Information

  • Housekeeping Audit

  • Community being audited

  • Conducted on

  • Personnel participating in the audit

General Information

GENERAL INFORMATION

  • Has last inspection been reviewed?

  • Are there any outstanding issues from last inspection

Resident Rooms

RESIDENT ROOMS

  • Free of objectionable odors

  • Ceilings clean and free of stains and marks

  • Ceiling vents clean

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

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

  • Lights bulbs all illuminate

  • Over bed light operational and free of dust and obstructions

  • Night light operational

  • Privacy curtains clean and free of holes and stains

  • Walls clean and free of spots and stains

  • Walls free of peeling paint and excessive damage

  • Window treatments clean and in good repair

  • Window glass free of finger prints and spots

  • Window screens in good repair

  • Baseboard heating vents clean, in good repair and free of dust

  • Artwork and decorations on walls free of dust

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

  • Carpeting clean of dirt, dust and litter including corners

  • Carpeting is free of stains

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

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

  • Baseboard are free of buildup of dirt and wax

  • Floors are free of slip/trip/fall hazards

  • Nurse call cords clean, intact and functional

  • Furniture is in good repair

  • Bed and frame is clean

  • Overbed table clean including base and wheels

  • Oxygen and other storage is appropriate

  • IV, Tube Feeding stands clean including base and wheels

  • Room is decorated and homelike

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

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

  • COMMENTS / RECOMMENDATIONS

RESIDENT BATHROOMS

  • Bathroom lighting functional

  • Bathroom mirror is free of debris and streaking

  • Bathroom ventilation is working

  • Bathroom commode is clean and free of stains

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

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

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

  • Commode chairs are clean and in good repair

  • Floors are free of slip/trip/fall hazards

  • COMMENTS / RECOMMENDATIONS

Restrooms, Public

RESTROOMS, PUBLIC / STAFF

  • Free of objectionable odors

  • Ceiling vents clean

  • Ventilation is working

  • Ceilings clean and free of stains and marks

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

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

  • Lights bulbs all illuminate

  • Walls clean and free of spots and stains

  • Walls free of peeling paint and excessive damage

  • Baseboard are free of buildup of dirt and wax

  • Artwork and decorations on walls free of dust

  • Bathroom mirror is free of debris and streaking

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

  • Grab bars for toilets are present, clean and secure

  • Bathroom toilet is clean and free of stains

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

  • Floor drains have grates covering piping

  • Floors free of dirt, dust, litter including corners

  • Floor is free of slip/trip/fall hazards

  • Floors waxed, polished and free of marks

  • COMMENTS / RECOMMENDATIONS

Spa / Bathing Rooms

TUB ROOMS

  • Free of objectionable odors

  • Ceilings clean and free of stains and marks

  • Ceiling vents clean

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

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

  • Lights bulbs all illuminate

  • Walls clean and free of spots and stains

  • Walls free of peeling paint and excessive damage

  • Artwork and decorations on walls free of dust

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

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

  • Baseboard are free of buildup of dirt and wax

  • Floor is free of slip/trip/fall hazards

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

  • Shower chairs are disinfected after each use

  • Whirlpool tubs are disinfected and cleaned after each use

  • Chemicals are properly labeled and stored in a locked area

  • Room ventilation is operational

  • Floor drains have grates covering piping

  • Bathing surfaces are non slip

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

  • COMMENTS / RECOMMENDATIONS

RESTROOM / SHOWER

  • Bathroom lighting functional

  • Bathroom mirror is free of debris and streaking

  • Bathroom ventilation is working

  • Bathroom commode is clean and free of stains

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

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

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

  • Floors are free of slip/trip/fall hazards

  • COMMENTS / RECOMMENDATIONS

Utility Room, Clean

UTILITY ROOM, CLEAN

  • Free of objectionable odors

  • Ceilings clean and free of stains and marks

  • Ceiling vents clean

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

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

  • Lights bulbs all illuminate

  • Walls clean and free of spots and stains

  • Walls free of peeling paint and excessive damage

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

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

  • Baseboard are free of buildup of dirt and wax

  • Floor is free of slip/trip/fall hazards

  • Floor is free of storage on the floor

  • COMMENTS / RECOMMENDATIONS

Utility Room, Soiled

UTILITY ROOM, SOILED

  • Door signage for bio-hazard

  • Free of objectionable odors

  • Ceilings clean and free of stains and marks

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

  • Ceiling vents clean

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

  • Lights bulbs all illuminate

  • Walls clean and free of spots and stains

  • Walls free of peeling paint and excessive damage

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

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

  • Floors free of slip/trip/fall hazards

  • Baseboard are free of buildup of dirt and wax

  • Floor is free of slip/trip/fall hazards

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

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

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

  • Gloves, gowns and eye protection are available

  • Disinfectant is stocked and available

  • Chemicals are properly labeled and stored in a locked area

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

  • Sinks are clean

  • No storage under sink cabinets

  • COMMENTS / RECOMMENDATIONS

Vestibule

VESTIBULE

  • Ceilings clean and free of stains and marks

  • Walk off mats clean, adequate and in proper locations

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

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

  • Lights bulbs all illuminate

  • Walls clean and free of spots and stains

  • Walls free of peeling paint and excessive damage

  • Window treatments clean and in good repair

  • Window glass free of finger prints and spots

  • Window screens in good repair

  • Baseboard heating vents clean, in good repair and free of dust

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

  • Flooring clean of dirt, dust and litter including corners

  • Baseboard are free of buildup of dirt and wax

  • Floors are free of slip/trip/fall hazards

  • COMMENTS / RECOMMENDATIONS

Exit Conference

EXIT CONFERENCE and SIGNATURES

  • COMMENTS / RECOMMENDATIONS

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

  • NAME and SIGNATURE OF ST ANNS HOME STAFF COMPLETING AUDIT

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