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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Instructions:<br />
1. Complete review on charts indicated in columns across<br />
2. Indicate with a √ if complete<br />
3. Utilize “I” for incomplete<br />
4. Utilize “N/A” for not applicable<br />
5. D/H = department head<br />
Criteria Requirement R.N. R.N. L.P.N. L.P.N. C.N.A. C.N.A. D/H D/H HRLY HRLY Comments<br />
Hiring<br />
Information<br />
Pre-Employment References<br />
Credentials/License Verified<br />
Orientation Checklist for General<br />
Orientation<br />
Checklist for Dept. Orientation<br />
Signature Resident Rights<br />
Standards of Conduct<br />
Employee Handbook<br />
> <strong>Facility</strong> Policies<br />
Fire & Disaster Plan<br />
State Specific:<br />
Abuse & Neglect<br />
Separate<br />
Personnel<br />
Medical File:<br />
TB Testing<br />
Records<br />
(keep in a HepB<br />
separate<br />
Consents/documentation<br />
location from<br />
personnel file<br />
and with very<br />
Criminal Background checks<br />
I-9 Information<br />
limited<br />
access) EDL checked<br />
Other<br />
Family Care Registry<br />
C.N.A. Registry<br />
OIG<br />
Drug testing<br />
PERSONNEL FILE CHECK LIST<br />
5.49
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