QUALITY OF CARE ROUNDS - Nursing Home Help

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Facility Inspection ReportAREAScoreAvailableA. Entrance/Lobby/Sitting Room 108B. Corridors and Walls 66C. Equipment 42D. Dietary 42E. Resident Rooms 82F. Departments/Offices 31TotalsFacility ScorePercentProjects:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Signature of Administrator: ________________________________ Date: ____________________Signature of Inspector: _____________________________________Date/Time Started: _______________________ Date/Time Completed: ____________________4.61
Figure A.7Survey tag assignmentTag descriptionDepartmentalresponsibilityTeammember nameCommentsF 150Facility meets skilled nursingfacility requirementsF 151-156Resident rights• Informed of changes• Informed of rights and responsibilities• Privacy• Personal funds• Exercise rightsF 152 Resident rights• Legal surrogate• Review resident deemed incompetent• Legal representative appointedF 157 Notification of changes• Inform the resident• Inform the physician• Inform family or legal representative• Accidents• Condition change• Change in roommate• TransferF 157-162 Protection of resident funds• Funds of $50.00 interest bearing account• Management of resident accounts• Conveyance upon death• Surety bondF 163 Choice of physicianF 164-170 Privacy• Full visual• Auditory• Resident records• Grievances• Resolution to grievances• Survey results• Work• Mail4.62
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Quality ofCare RoundsUnlike the Moc
Page 4 and 5:
RR SS PE IC EP F-Tag Observations S
Page 6 and 7:
Page 8 and 9:
Page 10 and 11:
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 64 and 65: Figure A.7Survey tag assignment (co
Page 72: Figure A.7Survey tag assignment (co
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QUALITY OF CARE ROUNDS - Nursing Home Help

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