QUALITY OF CARE ROUNDS - Nursing Home Help

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RR SS PE IC EP F-Tag Observations Standards/CommentsF447F447F333Soiled linen is handled correctly; carried away from body;transported in a covered container, not found on floor,separated from clean linen by at least 3 feet, and baggedbefore placed in chuteClean linen Is carried away from body; clean linen carts arecoveredIce distribution – ice passing technique is conducted in asanitary manner, ice scoop is covered when not in useGait belts present and used by staff upon transferringresidents70.71.72.73.ROOM/MEAL SERVICEF354F354Residents are readied for meal (i.e., toileted, positioned,protectors, if appropriate are in place)<strong>Nursing</strong> staff present while residents are eating, provideassistance to residents74.75.F377 Door to food cart remains closed when unattended 76.F377Uncovered food trays are not carried more than twodoorways from the food cart77.F377 Clean trays on food cart are not cross-contaminated 78.RESIDENT ROOMF176F176F472F477Resident is afforded privacy, i.e., curtain closed during care,staff knocks on door prior to entering room, only authorizedstaff present during care and treatmentsPrivacy curtain present (except in private room), clean and ingood repairCall light is operative, visible and accessible to resident, staffand othersRoom is adequately furnished; allows resident to engage inactivities (chair, dresser, closet present79.80.81.82.4.7
RR SS PE IC EP F-Tag Observations Standards/CommentsF478Sufficient space to accommodate resident’s needs; can moveabout room, access space safety, does not appear crowded83.F260F329F260F329F260F329Walls and ceilings are clean, free of satins and in good repair 84.Floors are clean, buffed or vacuumed 85.Furniture is dust free and in good repair 86.F483No evidence of pest infestation observed; unit, rooms arepest- free87.F260 Bathroom is clean and free of persistent odors 88.F260F329Bathroom fixtures are clean and in good repair 89.F329 Grab bars are present and secure 90.F441Shared bathrooms are free of personal care items and barsoaps91.F446 Liquid soap, paper towels available for hand washing 92.F454A No flammable products observed 93.F260F253F468F262Rooms are individualized, homelike with presence ofpersonal articles to encourage link with pastPhysical environment adapted to residents’ needs, i.e.,reorienting devices such as clocks, calendars, commode seatelevatedMattress is correct size for the resident; clean, comfortable,in good conditionBed linen is in good condition (i.e., in good repair), cleanand stain free94.95.96.97.4.8
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 66 and 67:
Page 68 and 69:
Page 70 and 71:
Page 72:
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