SKILLED NURSING CARE EVALUATION CHECKLIST Nursing Home Name: _______________________________________________ Contact Name: _____________________________________________________ Address: _________________________________________________________ Telephone: _____________________ Email: _____________________________ Date Visited: ___________ Day of the Week: _________
Circle: Circle:
First Visit
Second Visit
Third Visit
Morning
Afternoon
Evening
Floor Plans and Safety Accommodations Is the floor plan logical and easy to follow? What types of rooms are offered? Private or semi-private? Do the hallways have handrails? Do rooms/bathrooms have grab bars and call buttons? Are there safety locks on the doors and windows? Are there security/fire safety systems? Is there an emergency generator or alternate power source? Circle the in-room amenities that are available. Is there an extra cost? Phone TV Cable Internet Other
Healthcare Services Is specialized memory care available for individuals with dementia or Alzheimer’s? If memory care is offered, is it provided in a separate unit with additional security and specially trained staff? Is transportation available for visits to the resident’s personal physician or special medical services such as dialysis? Is there an extra cost? Are there any restrictions? Is physical therapy available for as long as the resident needs it? Does the facility provide EMSA/TotalCare ambulance services membership? Is there an extra cost?
Quality of Care and Life What is the facility’s philosophy of care? Do they focus on person-centered care? Are care planning meetings held at times convenient for residents/family to attend? Does the skilled nursing facility have an active family council? Do residents have the same caregivers on a daily basis? Does the staff knock before entering a resident’s room? Are the doors shut when a resident is being dressed or bathed? Are there any onsite amenities? (e.g., beauty salon, chapel, library, etc.)
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LIFE’s Vintage Guide to Housing & Services
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