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���������������� ������ ���������������� ������ ���������������� ���������� FACILITY FEATURES �� ���� ���� ���� ���� ���� �� Is the nursing home near a hospital? ���� ���� ���� ���� ���� �� Is the facility conveniently located for family, friends and physician? ���� ���� ���� ���� ���� �� Does cleanliness meet personal standards throughout the facility? ���� ���� ���� ���� ���� �� Is the facility well lit inside and out? ���� ���� ���� ���� ���� �� Is furniture sturdy, attractive and clean? ���� ���� ���� ���� ���� �� Are there plenty of sitting areas for people to gather? ���� ���� ���� ���� ���� �� Is there an outdoor porch with a sitting area? ���� ���� ���� ���� ���� �� Is the porch secured? ���� ���� ���� ���� ���� �� Is the facility free of unpleasant odors? ���� ���� ���� ���� ���� �� Is the scent of “pleasant” odor too strong? (If so, the facility could be masking foul odors) ���� ���� ���� ���� ���� �� Are there handrails and grab bars throughout the facility including patient’s room and bathroom? ���� ���� ���� ���� ���� �� Are exits clearly marked and unobstructed? ���� ���� ���� ���� ���� �� Is there a nurse call button by each bed? ���� ���� ���� ���� ���� �� Is fresh drinking water beside each bed? ���� ���� ���� ���� ���� �� Is there at least one comfortable chair per patient in patient’s room? ���� ���� ���� ���� ���� �� Is there easy access to each bed for a wheelchair? �� ���� ���� ���� ���� ���� �� Is there an emergency call button in the bathroom? STAFF How long have key personnel been at the facility? ____ ____ ____ Administrator/Executive Director? ____ ____ ____ Director of Nursing? ____ ____ ____ Dietary Director? ____ ____ ____ Activities Director? ������������ ������������ ���������� How many RNs or LPNs are on duty? What is the ratio of nurses to patients? ____ ____ ____ Day? ____ ____ ____ Evening? ____ ____ ____ Night? ������������ ������������ ���������� How many nurse aides are on duty? What is the ratio of nurse aides to patients? ____ ____ ____ Day? ____ ____ ____ Evening? ____ ____ ____ Night? ���� ���� ���� ���� ���� �� Are common dining areas available? May they sit anywhere? ���� ���� ���� ���� ���� �� Are you greeted by staff as you tour the facility? ���� ���� ���� ���� ���� �� Does staff demeanor seem to be chaotic or stressed? ���� ���� ���� ���� ���� �� Does staff seem to be generally happy? ���� ���� ���� ���� ���� �� Does staff show interest in and affection for individual patients? ���� ���� ���� ���� ���� �� Does staff respond quickly to patient calls for assistance? ���� ���� ���� ���� ���� �� Does staff smile while they are interacting with the patients? �� ���� ���� ���� ���� ���� �� Does staff respect patient’s dignity and privacy? ���� ���� ���� ���� ���� �� Does staff knock before entering patient’s room? ���� ���� ���� ���� ���� �� Does staff draw bed separation curtain when care is being given? ���� ���� ���� ���� ���� �� When care is being given is the patient’s dignity being respected? www.PolkElderCare.com 35


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