QUALITY OF CARE ROUNDS - Nursing Home Help

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INFECTION CONTROL AND SAFETY SURVEILLANCE:Responsible Person:CENTRAL SUPPLYDate:Yes No All work areas are cleaned and disinfected as needed.Yes No Sink is cleaned and disinfected.Yes No Floor is clean and free of debris.Yes No Garbage receptacles have covers, are lined with plastic bag and emptied daily.YesNoAll reusable equipment is cleaned, disinfected and properly stored after eachresident’s use.Yes No All supplies are stored in an organized and neat manner.Yes No Storage area is clean and free of peeling paint, chips, and cracked equipment.YesYesNoNoPersonal Protective Equipment (gloves, gowns, masks) is readily available and easyto locate.Safety sharps devices (retractable syringes and lancets, and needleless IV supplies)are only used and are readily available and easy to locate.Yes No No supplies are stored directly on the floor.Yes No MSDS & Safety Manuals are available in each department.Yes No Floors do not have any slip, trip or fall hazards.Corrective action and/or follow-up required:4.47
INFECTION CONTROL AND SAFETY SURVEILLANCE:Responsible Person:HAZARDOUS WASTEDate:YesNoSharps containers are readily available, capped when ¾ full and are NOT accessible toresidents.Yes No Soiled utility rooms have biohazard signage.YesNoRegulated waste containers are closable, leak proof, clearly marked and located in thesoiled utility room.Yes No Nurses dispose of contaminated dressings by double bagging.Yes No Trash / garbage (non-contaminated) is not placed in the biohazard container.YesNoOnly safety sharps devices, such as retractable syringes and lancets, and needleless IVsupplies are used.Yes No Biohazard waste is picked up and disposed of by an outside source in a timely manner.Yes No Disposal log is up to date and accurate.Yes No MSDS & Safety Manuals are available in each department.Yes No Floors do not have any slip, trip or fall hazards.Corrective action and/or follow-up required:4.48
Page 1 and 2: Quality ofCare RoundsUnlike the Moc
Page 4 and 5: RR SS PE IC EP F-Tag Observations S
Page 12 and 13: Exit lightsRESIDENT ROOMS “U”
Page 14 and 15: OTHER AREAS “U” “S” COMMENT
Page 16 and 17: Thawing foods put in refrigerator c
Page 18 and 19: SS follows upon discharge needs of
Page 20 and 21: - re-feeding/walk and dine- bowel/b
Page 22 and 23: Pumps/poles and equipment cleanWEIG
Page 24 and 25: No expired medications on handSharp
Page 26 and 27: Medical Director review of all repo
Page 28 and 29: MDS/CARE PLAN TRACKING FORMName: Ro
Page 30 and 31: HOT HOLDINGHot holding unit / steam
Page 32 and 33: Step ladders are sturdy and in good
Page 34 and 35: Yes No Buckets, tubs and pans are i
Page 36 and 37: Yes No Cleaning schedules posted an
Page 38 and 39: INFECTION CONTROL AND SAFETY SURVEI
Page 40 and 41: Yes No Electric cords for lights, r
Page 52 and 53: Yes No All wandering bracelets are
Page 54 and 55: Extended menusavailableDumpster lid
Page 56 and 57: Housekeeping Carts, Equipment, and
Page 58 and 59: Facility InspectionFacility _______
Page 60 and 61: Facility Inspection ReportPossibleA
Page 62 and 63: Facility Inspection ReportAREAScore
Page 64 and 65: Figure A.7Survey tag assignment (co
Page 72: Figure A.7Survey tag assignment (co

QUALITY OF CARE ROUNDS - Nursing Home Help

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