Facility Self-Assessment (Mock Survey) Tool - Nursing Home Help
Facility Self-Assessment (Mock Survey) Tool - Nursing Home Help
Facility Self-Assessment (Mock Survey) Tool - Nursing Home Help
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Abuse<br />
Neglect<br />
Call lights<br />
Care needs<br />
met<br />
Medical<br />
Condition<br />
Finance<br />
Charges<br />
Trust Fund<br />
Ombudsman<br />
<strong>Survey</strong><br />
Rights<br />
F-223<br />
F-165<br />
Has anyone physically harmed you?<br />
Has any staff member yelled or swore at you?<br />
Did you tell anyone?<br />
What happened?<br />
If you are unhappy with something, how do you let<br />
the facility know?<br />
Does the staff listen and respond to your requests?<br />
If they can’t honor your request, do they give you a<br />
reasonable explanation?<br />
F-241 Does the staff answer your call bell/light when you<br />
put it on?<br />
F-311<br />
F-310<br />
F-328<br />
F-385<br />
F-387<br />
F-411<br />
F-156<br />
F-162<br />
Do you get help when you need it?<br />
Does the staff encourage you to do as much as you<br />
can for yourself?<br />
How about your nursing care and treatment?<br />
Do you participate in meetings where your care<br />
plan is discussed?<br />
If not, does someone discuss your plan of care with<br />
you?<br />
Are you satisfied with the care provided by your<br />
physician?<br />
Can you see a doctor if you need to?<br />
Do you see the doctor here or at the office?<br />
How do you get to the doctor’s office? Does the<br />
facility help you make appointments and arrange<br />
transportation? Can you see the podiatrist, dentist,<br />
optometrist or other specialist if you need to?<br />
Do you know how to get in touch with the<br />
Medicaid & Medicare office about your bill? Does<br />
the facility explain charges to you?<br />
F-159 Can you get money from your trust fund when you<br />
need it?<br />
F-168 Do you know how to call the Ombudsman?<br />
F-169 Have you seen the facility’s survey results?<br />
F-151 Did you have an opportunity to vote in the last<br />
election?<br />
GENERAL COMMENTS:<br />
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