Title Page
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Conducted on
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Prepared by
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Location
First impressions
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did you feel welcome?
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was it an odourless/pleasant smelling environment?
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did the environment appear calm and well organised?
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did the areas look clean?
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are staff interacting with residents/patients?
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did the work and shared spaces look tidy?
Cleanliness and Infection Control
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Are there housekeeping records in place?
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Has it been cleaned at appropriate times?
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Are staff wearing uniforms? (scrubs if dealing with Covid outbreak?)
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Are there gloves available for staff?
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Are there handwashing signs in place?
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Are there handwashing materials available?
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Are there paper towels in the staff toilet?
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Look in 3 rooms. room 1 of 3. document room number:
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Is the room clean and tidy?
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Is there fresh drinking water in reach of the resident/patient?
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Look in 3 rooms. room 2 of 3. document room number:
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Is the room clean and tidy?
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Is there fresh drinking water in reach of the resident/patient?
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Look in 3 rooms. room 3 of 3. Document room number:
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Is the room clean and tidy?
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Is there fresh drinking water in reach of the resident/patient?
Safety and Suitability of premises and equipment
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Does the notice board look tidy with clear up to date information?
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Are there any environment issues that could lead to harm?
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Are audits complete and accessible?
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Are the fire exits clear of obstacles?
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Is there any damaged equipment/broken furniture?
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has this been reported?
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Set off a call bell, was there an appropriate response?
Resident/patient feedback
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Do you feel the food menus are personal and balanced?
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Do you feel staff have a good attitude to working and engage with residents/patients?
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Are there activities offered to residents/patients and are they person centred?
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Do you know who to contact, or how to raise any concerns, ie safeguards or complaints?
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Do you feel you are treated with dignity and respect?
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Do you feel safe?
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Is there anything else you wish to discuss, or any other feedback to add?
Staff feedback
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Do you feel safe at work today?
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Are there any staffing issues?
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Is your mandatory training up to date?
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Have you had supervision within the last month?
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Do you know how to raise a safeguarding concern?
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Is there anything else you wish to discuss, or any other feedback to add?