WHCA

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 licensor’s 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 resident’s 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?

FOCUS / YES / NO / COMMENTS
TOUR
Quality of Life
Residents appropriately groomed and
dressed?
Staff-to-resident interactions appropriate,
Including eye contact, touch, verbal
communication
Appropriate delivery of care and services
General appearance of residents
General appearance of resident care
needs and level of assistance
Impact of environment & safety issues
Infection control practices
Maintenance of facility equipment
Homelike setting
Safety practices
Observe 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 grounds
Posters/notices:
Complaint Resolution Unit
Ombudsman’s office
Current BH license
Most recent inspection (including cover letter
and POC)
FOCUS / YES / NO / COMMENTS
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
Abilities
Resident 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, ADMINISTRATOR
Discuss 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
FOCUS / YES / NO / COMMENTS
MEDICATION SERVICES
Medication storage
Medication delivery, including
Documentation
Assistance/administration
Medication alterations
Appropriate for resident needs
Respect of resident rights, including
Right to refuse
Individual choice and preference
Medication 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 staff
Medication observation, including:
Staff to resident interaction
Appropriate level of assistance
Infection control
Safety and security of medications and
documents
Interviews, including:
Staff knowledge and techniques
FOCUS / YES / NO / COMMENTS
ENVIRONMENTAL OBSERVATION (ATTACHMENT I)
Common areas for general appearance
Pets, including cleanliness and demeanor
Communication 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 egress
INFORMATION 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 room
SAFETY
Resident access to:
Cleaning supplies
Hazardous and toxic chemicals
Medications
Water temperature (105-120 degrees)
FOCUS / YES / NO / COMMENTS
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
FOCUS / YES / NO / COMMENTS
FOOD SERVICES (ATTACHMENT I)
Dining observation, including
Staff interaction with residents
Assistance available and provided
Quantities eaten by residents
Time offered to complete meal
Consideration 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 eating
Food preparation area:
Cleanliness
Personal hygiene practices by staff
Condition of equipment
Handwashing facilities
Handling of food by staff
Food storage areas, including:
Cleanliness
Storage to prevent contamination
Menus, including:
Variety and nutritious content of food
Times of meals and snacks
Availability of menus to residents
Interviews 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
FOCUS / YES / NO / COMMENTS
RESIDENT RECORD REVIEW
(ATTACHMENT J)
Pre-admission assessment
Full assessment
Limited assessment if change in condition
Qualified assessor
Negotiated Service Agreement
Updated as needed
Plan to meet resident’s needs and preferences
Roles and responsibilities of:
Staff
Resident
Family/representative
Resident preferences are identified
ID medication assistance or administration
Family involvement, alternate plan
Progress notes
Medication 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 actions
Physician orders:
Therapeutic/modified diet
Treatments
Incident reports, if indicated
FOCUS / YES / NO / COMMENTS
FACILITY RECORD REVIEW
Policies and procedures
QA Committee notes
Incident/accident reports
Financial records (only if resident services or care not being met)
STAFF RECORD REVIEW
(ATTACHMENT K)
Staff meet all requirements
Administrator meets all requirements
10 hours of CE completed
*FOR EARC-SPECIALIZED DEMENTIA CARE:
6 of the 10 hours must be focused on
dementia care

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