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Nursing Home Safety Checklist
Section 1: Nursing Home Information
1. 1. What is the name of the nursing home?
2. 2. What is the address of the nursing home?
3. 3. What is the contact person's name?
4. 4. What is the contact phone number or email address?
Section 2: General Information
1. 1. Is the facility Medicare-certified?
Yes
No
N/A
2. 2. Is a valid license posted?
Yes
No
N/A
3. 3. Is the latest state survey or inspection report available for review?
Yes
No
N/A
4. 4. Has the facility corrected all deficiencies (federal or state) identified in its latest inspection report?
Yes
No
N/A
5. 5. Has the license ever been revoked?
Yes
No
N/A
6. 6. Is there a waiting period for admission?
Yes
No
N/A
7. 7. Is the level of care needed offered and a bed available?
Yes
No
N/A
8. 8. Are special services (dementia, ventilator, rehab) needed to be offered in a separate unit and a bed available?
Yes
No
N/A
9. 9. Is the facility located close enough to friends and family?
Yes
No
N/A
Section 3: Financial And Legal Information
1. 1. What is the base monthly fee?
2. 2. What services are included in that fee?
Yes
No
N/A
3. 3. If care is covered by Medicare, what are the out-of-pocket costs?
Yes
No
N/A
4. 4. Is a deposit required?
Yes
No
N/A
5. 5. Are payment plans available?
Yes
No
N/A
6. 6. What are the additional services available and what are their costs?
7. 7. What is the procedure for when fees are changed?
8. 8. If a resident is hospitalized or placed in other care, how long will his or her bed be held, and at what cost?
9. 9. If a resident leaves the facility, are the advanced payments returned?
Yes
No
N/A
10. 10. What are the reasons for discharge? How much notice is given and to whom?
11. 11. Is there an acceptable internal appeal and/or grievance process?
Yes
No
N/A
12. 12. What are the eviction procedures?
13. 13. Does the facility offer a separate insurance policy that covers residents’ personal property?
Yes
No
N/A
14. 14. Who is responsible for repairs or replacement after spills or accidents that destroy the facility or resident’s property?
Section 4: Personal And Health Care
1. 1. Are residents encouraged to be as independent as possible?
Yes
No
N/A
2. 2. Are residents allowed to make choices about their daily routines?
Yes
No
N/A
3. 3. Are assessments performed on residents to assess needs regularly?
Yes
No
N/A
4. 4. Can the facility accommodate resident’s changing needs?
Yes
No
N/A
5. 5. Does the facility have the ability to determine the cause of confusion a resident may develop (medications vs. dementia or Alzheimers’)?
Yes
No
N/A
6. 6. Does the facility have the ability to deal with a resident’s behavior that may change and become abusive?
Yes
No
N/A
7. 7. Are there any limitations on how the staff will handle medications?
Yes
No
N/A
8. 8. Are there safeguards in place to ensure that medications are taken correctly?
Yes
No
N/A
9. 9. Is a pharmacist available?
Yes
No
N/A
10. 10. Does window glare make it difficult to see?
Yes
No
N/A
11. 11. Who dispenses medications?
12. 12. Do residents receive preventive care such as yearly flu shots?
Yes
No
N/A
13. 13. Does the facility monitor residents’ health including weight?
Yes
No
N/A
14. 14. Does staff routinely check each resident thoroughly to avoid bed sores?
Yes
No
N/A
15. 15. May residents still see their doctors?
Yes
No
N/A
16. 16. How will the physician and facility communicate about the resident’s care?
17. 17. Are there healthcare facilities available at the facility (physical therapy, wound care, hospice care, social services, etc.)?
Yes
No
N/A
18. 18. Are there various medical services available (dentist, podiatrist, optometrist)?
Yes
No
N/A
19. 19. Will the staff set up appointments for residents?
Yes
No
N/A
20. 20. Does staff respond quickly when residents push the call buttons?
Yes
No
N/A
21. 21. Does the facility have an arrangement with a nearby hospital for emergencies?
Yes
No
N/A
22. 22. Does the facility call family or a personal doctor when emergencies arise?
Yes
No
N/A
23. 23. Does the facility use physical or chemical restraints?
Yes
No
N/A
24. 24. Is there a beauty salon or barber available?
Yes
No
N/A
25. 25. Are laundry services available?
Yes
No
N/A
Section 5: Plan Of Care
1. 1. Does the facility prepare a written plan for how it will care for residents?
Yes
No
N/A
2. 2. Are certified nursing assistants involved in care planning meetings?
Yes
No
N/A
3. 3. Are care plan meetings held with residents and family at convenient if possible?
Yes
No
N/A
4. 4. How will the family be involved in the plan?
5. 5. Does the plan cover all aspects of a resident’s life (physical, mental, social and medical)?
Yes
No
N/A
6. 6. Is the plan and any medical records stored, and is confidentiality guaranteed?
Yes
No
N/A
7. 7. Does a pharmacist review individual drug treatment plans?
Yes
No
N/A
Section 6: Residents
1. 1. Are residents clean, appropriately dressed for the season or time of day, and well-groomed?
Yes
No
N/A
2. 2. Are residents interacting with each other and appear content and engaged?
Yes
No
N/A
3. 3. What is the average age of the residents?
4. 4. What do residents like best?
5. 5. What do residents like least?
6. 6. What is daily life like at the facility?
7. 7. Are most residents at the same level of mental function?
8. 8. Is there a resident and/or family council? How often does it meet? Has the council taken any action recently?
9. 9. Are residents’ rights posted and does the facility follow a resident’s bill of rights?
Yes
No
N/A
10. 10. Do residents have the right to come and go as they please?
Yes
No
N/A
11. 11. Is mail delivered promptly and unopened? Can residents have subscriptions to magazines and newspapers?
Yes
No
N/A
Section 7: Environment
1. 1. Are there any overwhelming unpleasant odors?
Yes
No
N/A
2. 2. Is the facility clean and well-kept?
Yes
No
N/A
3. 3. Is the temperature comfortable for residents?
Yes
No
N/A
4. 4. Is the facility well-lit?
Yes
No
N/A
5. 5. Are there quiet and/or private areas for visiting?
Yes
No
N/A
6. 6. Are noise levels in common areas comfortable?
Yes
No
N/A
7. 7. Is smoking forbidden or restricted to certain sections of the facility?
Yes
No
N/A
8. 8. Are furnishings comfortable, sturdy, and attractive?
Yes
No
N/A
9. 9. Are the buildings and grounds well cared for and attractive?
Yes
No
N/A
Section 8: Staff
1. 1. Is the staff visible?
Yes
No
N/A
2. 2. Does the staff wear name tags?
Yes
No
N/A
3. 3. Does the relationship between staff and residents appear to be polite, warm, and respectful?
Yes
No
N/A
4. 4. Are the staff friendly, considerate, and helpful?
Yes
No
N/A
5. 5. If residents or staff are not native English speakers, can they communicate effectively with each other?
Yes
No
N/A
6. 6. Is the staff’s morale upbeat?
Yes
No
N/A
7. 7. Does the staff refer to residents by name and knock before entering a resident’s room?
Yes
No
N/A
8. 8. Are training and continuing education programs available to all staff?
Yes
No
N/A
9. 9. Does the staff receive abuse prevention training?
Yes
No
N/A
10. 10. Are background checks completed for all staff?
Yes
No
N/A
11. 11. Does the tour guide know residents’ names and is recognized by residents?
Yes
No
N/A
12. 12. Is there at least one full-time registered nurse (RN) on duty around the clock besides the administrator or director of nursing?
Yes
No
N/A
13. 13. Who is the director of nursing?
14. 14. Does he or she hold a current state license?
Yes
No
N/A
15. 15. Is the administrator or director of nursing available to answer questions, hear complaints, or discuss problems and concerns?
Yes
No
N/A
16. 16. Does the same team of nurses work with the same residents most days of the week?
Yes
No
N/A
17. 17. How long are nurse’s shifts?
18. 18. Is the ratio of Certified Nursing Assistants to residents reasonable at all times?
Yes
No
N/A
19. 19. Is the ratio of aides to residents reasonable at all times?
Yes
No
N/A
20. 20. Are staff expected and trained to handle emergencies?
Yes
No
N/A
21. 21. Is there at least one full-time social worker on staff?
Yes
No
N/A
22. 22. Is a licensed doctor on staff and on-site daily?
Yes
No
N/A
23. 23. Has the management team worked together for at least one year?
Yes
No
N/A
Section 9: Residents’ Room
1. 1. Is the living space adequate?
Yes
No
N/A
2. 2. Is it well-lit?
Yes
No
N/A
3. 3. How often is the room cleaned?
4. 4. Can residents have personal belongings and/or furniture in their rooms?
Yes
No
N/A
5. 5. Does each resident have storage space in his or her room?
Yes
No
N/A
6. 6. Is there a window in every resident’s room?
Yes
No
N/A
7. 7. Do residents have access to a personal telephone, internet, and television?
Yes
No
N/A
8. 8. Is there a cable TV connection in each room?
Yes
No
N/A
9. 9. Are doors shut when a resident is being dressed or bathed?
Yes
No
N/A
10. 10. Are water pitchers within a resident’s reach?
Yes
No
N/A
11. 11. Do policies and procedures exist to protect residents’ possessions?
Yes
No
N/A
12. 12. Are call buttons near each bed or do residents wear a device instead?
13. 13. Is there a private bathroom?
Yes
No
N/A
14. 14. How often is it cleaned?
Yes
No
N/A
15. 15. Is there a call button in the bathroom?
Yes
No
N/A
16. 16. How many residents per room?
17. 17. Is there a privacy curtain around each bed or between beds?
Yes
No
N/A
18. 18. What is the policy if roommates don’t get along? How does the facility deal with conflict?
Section 10: Menus And Food
1. 1. Do residents have a choice of food items at each meal?
Yes
No
N/A
2. 2. Is there enough time to eat at meals?
Yes
No
N/A
3. 3. Are favorite foods offered?
Yes
No
N/A
4. 4. Does the food look and smell good?
Yes
No
N/A
5. 5. Are special dietary needs accommodated?
Yes
No
N/A
6. 6. Are nutritious snacks available upon request?
Yes
No
N/A
7. 7. Can staff help residents eat at mealtimes if needed?
Yes
No
N/A
8. 8. Is the meal schedule flexible? At what times are meals served?
9. 9. Does a nutritionist or dietician review meals and special diets?
Yes
No
N/A
10. 10. Can a meal tray be delivered to a resident’s room?
Yes
No
N/A
11. 11. Is the food prep separated from the dishwashing and garbage areas?
Yes
No
N/A
12. 12. Is food requiring refrigeration properly stored?
Yes
No
N/A
13. 13. Do kitchen workers observe sanitation rules?
Yes
No
N/A
Section 11: Activities
1. 1. Are residents (even those who are unable to leave their rooms) able to choose to take part in activities? Are they encouraged (but not pushed) to participate?
Yes
No
N/A
2. 2. Are activity schedules varied and include the resident's interests and do they provide input?
Yes
No
N/A
3. 3. Is there someone with adequate training who develops and supervises recreational activities?
Yes
No
N/A
4. 4. Is reading assistance available?
Yes
No
N/A
5. 5. Does the facility have pleasant outdoor areas for resident use?
Yes
No
N/A
6. 6. Does the staff help residents go outside?
Yes
No
N/A
7. 7. Are there protected/enclosed areas for residents with dementia?
Yes
No
N/A
8. 8. Are residents involved in the community outside of the facility? If so, how?
Yes
No
N/A
9. 9. Is there a game room or other recreational facility on site?
Yes
No
N/A
10. 10. Are there adequate facilities for residents to exercise?
Yes
No
N/A
11. 11. Does the facility have a volunteer program, and if so, are volunteers thoroughly screened?
Yes
No
N/A
12. 12. What is the visiting policy?
13. 13. Does the facility have pets?
Yes
No
N/A
14. 14. Can family pets come with visitors?
Yes
No
N/A
15. 15. How does the facility accommodate religious or spiritual needs?
Section 12: Safety And Security
1. 1. Is there a security checkpoint at the entrance?
Yes
No
N/A
2. 2. Does the facility meet local, state, and federal fire codes?
Yes
No
N/A
3. 3. Are emergency exits marked, accessible, and opened from the inside?
Yes
No
N/A
4. 4. Are there fire safety systems in place?
Yes
No
N/A
5. 5. Is there an emergency evacuation plan and is it posted?
Yes
No
N/A
6. 6. Does the facility hold regular fire drills that include bed-bound residents?
Yes
No
N/A
7. 7. Are exit doors alarmed?
Yes
No
N/A
8. 8. Are there safety locks on windows?
Yes
No
N/A
9. 9. Are there handrails in the hallways and grab bars in the bathrooms?
Yes
No
N/A
10. 10. Are stairway doors kept closed to prevent the potential spread of fire?
Yes
No
N/A
11. 11. Are facility doors locked? How do residents or family members get in when the doors are locked?
12. 12. Is the facility wheelchair accessible?
Yes
No
N/A
13. 13. Is the floor covering made of non-skid material?
Yes
No
N/A
14. 14. Is the building generally free of clutter?
Yes
No
N/A
15. 15. Are safety measures in place to protect residents from wandering?
Yes
No
N/A
16. 16. Is there an emergency generator or alternate power source?
Yes
No
N/A
17. 17. Are there written policies about when 911 is called and who decides to call?
Yes
No
N/A
Section 13: Transportation
1. 1. How does the facility handle transportation for appointments?
2. 2. What are the costs involved in using their transportation?
3. 3. Is transportation wheelchair accessible?
Yes
No
N/A
4. 4. Is transportation available for non-medical appointments?
Yes
No
N/A
5. 5. Is parking available?
Yes
No
N/A
6. 6. Is there public transportation nearby?
Yes
No
N/A