FRIENDLINESS OF ACTIVITY STAFF
AVAILABILITY OF ACTIVITIES
APPROPRIATENESS OF ACTIVITIES PROVIDED
EXPLANATION OF RESIDENTS RIGHTS
COURTESY OF THE ADMISSIONS COORDINATOR
EXPLANATION OF SERVICES PROVIDED
VARIETY OF FOOD SELECTION
PROFESSIONAL APPROACH OF DIETARY STAFF
COURTESY OF HOUSEKEEPING STAFF
ELIMINATION RATE OF ODORS
COURTESY OF LAUNDRY STAFF
QUALITY OF LAUNDRY SERVICE
LOSS OF PERSONAL ITEMS OR CLOTHING
COURTESY OF MAINTENANCE STAFF
SKILL LEVEL OF MAINTENANCE STAFF
RESPONSE TIME OF MAINTENANCE
FUNCTIONING OF APPLIANCES
FRIENDLINESS OF NURSING STAFF
PROFESSIONAL APPROACH OF NURSING STAFF
TREATED WITH RESPECT & DIGNITY
TIMELINESSS OF PAIN MEDICATION
TIMELINESSS ROUTINE MEDICATION
FRIENDLINESS OF NURSING ASSISTANTS STAFF
PROFESSIONAL APPROACH OF NURSING ASSISTANT STAFF
EXPLANATION OF CARE BY NURSING ASSISTANTS
TREATED WITH RESPECT & DIGNITY BY NURSING ASSISTANTS
NIGHT SHIFT CARE RECEIVED
ASSISTING WITH DISCHARGE PLAN
PROFESSIONAL APPROACH OF SOCIAL SERVICE STAFF
EFFICIENCY OF DISCHARGE PROCESS
FRIENDLINESS OF THERAPIST
PROFESSIONAL APPROACH OF THERAPIST
TREATED WITH RESPECT & DIGNITY BY THERAPIST
CLOTHING IN POOR REPAIR, IMPROPER FIT, OR WORN INAPPROPRIATELY
CONTRACTURES - DOES THE RESIDENT HAVE A CONTRACTURE? (DEFINED AS A CONDITION OF FIXED HIGH RESISTANCE TO PASSIVE STRETCH OF A MUSCLE)
CONTRACTURES - DOES THE RESIDENT HAVE SPLINT DEVICES IN PLACE?
CHAIR POTENTIALLY PREVENTS RISING
DOES THE RESIDENT HAVE A POTENTIAL RESTRAINT IN PLACE
POTENTIAL LIMB RESTRAINTS
POTENTIAL TRUNK RESTRAINT
IS THE DEVICE CORRECTLY APPLIED? (SUCH AS POTENTIAL TRUNK AND LIMB RESTRAINTS)
DID YOU OBSERVE THE RESIDENT IN ACTIVITIES
PAIN - FACIAL EXPRESSIONS
PAIN - VOCALIZATION OF PAIN
ACCOMMODATION OF INDIVIDUAL NEEDS
HYDRATION - PHYSICAL SIGNS OF DEHYDRATION
ACCIDENT HAZARDS - SIDE RAILS
ACCIDENT HAZARDS - SIDE RAILS PROPERLY FIT BED
CLEANLINESS OF WALLS, FLOORS, CEILINGS, DRAPES, AND FURNITURE
POSITIONING - LACK OF HEAD OR TORSO SUPPORT
EVIDENCE OF INSECTS OR RODENTS
ELECTRIC CORDS, EXTENSION CORDS, OUTLETS SAFETY
AMBULATION, TRANSFER, OR THERAPY EQUIPMENT ARE UNCLEAN
SUFFICIENT STAFF - ENOUGH STAFF TO PROVIDE CARE AND ASSISTANCE WITHOUT A LONG WAIT
POSITIONING - BED SHEETS TUCKED TIGHTLY OVER TOES HOLDING THE FEET IN PLANTAR FLEXION
POSITIONING - DANGLING LEGS AND FEET
POSITIONING - LACK OF ARM OR SHOULDER SUPPORT
POSITIONING - LEANING TO THE SIDE WITHOUT SUPPORT
POSITIONING - MATTRESS SIZE
POSITIONING - PADDING BETWEEN BONY PROMINENCES
POSITIONING - OTHER POSITIONING CONCERNS
POSITIONING - SAGGING MATTRESS WHILE LAYING IN BED
POSITIONING - UNCOMFORTABLE GERI-CHAIR POSITIONING
POSITIONING - WHEELCHAIR SIZING
BED AND LINENS ARE VISIBLY SOILED WITH STOOL OR URINE
INCONTINENCE - SIGNS OF INCONTINENCE, SUCH AS ODOR AND/OR WETNESS
ABRASIONS AND / OR LACERATIONS
EXPLANATION OF SERVICE AND / OR CARE BY STAFF
FAILURE TO COVER A URINARY CATHETER BAG OR ANY OTHER TYPE OF BODY FLUID COLLECTION DEVICE
FAILURE TO RESPOND TO RESIDENT'S CALL LIGHTS FOR ASSISTANCE IN TIMLY MANNER
FAILURE TO TREAT RESIDENT RESPECTFULLY WHILE PROVIDING CARE TO RESIDENT OR ROOMMATE
VISIBILITY OF RESIDENT'S NAME ON CLOTHES
VISUAL PRIVACY OF RESIDENTS BODY IN PUBLIC AREAS
SEDATION - EXCESSIVELY SEDATED RESIDENTS
OTHER IDENTIFIED DIGNITY CONCERNS (DOCUMENT CONCERNS)
POSTING OF RESIDENT CONFIDENTIAL CLINICAL OR PERSONAL CARE INSTRUCTIONS IN VISIBLE AREAS
STAFF DRESSED RESIDENT IN INSTITUTIONALIZED FASHION DURING THE DAY
RESIDENT INCLUSION OF CONVERSATIONS WHILE PROVIDING CARE OR SERVICES
STAFF FAILED TO TREAT THE RESIDENT WITH RESPECT AND DIGNITY DURING CARE AND SERVICES
STAFF KNOCK / REQUEST PERMISSION TO ENTER RESIDENT'S ROOM
STAFF USAGE OF LABEL OF RESIDENT (I.E.,
CALL LIGHT NOT WITHIN REACH OF RESIDENT
ACCESSIBLE CHEMICALS OR OTHER HAZARDS IN BEDROOM OR BATHROOM
POSITIONING - LONG PERIODS OF SAME POSITION
INAPPROPRIATE FOOT COVERINGS
INCONTINENCE - RESIDENT OBSERVATION FOR LONG PERIODS OF TIME WITHOUT BEING PROVIDED INCONTINENCE CARE
RESIDENT OBSERVED SMOKING DURING THE TWO DAYS OF STAGE 1
ENCOURAGED BY STAFF TO BRING PERSONAL ITEMS
INFORM STAFF OF MISSING PERSONAL ITEMS
STAFF LOOKING FOR MISSING ITEMS
PERSONAL FUNDS - ACCESS TO PERSONAL FUNDS
PERSONAL FUNDS - KNOWLEDGE OF YOUR PERSONAL FUNDS
PERSONAL FUNDS - PERSONAL FUNDS ACCOUNT WITH FACILITY
BUILDING AND ENVIRONMENT - CLEANLINESS OF BUILDING
BUILDING AND ENVIRONMENT - PROBLEMS EFFECTING COMFORT
VISITOR AND RESIDENT PRIVACY
WHEN WORKING WITH RESIDENT
AVAILABILITY OF ACTIVITIES
ITEMS FOR INDIVIDUAL ACTIVITIES
MEET INTEREST OF RESIDENTS
PARTICIPATION IN ACTIVITY PROGRAMS
PARTICIPATION IN CARE PLAN - RESIDENT INCLUSION OF MEDICINE, THERAPY, AND OTHER TREATMENTS
RESIDENTS TREATED WITH RESPECT AND DIGNITY
ABUSE - ABUSE TO RESIDENT
CHOICES - CHOOSE WHEN TO GO TO BED
CHOICES - VISITATION TIME
CHOICES - CHOOSE WHETHER TO TAKE SHOWER, TUB, OR BATH
CHOICES - CHOOSE WHEN TO GET UP IN THE MORNING
INTERACTION WITH OTHERS - CONCERNS OR PROBLEMS WITH A ROOMMATE OR OTHER RESIDENT
INTERACTION WITH OTHERS - STAFF ADDRESSING CONCERN(S)
NOTICE BEFORE ROOM CHANGE OR CHANGE IN ROOMMATE
MOVED TO DIFFERENT ROOM OR ROOMMATE CHANGE IN LAST NINE MONTHS
ABUSE - ABUSE BY STAFF, OTHER RESIDENTS, OR ANYONE ELSE
ABUSE - INFORMED STAFF OF ABUSE
ABUSE - OTHER RESIDENT ABUSE
PAIN - RESIDENT IN DISCOMFORT
ADL ASSISTANCE/URINARY INCONTINENCE - HELP NEEDED FOR GETTING DRESSED
ADL ASSISTANCE/URINARY INCONTINENCE - HELP NEEDED FOR ORAL CARE
DENTAL - PROBLEMS WITH TEETH, GUMS, OR DENTURES
DENTAL - STAFF SOLVING DENTAL PROBLEMS TO RESIDENT SATISFACTION
ADL ASSISTANCE/URINARY INCONTINENCE - HELP NEEDED FOR GOING TO BATHROOM
CoreQ – Short-Stay Discharge - Question 1
CoreQ – Short-Stay Discharge - Question 2
CoreQ – Short-Stay Discharge - Question 3
CoreQ – Short-Stay Discharge - Question 4
CoreQ – Long-Stay Residents & Family Members - Question 1
CoreQ – Long-Stay Residents & Family Members - Question 2
CoreQ – Long-Stay Residents & Family Members - Question 3
ASSIGN
