illinoisnursinghomeguide_Checklist.pdf
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Illinois Nursing Home Checklist
Name of nursing home:
Address:
Phone number:
Date of visit:
| Nursing Home Basic Questions | Yes | No | Notes |
|---|---|---|---|
| Who is the Administrator of the nursing home? | Y | N | _________________________________________________________________________________ |
| Who is the Director of Nursing (DON)? | Y | N | _________________________________________________________________________________ |
| Who is the Medical Director? | Y | N | _________________________________________________________________________________ |
| Does the nursing home have the level of care I need? | Y | N | _________________________________________________________________________________ |
| Does the nursing home offer specialized services, like a special care unit for a resident with dementia, ventilator care, or rehabilitation services? | Y | N | _________________________________________________________________________________ |
| Is the nursing home located close enough for friends and family to visit? | Y | N | _________________________________________________________________________________ |
| Resident Appearance | Yes | No | Notes |
|---|---|---|---|
| Are the residents clean, well groomed, and appropriately dressed for the season or time of day? | Y | N | _________________________________________________________________________________ |
| Nursing Home Living Spaces | Yes | No | Notes |
|---|---|---|---|
| Does the nursing home appear clean and well kept? | Y | N | _________________________________________________________________________________ |
| Is the temperature in the nursing home comfortable for residents? | Y | N | _________________________________________________________________________________ |
| Are the noise levels in the dining room and other common areas comfortable? | Y | N | _________________________________________________________________________________ |
| Is smoking allowed? If so, is it restricted to certain areas of the nursing home? | Y | N | _________________________________________________________________________________ |
| Hallway, Stairs, Lounges, & Bathrooms | Yes | No | Notes |
|---|---|---|---|
| Are exits clearly marked? | Y | N | _________________________________________________________________________________ |
| Does the nursing home have smoke detectors and sprinklers? | Y | N | _________________________________________________________________________________ |
| Are all common areas, resident rooms, and doorways designed for wheelchair use? | Y | N | _________________________________________________________________________________ |
| Are handrails and grab bars appropriately placed in the hallways and bathrooms? | Y | N | _________________________________________________________________________________ |
| Staff | Yes | No | Notes |
|---|---|---|---|
| How many residents per CNA? | Y | N | _________________________________________________________________________________ |
| How many residents per Nurse? | Y | N | _________________________________________________________________________________ |
| How many residents per Physician? | Y | N | _________________________________________________________________________________ |
| Does the relationship between the staff and residents appear to be warm, polite, and respectful? | Y | N | _________________________________________________________________________________ |
| Does the staff wear name tags? | Y | N | _________________________________________________________________________________ |
| Does the staff knock on the door before entering a resident’s room? Do they refer to residents by name? | Y | N | _________________________________________________________________________________ |
| Does the nursing home offer a training and continuing education program for all staff? | Y | N | _________________________________________________________________________________ |
| Does the nursing home check to make sure they don’t hire staff members who have been found guilty of abuse, neglect or mistreatment of residents; or have a finding of abuse, neglect, or mistreatment of residents in the state nurse aid registry? | Y | N | _________________________________________________________________________________ |
| Is there a licensed nursing staff 24 hours a day, including a Registered Nurse (RN) present at least 8 hours per day, 7 days a week? | Y | N | _________________________________________________________________________________ |
| Will a team of nurses and Certified Nursing Assistants (CNAs) work with me to meet my needs? | Y | N | _________________________________________________________________________________ |
| Do CNAs help plan the care of residents? | Y | N | _________________________________________________________________________________ |
| Is there a person on staff that will be assigned to meet my social service needs? | Y | N | _________________________________________________________________________________ |
| Will the staff call my doctor for me if I have a medical need? | Y | N | _________________________________________________________________________________ |
| Has there been a turnover in administration staff, like the administrator or director of nurses, in the past year? | Y | N | _________________________________________________________________________________ |
| Residents’ Rooms | Yes | No | Notes |
|---|---|---|---|
| Can residents have personal belongings and furniture in their rooms? | Y | N | _________________________________________________________________________________ |
| Does each resident have storage space (closet and drawers) in his or her room? | Y | N | _________________________________________________________________________________ |
| Does each resident have a window in his or her bedroom? | Y | N | _________________________________________________________________________________ |
| Do residents have access to a personal phone and television? | Y | N | _________________________________________________________________________________ |
| Do residents have a choice of roommates? | Y | N | _________________________________________________________________________________ |
| Menus & Food | Yes | No | Notes |
|---|---|---|---|
| Do residents have a choice of food items at each meal? | Y | N | _________________________________________________________________________________ |
| Can the nursing home provide for special dietary needs (like low-salt or no-sugar-added diets)? | Y | N | _________________________________________________________________________________ |
| Does the staff help residents eat and drink at mealtimes if help is needed? | Y | N | _________________________________________________________________________________ |
| Legal Considerations | Yes | No | Notes |
|---|---|---|---|
| Does the nursing home require residents to sign an arbitration clause? | Y | N | _________________________________________________________________________________ |
| Is the facility Medicare certified? | Y | N | _________________________________________________________________________________ |
| Is the facility Medicaid certified? | Y | N | _________________________________________________________________________________ |
| Safety & Care | Yes | No | Notes |
|---|---|---|---|
| Can residents still see their personal doctors? Does the facility help arrange transportation for this purpose? | Y | N | _________________________________________________________________________________ |
| How often are charts reviewed by a doctor? | Y | N | _________________________________________________________________________________ |
| Does the nursing home have an arrangement with a nearby hospital for emergencies? | Y | N | _________________________________________________________________________________ |
| Are care plan meetings held with residents and family members at times that are convenient and flexible whenever possible? | Y | N | _________________________________________________________________________________ |
| Has the nursing home corrected all defciencies (failure to meet one or more state or federal requirements) on its last state inspection report? | Y | N | _________________________________________________________________________________ |
| Does the nursing home have specific policies and procedures related to the care of individuals with dementia? If so, does the policy include the use of non-medication based approaches to care as a first attempt to respond to behavioral symptoms, which are often a means of communication, for patients living with dementia? | Y | N | _________________________________________________________________________________ |
| What percentage of resident’s who have a diagnosis of dementia are currently being prescribed an antipsychotic medication? | Y | N | _________________________________________________________________________________ |
| What’s the nursing home’s current rate of antipsychotic medication use? | Y | N | _________________________________________________________________________________ |
| Does the nursing home participate in any efforts related to reducing the use of antipsychotic medication in nursing homes? (these include National Partnership to Improve Dementia Care, National Nursing Home Quality Care Collaborative, and Advancing Excellence in America’s Nursing Homes Campaign.) | Y | N | _________________________________________________________________________________ |
Go to a resident council or family council meeting
While you’re visiting the nursing home, ask a member of the resident council if you can attend a resident council or family council meeting. These councils are usually organized and managed by the residents or the residents’ families to address concerns and improve the quality of care and life for the resident. When you go to a meeting, ask about recent changes to the facility and upcoming improvements to the quality of life for the residents.
Visit again
It’s a good idea to visit the nursing home a second time. It’s best to visit a nursing home on a different day of the week and at a different time of day than your initial visit. Staffing can be different at different times of the day and on weekends.