| Atmosphere |
Yes |
No |
N/A |
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| As you arrive at the residence, do you like its location and outward appearance? |
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| As you enter the lobby and tour the residence, is the decor attractive and home-like? |
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| Does the administrator/staff call residents by name and interact warmly as you tour? |
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| Do residents socialize with each other and appear happy and comfortable? |
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| Are you able to talk with residents about how they like the residence and staff? |
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| Do the residents seem to be appropriate housemates for you or your loved one? |
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| Are staff appropriately dressed, personable and outgoing? |
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| Do the staff members treat each other in a professional manner? |
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| Are the staff members that you pass during your tour friendly to you? |
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| Are visits with the resident welcome at any time? |
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| Physical Features |
Yes |
No |
N/A |
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| Is the community well-designed for resident's needs? |
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| Is the floor plan easy to follow? |
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| Are doorways, hallways and rooms accommodating to wheelchairs and walkers? |
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| Are elevators available for those unable to use stairways? |
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| Are hand rails available to aid in walking? |
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| Are floors of a non-skid material and carpets firm to ease walking? |
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| Is the residence clean, free of odors and appropriately heated/cooled? |
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| Does the residence meet local and/or state licensing requirements? |
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| Does the residence have sprinklers and clearly marked exits? |
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| Does the residence have a means of security if a resident wanders? |
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| Medication & Health Care |
Yes |
No |
N/A |
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| Does the residence have specific policies regarding storage of medication, assistance with medications, training and supervision of staff and record keeping? |
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| Is self-administration of medication allowed? |
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| Is there a staff person to coordinate home care visits from a nurse, physical therapist, occupational therapist, etc. if needed? |
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| Is staff available to assist residents who experience memory, orientation, of judgment losses? |
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| Does a physician or nurse visit the resident regularly to provide medical checkups? |
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| Does the residence have a clearly stated procedure for responding to a medical emergency? |
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| To what extent are medical services available, and how are these services provided? |
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| Individual Unit Features |
Yes |
No |
N/A |
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| Do dining room menus vary from day to day and meal to meal? |
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| Are different sized and types of units available? |
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| Are units for single and double occupancy available? |
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| Is a 24-hour emergency response system accessible from the unit? |
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| Are bathrooms private with handicapped accommodations - wheelchairs and walkers? |
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| Do all units have a telephone and cable TV and how is billing handled? |
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| Is a kitchen area/unit provided with a refrigerator, sink and cooking element? |
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| May residents keep food in their units? |
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| May residents smoke in their units? In public spaces? |
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| Needs Assessments, Contracts, Costs & Finances |
Yes |
No |
N/A |
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| Is a contractual agreement available that discloses healthcare and supportive services, all fees, as well as admission and discharge provisions? |
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| Does the residence have a process for assessing a potential resident's need for services and are those needs addressed periodically? |
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| When may a contract be terminated and what are refund policies? |
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| Are there any government, private or corporate programs available to help cover the cost of services to the resident? |
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| Is a contractual agreement available to include accommodations, personal care, health care and supportive services? |
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| Are additional services available if the resident's needs change? |
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| Is there a procedure to pay for additional services when temporary services are needed? |
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| Are there different costs for various levels or categories of services? |
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| Do billing, payment and credit policies seem fair and reasonable? |
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| May a resident handle their own finances with staff assistance if able or should a family member or outside party be designated to do so? |
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| Is staff available to meet scheduled and unscheduled needs? |
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| When may a contract be terminated? What are the policies for refunds and transfers? |
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| Is there an appeals process for dissatisfied residents? |
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| Services |
Yes |
No |
N/A |
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| Can the residence provide a list of services available? |
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| Is staff available to provide 24-hour assistance with activities of daily living (ADLs) if needed? ADLs include: Dressing; Eating; Mobility; Hygiene and grooming; Bathing, toileting and incontinence; Using the telephone; Shopping; and Laundry |
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| Does the residence provide housekeeping services in residents' units? |
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| Do they provide transportation to doctors' offices and other activities desired by residents? |
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| Can residents arrange for transportation on fairly short notice? |
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| Are pharmacy, barber/beautician and/or physical therapy services offered on-site? |
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| Social & Recreational Activities |
Yes |
No |
N/A |
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| Is there evidence of an organized activities program, such as a posted daily schedule, events in progress, reading materials, visitors, etc.? |
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| Do residents participate in activities outside of the residence in the neighboring community? |
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| Do volunteers, including family members, come into the residence to help with programs? |
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| Does the residence create a sense of community by requiring residents to participate in certain activities or perform simple chores for the group as a whole? |
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| Are residents' pets allowed in the residence? Who is responsible for their care? |
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| Food Service |
Yes |
No |
N/A |
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| Does the residence provide three nutritionally balanced meals a day, seven days a week? |
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| Are snacks available? |
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| May a resident request special foods? |
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| Are common dining areas available? |
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| May residents eat meals in their units? |
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| May meals be provided at a time a resident would like or are there set times for meals? |
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