Residential Premises

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Physical Plant Inspection

  Date

• Program name and address; reviewers

  Yes

  No

  N/A

CR 1.11 Medication storage and monitoring assures resident safety

• Communally held medication is in locked storage

  Yes

  No

  N/A

• Controlled substances are under double lock

  Yes

  No

  N/A

• Keys to medication storage are properly safeguarded

  Yes

  No

  N/A

• Medication kept by individual residents is securely locked

  Yes

  No

  N/A

CR 1.32 The building, its equipment and fixtures are free from fire and safety hazards.

• The residence is free from items prohibited under Part 595.15(a) (4)(iii)

  Yes

  No

  N/A

• Items restricted by 5.95.15(a)(4)(iv) have been approved by OMH and requred maintenance procedures are followed.

  Yes

  No

  N/A

• Building exits are unobstructed by accumulated material, furniture, or by locking devices which could inhibit emergency egress

  Yes

  No

  N/A

• The building is free from unsafe accumulations of combustible materials

  Yes

  No

  N/A

• Flammable materials are safely stored

  Yes

  No

  N/A

• Electrical circuits are free from overload

  Yes

  No

  N/A

CR 1.33 Smoke detectors and fire fighting equipment are located and maintained as requred by regulation

• Smoke detectors are placed as required by regulation

  Yes

  No

  N/A

• Hardwired detectors are tested not less then once/month and battery operated devices at least weekly

  Yes

  No

  N/A

• Battery operated detectors are capable of issuing a trouble signal prior to battery failure

  Yes

  No

  N/A

• At least one fire extinguisher is accessible on each floor

  Yes

  No

  N/A

• All extinguishers have been tested and recharged as required

  Yes

  No

  N/A

• The building emergency evacuation plan is posted

  Yes

  No

  N/A

CR 1.41 Personal living spaces meet minimum regulatory requirements for furniture and linen and are properly maintained and clean

• Adequate cleanliness is maintained

  Yes

  No

  N/A

• Bathroom fixtures are in good repair and free from leakage

  Yes

  No

  N/A

• Walls, ceilings and floors are free from prominent holes or signs of leakage

  Yes

  No

  N/A

• The condition of paint or wall coverings in the space is satisfactory

  Yes

  No

  N/A

• Each resident is provided with a bed, chair, desk or table, dresser and closet or wardrobe

  Yes

  No

  N/A

• Furniture is in satisfactory condition

  Yes

  No

  N/A

• Each resident is provided with at least 2 sets of sheets, a blanket, 2 towels and a washcloth

  Yes

  No

  N/A

• Linens are kept clean and in satisfactory condition

  Yes

  No

  N/A

• Each bedroom has window coverings that are clean and in acceptable repair

  Yes

  No

  N/A

CR 1.42 Common living spaces are appropriately furnished and furniture and spaces are properly maintained and clean

• Adequate cleanliness is maintained

  Yes

  No

  N/A

• Bathroom fixtures are in good repair and free from leakage

  Yes

  No

  N/A

• Walls, ceilings and floors are free from prominent holes or signs of leakage

  Yes

  No

  N/A

• The condition of paint or wall coverings in the space is satisfactory

  Yes

  No

  N/A

• Common areas are furnished appropriately to the function of the space, and the population (Includes decorative items, activity supplies, recreational equipment, etc)

  Yes

  No

  N/A

• Furniture and other room furnishings are in satisfactory condition

  Yes

  No

  N/A

CR 2.31 The confidentiality of resident records is maintained

• Resident specific materials are securely maintained, including written materials, computer disks, and hard drives

  Yes

  No

  N/A