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Facility Self-Assessment (Mock Survey) Tool - Nursing Home Help

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PHYSICAL PLANT ROUNDS - INITIAL TOUR (continued)<br />

TAG # STANDARD MET NOT MET COMMENTS<br />

F-441 MSDS current<br />

F-431, F-323 OTC drugs stored in rooms?<br />

F-455 Emergency power<br />

F-518 Emergency procedure training<br />

DIGNITY/RESIDENT RIGHTS<br />

F-174 Hearing impaired phone access for resd in private area<br />

F-252 <strong>Home</strong>like environment<br />

F-258 Sound level<br />

F-241 Resident Rights respected<br />

F-241 Knocking before entering<br />

F-241 Privacy/no exposure<br />

F-241 Addressed appropriately<br />

F-241 No standing while feeding<br />

F-368 Meal times posted<br />

F-363, F-366 Menu and alternates posted<br />

F-248 Activity Calendar posted<br />

F-246,311,318 Positioning appropriate<br />

F-246,311,318 Bed/Chair<br />

F-246,311,318 Dining<br />

F-172 Private meeting place (visitors)<br />

ADMINISTRATIVE<br />

F-464 Space adequate<br />

F-464 Furnishings<br />

F-156 Information Posted<br />

F-167 Prior <strong>Survey</strong><br />

F-172 Ombudsman Information<br />

F-172 MC/MA info<br />

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