Facilities Management - Environment of Care Audit

• Document No.

• Community being audited

  Select Abbey, Sanctuary at the Alverno, Sanctuary at Bellbrook, Sanctuary at Clinton Villa, Sanctuary at Fraser Villa, Sanctuary at Heritage Place Highland Haven Highland Meadowview Holy Cross - IN, Sanctuary at Holy Cross - MD, Sanctuary at Maple Vista, Sanctuary at Marian Oakland, Sanctuary at Marian Place, Sanctuary at Mary Crest Heights, Sanctuary at Mary Crest Manor, Sanctuary at Maryhaven, Sanctuary at McAuley, Sanctuary at McAuley Commons McGivney-Bethune Mercy Manor Mercy Village, Sanctuary at Oaks, Sanctuary at the Park, Sanctuary at the Shore, Sanctuary at the St Frances Home St Josephs Village, Sanctuary at St Mary's, Sanctuary at St Paul's, Sanctuary at Theresa Maxis Trinity Tower TSLC Home Office Villa Marie, Sanctuary at White Lake, Sanctuary at Woodland, Sanctuary at Undefined

  • Abbey, Sanctuary at the
  • Alverno, Sanctuary at
  • Bellbrook, Sanctuary at
  • Clinton Villa, Sanctuary at
  • Fraser Villa, Sanctuary at
  • Heritage Place
  • Highland Haven
  • Highland Meadowview
  • Holy Cross - IN, Sanctuary at
  • Holy Cross - MD, Sanctuary at
  • Maple Vista, Sanctuary at
  • Marian Oakland, Sanctuary at
  • Marian Place, Sanctuary at
  • Mary Crest Heights, Sanctuary at
  • Mary Crest Manor, Sanctuary at
  • Maryhaven, Sanctuary at
  • McAuley, Sanctuary at
  • McAuley Commons
  • McGivney-Bethune
  • Mercy Manor
  • Mercy Village, Sanctuary at
  • Oaks, Sanctuary at the
  • Park, Sanctuary at the
  • Shore, Sanctuary at the
  • St Frances Home
  • St Josephs Village, Sanctuary at
  • St Mary's, Sanctuary at
  • St Paul's, Sanctuary at
  • Theresa Maxis
  • Trinity Tower
  • TSLC Home Office
  • Villa Marie, Sanctuary at
  • White Lake, Sanctuary at
  • Woodland, Sanctuary at
  • Undefined

• Conducted on

  Date

• Personnel participating in the audit

• Prepared by

PARKING / BUILDING EXTERIOR

• Parking lots in good repair, free of potholes

  Yes

  No

  N/A

• Parking lot striping is visible and defines parking spots clearly

  Yes

  No

  N/A

• Parking lot free of ice and trip, slip and fall hazards

  Yes

  No

  N/A

• Exterior trim of the building is in good repair

  Yes

  No

  N/A

• Lawns and landscaping attractive and clear of litter and debris

  Yes

  No

  N/A

• Walkways clean of snow and ice

  Yes

  No

  N/A

• Walkways do not present fall hazards (uneven surfaces, Ice)

  Yes

  No

  N/A

• Parking lots, sidewalks and landscaping fee of trash and litter

  Yes

  No

  N/A

ENTRANCES

• Walkways clean of snow and ice

  Yes

  No

  N/A

• Walkways do not present fall hazards

  Yes

  No

  N/A

• Cigarette urns clean and free of trash and litter

  Yes

  No

  N/A

• No visible cigarette butts

  Yes

  No

  N/A

• Awnings, overhangs in clean and in good repair

  Yes

  No

  N/A

• Fire sprinkler heads and pipe clean of dust, paint or other obstructions

  Yes

  No

  N/A

• Door signage stating NO SMOKING

  Yes

  No

  N/A

• Window glass free of finger prints

  Yes

  No

  N/A

• Door sweeps restrict the passage of light

  Yes

  No

  N/A

• COMMENTS / RECOMMENDATIONS

LOBBIES / COMMON AREAS

• Free of objectionable odors

  Yes

  No

  N/A

• Ceilings clean and free of stains and marks

  Yes

  No

  N/A

• Walk off mats clean, adequate and in proper locations

  Yes

  No

  N/A

• Ceiling vents clean

  Yes

  No

  N/A

• Fire sprinkler heads and pipe clean of dust, paint or other obstructions

  Yes

  No

  N/A

• Light lenses clean and free of debris (insects, etc...)

  Yes

  No

  N/A

• Lights bulbs all illuminate

  Yes

  No

  N/A

• Artwork and decorations on walls free of dust

  Yes

  No

  N/A

• Walls clean and free of spots and stains

  Yes

  No

  N/A

• Walls free of peeling paint and excessive damage

  Yes

  No

  N/A

• Window treatments clean and in good repair

  Yes

  No

  N/A

• Window glass free of finger prints and spots

  Yes

  No

  N/A

• Window screens in good repair

  Yes

  No

  N/A

• Baseboard heating vents clean and free of dust

  Yes

  No

  N/A

• Ledges, window sils and shelves are free of dust and debris

  Yes

  No

  N/A

• Carpeting clean of dirt, dust and litter including corners

  Yes

  No

  N/A

• Carpeting is free of stains

  Yes

  No

  N/A

• Vinyl floors free of dirt, dust, litter including corners

  Yes

  No

  N/A

• Floors waxed, polished and free of marks from wheelchairs and walkers

  Yes

  No

  N/A

• Baseboard are free of buildup

  Yes

  No

  N/A

• Floors are free of slip/trip/fall hazards

  Yes

  No

  N/A

• Hallways are free of obstructions from equipment not currently in use

  Yes

  No

  N/A

• COMMENTS / RECOMMENDATIONS

HALLWAYS / CORRIDORS

• Free of objectionable odors

  Yes

  No

  N/A

• Ceilings clean and free of stains and marks

  Yes

  No

  N/A

• Ceiling vents clean

  Yes

  No

  N/A

• Fire sprinkler heads and pipe clean of dust, paint or other obstructions

  Yes

  No

  N/A

• Light lenses clean and free of debris (insects, etc...)

  Yes

  No

  N/A

• Lights bulbs all illuminate

  Yes

  No

  N/A

• Walls clean and free of spots and stains

  Yes

  No

  N/A

• Walls free of peeling paint and excessive damage

  Yes

  No

  N/A

• Window treatments clean and in good repair

  Yes

  No

  N/A

• Window glass free of finger prints and spots

  Yes

  No

  N/A

• Window screens in good repair

  Yes

  No

  N/A

• Baseboard heating vents clean and free of dust

  Yes

  No

  N/A

• Artwork and decorations on walls free of dust

  Yes

  No

  N/A

• Ledges, window sils and shelves are free of dust and debris

  Yes

  No

  N/A

• Carpeting clean of dirt, dust and litter including corners

  Yes

  No

  N/A

• Carpeting is free of stains

  Yes

  No

  N/A

• Vinyl floors free of dirt, dust, litter including corners

  Yes

  No

  N/A

• Floors waxed, polished and free of marks from wheelchairs and walkers

  Yes

  No

  N/A

• Baseboard are free of buildup

  Yes

  No

  N/A

• Floors are free of slip/trip/fall hazards

  Yes

  No

  N/A

• Hallways are free of obstructions from equipment not currently in use

  Yes

  No

  N/A

• Handrails on both sides of hallway are clean and secure and free of hazards

  Yes

  No

  N/A

• COMMENTS / RECOMMENDATIONS

RESIDENT ROOMS

• Free of objectionable odors

  Yes

  No

  N/A

• Ceilings clean and free of stains and marks

  Yes

  No

  N/A

• Ceiling vents clean

  Yes

  No

  N/A

• Fire sprinkler heads and pipe clean of dust, paint or other obstructions

  Yes

  No

  N/A

• Light lenses clean and free of debris (insects, etc...)

  Yes

  No

  N/A

• Lights bulbs all illuminate

  Yes

  No

  N/A

• Over bed light operational and free of dust and obstructions

  Yes

  No

  N/A

• Night light operational

  Yes

  No

  N/A

• Privacy curtains clean and free of holes and stains

  Yes

  No

  N/A

• Walls clean and free of spots and stains

  Yes

  No

  N/A

• Walls free of peeling paint and excessive damage

  Yes

  No

  N/A

• Window treatments clean and in good repair

  Yes

  No

  N/A

• Window glass free of finger prints and spots

  Yes

  No

  N/A

• Window screens in good repair

  Yes

  No

  N/A

• Baseboard heating vents clean and free of dust

  Yes

  No

  N/A

• Artwork and decorations on walls free of dust

  Yes

  No

  N/A

• Ledges, window sils and shelves are free of dust and debris

  Yes

  No

  N/A

• Carpeting clean of dirt, dust and litter including corners

  Yes

  No

  N/A

• Carpeting is free of stains

  Yes

  No

  N/A

• Vinyl floors free of dirt, dust, litter including corners

  Yes

  No

  N/A

• Floors waxed, polished and free of marks from wheelchairs and walkers

  Yes

  No

  N/A

• Baseboard are free of buildup

  Yes

  No

  N/A

• Floors are free of slip/trip/fall hazards

  Yes

  No

  N/A

• Nurse call cords clean, intact and functional

  Yes

  No

  N/A

• Furniture is in good repair

  Yes

  No

  N/A

• Bed and frame is clean

  Yes

  No

  N/A

• Overbed table clean including base and wheels

  Yes

  No

  N/A

• Oxygen and other storage is appropriate

  Yes

  No

  N/A

• IV, Tube Feeding stands clean including base and wheels

  Yes

  No

  N/A

• Room is decorated and homelike

  Yes

  No

  N/A

• Sharps containers are readily available, removed when 3/4 full and not accessible to residents

  Yes

  No

  N/A

• Personal care items are sanitized and properly stored (Basins, bed pans, urinals, etc...)

  Yes

  No

  N/A

• COMMENTS / RECOMMENDATIONS

RESIDENT BATHROOMS

• Bathroom lighting functional

  Yes

  No

  N/A

• Bathroom mirror is free of debris and streaking

  Yes

  No

  N/A

• Bathroom ventilation is working

  Yes

  No

  N/A

• Bathroom commode is clean and free of stains

  Yes

  No

  N/A

• Bathroom is stocked with soap, paper towels and toilet tissue

  Yes

  No

  N/A

• Sink is clean, free of soap and other buildup including any exposed piping

  Yes

  No

  N/A

• Grab bars for showers and toilets are present, clean and secure

  Yes

  No

  N/A

• Commode chairs are clean and in good repair

  Yes

  No

  N/A

• Floors are free of slip/trip/fall hazards

  Yes

  No

  N/A

• COMMENTS / RECOMMENDATIONS

DINING ROOMS

• Free of objectionable odors

  Yes

  No

  N/A

• Ceilings clean and free of stains and marks

  Yes

  No

  N/A

• Ceiling vents clean

  Yes

  No

  N/A

• Fire sprinkler heads and pipe clean of dust, paint or other obstructions

  Yes

  No

  N/A

• Light lenses clean and free of debris (insects, etc...)

  Yes

  No

  N/A

• Lights bulbs all illuminate

  Yes

  No

  N/A

• Walls clean and free of spots and stains

  Yes

  No

  N/A

• Walls free of peeling paint and excessive damage

  Yes

  No

  N/A

• Window treatments clean and in good repair

  Yes

  No

  N/A

• Window glass free of finger prints and spots

  Yes

  No

  N/A

• Window screens in good repair

  Yes

  No

  N/A

• Artwork and decorations on walls free of dust

  Yes

  No

  N/A

• Baseboard are free of buildup

  Yes

  No

  N/A

• Ledges, window sils and shelves are free of dust and debris

  Yes

  No

  N/A

• Carpeting clean of dirt, dust and litter including corners

  Yes

  No

  N/A

• Carpeting is free of stains

  Yes

  No

  N/A

• Vinyl floors free of dirt, dust, litter including corners

  Yes

  No

  N/A

• Floors waxed, polished and free of marks from wheelchairs and walkers

  Yes

  No

  N/A

• Baseboard are free of buildup

  Yes

  No

  N/A

• Floors are free of slip/trip/fall hazards

  Yes

  No

  N/A

• Furniture is in good repair

  Yes

  No

  N/A

• Furniture is clean

  Yes

  No

  N/A

• Area is clear of clutter and dishes

  Yes

  No

  N/A

• COMMENTS / RECOMMENDATIONS

BARBER / BEAUTY SALON

• Free of objectionable odors

  Yes

  No

  N/A

• Ceilings clean and free of stains and marks

  Yes

  No

  N/A

• Ceiling vents clean

  Yes

  No

  N/A

• Fire sprinkler heads and pipe clean of dust, paint or other obstructions

  Yes

  No

  N/A

• Light lenses clean and free of debris (insects, etc...)

  Yes

  No

  N/A

• Lights bulbs all illuminate

  Yes

  No

  N/A

• Walls clean and free of spots and stains

  Yes

  No

  N/A

• Walls free of peeling paint and excessive damage

  Yes

  No

  N/A

• Window treatments clean and in good repair

  Yes

  No

  N/A

• Window glass free of finger prints and spots

  Yes

  No

  N/A

• Window screens in good repair

  Yes

  No

  N/A

• Artwork and decorations on walls free of dust

  Yes

  No

  N/A

• Baseboard are free of buildup

  Yes

  No

  N/A

• Ledges, window sils and shelves are free of dust and debris

  Yes

  No

  N/A

• Vinyl floors free of dirt, dust, litter including corners

  Yes

  No

  N/A

• Floors waxed, polished and free of marks from wheelchairs and walkers

  Yes

  No

  N/A

• Baseboard are free of buildup

  Yes

  No

  N/A

• Furniture is in good repair

  Yes

  No

  N/A

• Furniture is clean

  Yes

  No

  N/A

• Sharps containers are readily available, removed when 3/4 full and not accessible to residents

  Yes

  No

  N/A

• Brushes, combs, clips, curlers are free of hair, cleaned and disinfected after each resident use

  Yes

  No

  N/A

• Capes and towels are clean and stored when not in use

  Yes

  No

  N/A

• Hair wash sink is cleaned and disinfected after each resident use

  Yes

  No

  N/A

• Hair is removed from the floor after each haircut

  Yes

  No

  N/A

• Chemicals are properly labeled and stored in a locked area

  Yes

  No

  N/A

• Floors are free of slip/trip/fall hazards

  Yes

  No

  N/A

• COMMENTS / RECOMMENDATIONS

CLEAN UTILITY ROOM(s)

• Free of objectionable odors

  Yes

  No

  N/A

• Ceilings clean and free of stains and marks

  Yes

  No

  N/A

• Ceiling vents clean

  Yes

  No

  N/A

• Fire sprinkler heads and pipe clean of dust, paint or other obstructions

  Yes

  No

  N/A

• Light lenses clean and free of debris (insects, etc...)

  Yes

  No

  N/A

• Lights bulbs all illuminate

  Yes

  No

  N/A

• Walls clean and free of spots and stains

  Yes

  No

  N/A

• Walls free of peeling paint and excessive damage

  Yes

  No

  N/A

• Baseboard are free of buildup

  Yes

  No

  N/A

• Floors waxed, polished and free of marks from wheelchairs and walkers

  Yes

  No

  N/A

• Vinyl floors free of dirt, dust, litter including corners

  Yes

  No

  N/A

• Baseboard are free of buildup

  Yes

  No

  N/A

• Floor is free of slip/trip/fall hazards

  Yes

  No

  N/A

• Floor is free of storage on the floor

  Yes

  No

  N/A

• COMMENTS / RECOMMENDATIONS

SOILED UTILITY / BIO-HAZARD ROOM(s)

• Door signage for bio-hazard

  Yes

  No

  N/A

• Free of objectionable odors

  Yes

  No

  N/A

• Ceilings clean and free of stains and marks

  Yes

  No

  N/A

• Ceiling vents clean

  Yes

  No

  N/A

• Fire sprinkler heads and pipe clean of dust, paint or other obstructions

  Yes

  No

  N/A

• Light lenses clean and free of debris (insects, etc...)

  Yes

  No

  N/A

• Lights bulbs all illuminate

  Yes

  No

  N/A

• Walls clean and free of spots and stains

  Yes

  No

  N/A

• Walls free of peeling paint and excessive damage

  Yes

  No

  N/A

• Baseboard are free of buildup

  Yes

  No

  N/A

• Floors waxed, polished and free of marks from wheelchairs and walkers

  Yes

  No

  N/A

• Vinyl floors free of dirt, dust, litter including corners

  Yes

  No

  N/A

• Floors waxed, polished and free of marks from wheelchairs and walkers

  Yes

  No

  N/A

• Floors free of slip/trip/fall hazards

  Yes

  No

  N/A

• Baseboard are free of buildup

  Yes

  No

  N/A

• Floor is free of slip/trip/fall hazards

  Yes

  No

  N/A

• Utility hopper sink is clean and in working order, hoses hung properly

  Yes

  No

  N/A

• Dirty linen barrels/hampers remain covered and emptied when necessary

  Yes

  No

  N/A

• Dirty linen barrels cleaned per facility schedule (Identify schedule of this event)

  Yes

  No

  N/A

• Gloves, gowns and eye protection are available

  Yes

  No

  N/A

• Disinfectant is stocked and available

  Yes

  No

  N/A

• Chemicals are properly labeled and stored in a locked area

  Yes

  No

  N/A

• Trash / Garbage (non contaminated) is not placed in bio-hazard container

  Yes

  No

  N/A

• Sinks are clean

  Yes

  No

  N/A

• No storage under sink cabinets

  Yes

  No

  N/A

• COMMENTS / RECOMMENDATIONS

Tub Rooms

• Free of objectionable odors

  Yes

  No

  N/A

• Ceilings clean and free of stains and marks

  Yes

  No

  N/A

• Ceiling vents clean

  Yes

  No

  N/A

• Fire sprinkler heads and pipe clean of dust, paint or other obstructions

  Yes

  No

  N/A

• Light lenses clean and free of debris (insects, etc...)

  Yes

  No

  N/A

• Lights bulbs all illuminate

  Yes

  No

  N/A

• Walls clean and free of spots and stains

  Yes

  No

  N/A

• Walls free of peeling paint and excessive damage

  Yes

  No

  N/A

• Artwork and decorations on walls free of dust

  Yes

  No

  N/A

• Baseboard are free of buildup

  Yes

  No

  N/A

• Vinyl floors free of dirt, dust, litter including corners

  Yes

  No

  N/A

• Floors waxed, polished and free of marks from wheelchairs and walkers

  Yes

  No

  N/A

• Baseboard are free of buildup

  Yes

  No

  N/A

• Floor is free of slip/trip/fall hazards

  Yes

  No

  N/A

• Sharps containers are readily available, removed when 3/4 full and not accessible to residents

  Yes

  No

  N/A

• Shower chairs are disinfected after each use

  Yes

  No

  N/A

• Whirlpool tubs are disinfected and cleaned after each use

  Yes

  No

  N/A

• Chemicals are properly labeled and stored in a locked area

  Yes

  No

  N/A

• Room ventilation is operational

  Yes

  No

  N/A

• Floor drains have grates covering piping

  Yes

  No

  N/A

• Bathing surfaces are non slip

  Yes

  No

  N/A

• Water temperatures are taken at least weekly and logged indicating within acceptable range

  Yes

  No

  N/A

• COMMENTS / RECOMMENDATIONS

RESTROOM / SHOWER

• Bathroom lighting functional

  Yes

  No

  N/A

• Bathroom lighting functional

  Yes

  No

  N/A

• Bathroom mirror is free of debris and streaking

  Yes

  No

  N/A

• Bathroom ventilation is working

  Yes

  No

  N/A

• Bathroom commode is clean and free of stains

  Yes

  No

  N/A

• Bathroom is stocked with soap, paper towels and toilet tissue

  Yes

  No

  N/A

• Sink is clean, free of soap and other buildup including any exposed piping

  Yes

  No

  N/A

• Grab bars for showers and toilets are present, clean and secure

  Yes

  No

  N/A

• Floors are free of slip/trip/fall hazards

  Yes

  No

  N/A

• COMMENTS / RECOMMENDATIONS

ENVIRONMENTAL SERVICES

• MSDS Available to all staff

  Yes

  No

  N/A

• COMMENTS / RECOMMENDATIONS

PROCESS - Housekeeping

• EVS staff use gloves appropriately

  Yes

  No

  N/A

• EVS staff knock before entering resident spaces where privacy is expected

  Yes

  No

  N/A

• EVS staff dust mops entire area before mopping

  Yes

  No

  N/A

• Microfiber mopping is used

  Yes

  No

  N/A

• Microfiber mop pad changed after ever room

  Yes

  No

  N/A

• EVS staff wet mop the entire floor

  Yes

  No

  N/A

• Mop water is changed every x rooms

  Yes

  No

  N/A

• Wet floor signs used as appropriate

  Yes

  No

  N/A

• COMMENTS / RECOMMENDATIONS

EQUIPMENT - Housekeeping

• COMMENTS / RECOMMENDATIONS

SCHEDULES - Housekeeping

• COMMENTS / RECOMMENDATIONS

SIGNATURES

• COMMENTS / RECOMMENDATIONS

• Date and time the audit was concluded and exit conference held

  Date

• SIGNATURE OF ST. ANNS HOME OFFICE STAFF COMPLETING AUDUT

  Sign