
they have scheduled religious services? |
| Your observation: |
| If a nursing home or PCBH, is the name of the local Ombudsman posted? |
| Your observation: |
| How are telephone services provided? |
| Your observation: |
