Facilities Management - Housekeeping Audit

• Housekeeping Audit

• 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

GENERAL INFORMATION

• Has last inspection been reviewed?

  Yes

  No

  N/A

• Are there any outstanding issues from last inspection

  Yes

  No

  N/A

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, in good repair 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 of dirt and wax

  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

RESTROOMS, PUBLIC / STAFF

• Free of objectionable odors

  Yes

  No

  N/A

• Ceiling vents clean

  Yes

  No

  N/A

• Ventilation is working

  Yes

  No

  N/A

• Ceilings clean and free of stains and marks

  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 of dirt and wax

  Yes

  No

  N/A

• Artwork and decorations on walls free of dust

  Yes

  No

  N/A

• Bathroom mirror is free of debris and streaking

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Grab bars for toilets are present, clean and secure

  Yes

  No

  N/A

• Bathroom toilet is clean and free of stains

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Floor drains have grates covering piping

  Yes

  No

  N/A

• Floors free of dirt, dust, litter including corners

  Yes

  No

  N/A

• Floor is free of slip/trip/fall hazards

  Yes

  No

  N/A

• Floors waxed, polished and free of marks

  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

• 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 of dirt and wax

  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 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

UTILITY ROOM, CLEAN

• 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

• 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 of dirt and wax

  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

UTILITY ROOM, SOILED

• 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

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

  Yes

  No

  N/A

• Ceiling vents clean

  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

• 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 free of slip/trip/fall hazards

  Yes

  No

  N/A

• Baseboard are free of buildup of dirt and wax

  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

VESTIBULE

• 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

• 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, in good repair and free of dust

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Flooring clean of dirt, dust and litter including corners

  Yes

  No

  N/A

• Baseboard are free of buildup of dirt and wax

  Yes

  No

  N/A

• Floors are free of slip/trip/fall hazards

  Yes

  No

  N/A

• COMMENTS / RECOMMENDATIONS

EXIT CONFERENCE and SIGNATURES

• COMMENTS / RECOMMENDATIONS

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

  Date

• NAME and SIGNATURE OF ST ANNS HOME STAFF COMPLETING AUDIT

  Sign