ࡱ>  `2bjbj D*E$$ggggg{{{8D{ 4  "%x g gg gg   3{d  0 , & & &g>,$8   &$ -: INSPECTION CHECK-LIST This form is a compilation of topics and areas of focus during a re-inspection. It can be used to perform a mock inspection, or to focus on certain areas that require close attention. By following this checklist and using the state forms (attachments), you and/or a designated staff person can effectively take note of concerns in your building, and implement changes to address those concerns. Be sure to utilize the three forms of data gathering: observation, interview, and record review. OBSERVATION: Many concerns can be brought to your attention through simply watching and listening. Observe staff-resident interactions, handwashing and personal care, medication assistances/administration, activities, environmental issues, food preparation and handling, etc. INTERVIEW: Interviews with staff, residents, volunteers, and resident family members can serve as a surfacing agent for many issues. By talking with staff and volunteers about policies, mandatory reporting, disaster preparedness, job duties and expectations, frustrations and general concerns, you can gather ideas to improve work practice, implement training opportunities, or clarify confusion. By talking with residents and their family members about living arrangements, activities, safety, privacy and resident rights, food service, and a host of other topics, you can discover their frustration(s), satisfaction, and ideas for improvement. RECORD REVIEW: Although record review is not an emphasis of the inspection process, it is important nonetheless. It is imperative that observation and interview information matches recorded data (i.e., if a resident refused his/her medication this morning, the medication administration record should reflect this refusal). Furthermore, dated materials (such as the resident assessment, service agreement, staff training information) must be updated and maintained current in order to ensure accurate and timely information. METHODS TO DO A MOCK INSPECTION: It is ideal if you have 2 to 3 participants. Break up the tasks and follow the state licensors inspection process. Share issues with the entire team, and plan on methods to correct any deficiencies. Choose certain areas of the inspection that are of particular concern to you (i.e., if your building was cited particularly heavy in the food service area, focus your efforts there) and follow through. You can break up the inspection into bite-size pieces by focusing on one topic per day, per week, etc. Swap buildings have a nearby boarding home conduct a mock inspection on your facility, and vice versa. That way, your staff may be more on their toes if they think the inspection is a real one. Think like and investigator. If you see something that concerns you, dig deeper. For example, if you observe a resident expressing an aggressive behavior, look at the residents service agreement to see if it is addressed there. If it is, did the staff respond to the resident based on information in the service agreement? FOCUSYESNOCOMMENTS TOURQuality of Life Residents appropriately groomed and dressed? Staff-to-resident interactions appropriate, Including eye contact, touch, verbal communicationAppropriate delivery of care and services General appearance of residents General appearance of resident care needs and level of assistanceImpact of environment & safety issues Infection control practices Maintenance of facility equipment Homelike setting Safety practicesObserve the following for cleanliness, neatness, safety: Common areas Resident furnishings, walls, floors Activity room(s) Laundry room(s) Storage area(s) Restrooms Nursing areas, including: Clean and dirty equipment handling Medication storage areas Exterior groundsPosters/notices: Complaint Resolution Unit Ombudsmans office Current BH license Most recent inspection (including cover letter and POC) FOCUSYESNOCOMMENTS INTERVIEW: RESIDENT (Attachment G)Resident Interview: Services and needs Preferences and choice Safety and well-being Environment Meals and food service Healthcare services Resident rights Activities AbilitiesResident observation during interview: Water temperature in room/apartment Cleanliness of room/clutter Cleanliness of resident/clothing Any safety issues Medication storage Personal care items (if state contract) INTERVIEW: STAFF, ADMINISTRATORDiscuss the following topics: What constitutes abuse Facility procedures regarding abuse Prevention of abuse Reporting Emergencies, including: Emergency lighting Location of first aid supplies Location of disaster plan Staff responsibilities in an emergency Provisions for essential resident needs, Including food, water, and medications FOCUSYESNOCOMMENTS MEDICATION SERVICESMedication storageMedication delivery, including Documentation Assistance/administration Medication alterations Appropriate for resident needsRespect of resident rights, including Right to refuse Individual choice and preferenceMedication storage, including: Secure Properly labeled Each resident medications separate from other resident medication, toxic substances Stored according to label directions Storage area locked and accessible only to designated staffMedication observation, including: Staff to resident interaction Appropriate level of assistance Infection control Safety and security of medications and documentsInterviews, including: Staff knowledge and techniques FOCUSYESNOCOMMENTS ENVIRONMENTAL OBSERVATION (ATTACHMENT I)Common areas for general appearancePets, including cleanliness and demeanorCommunication system* FOR AL CONTRACT: Homelike smoke-free common areas Access to outdoor area Meeting space outside of apartment Laundry room accessible to residents* FOR EARC-SPECIALIZED DEMENTIA CARE: Multiple common areas Opportunities for privacy, socialization, Wandering Outdoor area, accessible by residents without staff assistance Personal items/furnishings Use of communication/intercom system Activities Access to room at all times without assistance Restricted egressINFORMATION POSTED CRU Ombudsman Boarding home license Last full inspection (cover letter and POC, too)MAINTENANCE AND HOUSEKEEPING: INTERIOR Cleanliness Odors Housekeeping supply area: Storage of wet mops Storage of cleaning supplies Adequate ventilation Clean and soiled nursing equipment storage Handwashing areas Adequate lighting Stairs, ramps, handrails in good repair  QUALITY OF LIFE Shades in resident rooms Staff knocking prior to entering resident roomSAFETY Resident access to: Cleaning supplies Hazardous and toxic chemicals Medications Water temperature (105-120 degrees) FOCUSYESNOCOMMENTS ENVIRONMENTAL OBSERVATION (continued)EXTERIOR ENVIRONMENT Safe, sanitary, in good repair Garbage/refuse area Pests Ramps, stairs, handrails for appropriate placement and repair* FOR EARC-SPECIALIZED DEMENTIA CARE: At least one outdoor area Accessible to residents without staff assistance Walls/fence at least 72 inches high Protected from direct sunshine/rain throughout Day Firm, stable, slip-resistant walking surfaces Suitable outdoor furniture No poisonous or toxic plants FOCUSYESNOCOMMENTS FOOD SERVICES (ATTACHMENT I)Dining observation, including Staff interaction with residents Assistance available and provided Quantities eaten by residents Time offered to complete mealConsideration of resident needs, including: Preferences Alternate choices A system so residents can voice comments Prescribed diets Prescribed nutrient supplements Variety of daily food choices Assistance with eatingFood preparation area: Cleanliness Personal hygiene practices by staff Condition of equipment Handwashing facilities Handling of food by staffFood storage areas, including: Cleanliness Storage to prevent contaminationMenus, including: Variety and nutritious content of food Times of meals and snacks Availability of menus to residentsInterviews with staff regarding food service: Sanitation practices: temperature control, dishwasher method, handwashing sinks and practices Prescribed diets/supplements for specific residents Communication between nursing and food service Review food handler cards FOCUSYESNOCOMMENTSRESIDENT RECORD REVIEW (ATTACHMENT J)Pre-admission assessmentFull assessmentLimited assessment if change in conditionQualified assessorNegotiated Service Agreement Updated as needed Plan to meet residents needs and preferences Roles and responsibilities of: Staff Resident Family/representative Resident preferences are identified ID medication assistance or administration Family involvement, alternate planProgress notesMedication record: Appropriate for resident abilities/needs Include: Name of resident Name of medication Dosage and dosage frequency Name of prescriber Documentation of refusal and further actionsPhysician orders: Therapeutic/modified diet TreatmentsIncident reports, if indicated FOCUSYESNOCOMMENTSFACILITY RECORD REVIEWPolicies and proceduresQA Committee notesIncident/accident reportsFinancial records (only if resident services or care not being met)STAFF RECORD REVIEW (ATTACHMENT K)Staff meet all 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