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1 The Nursing Home Checklist Use the Nursing Home Checklist when you visit a nursing home. Take a copy of the Nursing Home Checklist when you visit to ask questions about resident life, nursing home living spaces, staff, residents’ rooms, hallways, stairs, lounges, bathrooms, menus, and food, activities, safety, and care. Use a new checklist for each nursing home you visit. You can photocopy the checklist or print additional copies available at: www.medicare.gov/NHcompare Name of Nursing Home: Phone Date of Basic Information Yes No COMMENTS Is the nursing home Medicare- certified? Is the nursing home Medicaid- certified? How many Medicaid beds does the nursing home have? Does the nursing home have the level of care I need Does the nursing home have a bed available? Does the nursing home offer specialized services, such as a special unit for care for a resident with dementia, ventilator care, or rehabilitation services? Is the nursing home located close enough for friends and family to visit? RESIDENT APPERANCE Yes No COMMENTS Are the residents clean, well groomed, and appropriately dressed for the season or time of day? ---PAGE BREAK--- 2 Staff Yes No COMMENTS Does the relationship between the staff and residents appear to be warm, polite, and respectful? Does the staff wear name tags? Does the staff knock on the door before entering a resident’s room? Do they refer to resident’s by name Does the nursing home offer a training and continuing education program for all staff? Does the nursing home do background check? Nursing Home Living Spaces Yes No COMMENTS Is the nursing home free from overwhelming unpleasant odors? Does the nursing home appear clean and well kept? Is the temperature in the nursing home comfortable for residents? Does the nursing have good lighting? Are the noise levels in the dining room and other common areas comfortable? Is smoking allowed? If so, is it restricted to certain areas of the nursing home? Are the furnishings sturdy, yet comfortable and attractive? ---PAGE BREAK--- 3 Residents’ Rooms Yes No COMMENTS Can residents have personal belongings and furniture in their rooms? Does each resident have storage space (closet and drawers) in his/her room? Does each resident have a window in his/her room? Do residents have access to a personal phone and television? Do residents have a choice of roommates? Are there policies and procedures to protect residents possession, including lockable cab Is there a licensed nursing staff 24 hours a day, including a Registered Nurse present at least 8 h ours per day seven days a week? Will a team of nurses and Certified Nursing Assistants work with me to meet my needs? Do C.N.A.’s help plan the care of residents? Is there a persona on staff that will be assigned to meet my social service needs? If have a medical need, will the staff contact my doctor for me? Has there been a turnover in administration staff, such as the administrator of director of nurses in the past year? ---PAGE BREAK--- 4 Hallways, Stairs, Lounges and Bathrooms Yes No COMMENTS Are exits clearly marked? Are there quiet areas where residents can visit with friends and family? Does the nursing home have smoke detectors and sprinklers? Are all common areas, resident rooms, and doorways designed for wheelchair use? Are handrails and grab bars appropriately placed in the hallways and bathrooms? Menus and Food Yes No COMMENTS Do residents have a choice of food items at each meal? (Ask if your favorite foods are served) Can the nursing home provide for special dietary needs (like low salt or no sugar added diets Are nutritious snacks available upon request? Does the staff assist residents eat and drink at mealtimes if help is needed? Activities Yes No COMMENTS Can residents, including those who are unable to leave their rooms choose to take part in a variety of activities? Do residents have a role in planning or choosing activities that are available? Does the nursing home have outdoor areas for resident use? Is the staff available to help residents go outside? Does the home have an active volunteer program?