Provider Agreement & Policies:
• Do the admission criteria match my needs?
• Terms of financial/provider agreement
• Unused portion of the rent refunded at
• Do I have a choice in the selection of health
care providers if additional services are
• Are specific services clearly identified in the
• Have I reviewed the house rules?
• Have I reviewed all of the reasons for which
I may be transferred of discharged?
• Is the facility licensed by the state and in
• Is the bedroom private or shared?
• Is the bathroom private or shared?
• Are the shared areas clean?
• Is there space for personal belongings?
• Does the floor plan allow for easy mobility
• Private areas other than the room for visits?
• Is bathroom safety equipment installed?
• Is there a call system?
• Are walkers/wheelchairs permitted?
• Hall and doors at width for wheelchairs?
• Am I involved in the care planning process?
• Is my family/responsible party involved?
• Is my physician-health provider involved?
• Are care plans updated reflecting changes in
Does the facility provide:
• Assistance with dressing?
• Assistance with bathing?
• How frequently is weekly bathing provided?
• Is there assistance with toileting?
• Is there assistance with incontinency?
• Help with transfers from wheelchair to bed
• Assistance with medications?
• What is the administrator’s training?
• Do staff receive special needs training?
• Is there high staff turn-over?
• What is the ratio of staff to resident?
• Are staff awake at night?
• Are specialized diets available?
• Cultural or ethnic preferences considered?
• Are residents involved in menu planning?
• Can residents help with meal preparation
• Do residents have access to the kitchen?
• Snacks/beverages available between meals?
• Are extra helpings – substitutions available?
• Are activities available within the facility?
• Does the facility take residents on outings?
• SOmeone designated to conduct activities?
• Do interests match level/type of activities?
• Are there residents I can socialize with?
• Is there a written schedule of activities?
• Does the facility provide transportation?
• Facility communicate with family/physician?
• Do you feel comfortable talking with the:
• Is the grievance procedure understood?
• Is telephone use accessible
• Is it conducive to privacy?
• Have I toured the entire facility?
• Have I observed the kitchen?
• Have I observed a meal preparation?
• Does the atmosphere seem pleasant?
• Seem to be enough staff available?
• Are pets allowed?
• Do residents seem happy and engaged?
• Do residents appear to be clean-groomed?
• Observed for staff/resident interaction?
• Have I observed for cleanliness and odors?