Site Audit - Brook (2018)

• Audit Title

Previous Quality Review

• Were the previous findings reviewed with the Designated Manager?

  Yes

  No

  N/A

• Are all maintenance items entered into Landport?

  Yes

  No

  N/A

Site Inspection

• Rating Scale:
  4 - Exceptional
  3 - Minor work needed
  2 - Does not meet expectations
  1 - Health and safety concern
  0 - Health and safety hazard

Brook

Outside

• General Cleanliness

• Yard free of weeds/debris

  Yes

  No

• Tree trimmed, free of overhangs

  Yes

  No

• Driveway free of weeds/debris

  Yes

  No

• Gutters clean and in place

  Yes

  No

• Mailbox intact/clear of obstructions

  Yes

  No

• Cigarette butt can is available and being emptied

  Yes

  No

  N/A

• Summer

  Off

  On

• The lawn is healthy and free of bald patches (Jim only, does not affect score)

  Yes

  No

  N/A

• The property is free of beehives/wasp nests

  Yes

  No

  N/A

• The property is free of burrows of rodents or small animals

  Yes

  No

  N/A

• Rock beds around the building cover the ground beneath (Jim only, does not affect score)

  Yes

  No

  N/A

• Plants around the property are trimmed and healthy

  Yes

  No

  N/A

• Winter

  Off

  On

• Salt on site

  Yes

  No

• Shovel on site

  Yes

  No

• Driveway plowed/shoveled and de-iced

  Yes

  No

• Walkways shoveled and de-iced

  Yes

  No

Front Hallway

• General Cleanliness

• Railings are intact and secure

  Yes

  No

  N/A

• Flooring is in good condition

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

  N/A

• Closets organized

  Yes

  No

  N/A

Back Hallway

• General Cleanliness

• Railings are intact and secure

  Yes

  No

  N/A

• Flooring is in good condition

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

  N/A

• Closets organized

  Yes

  No

  N/A

Laundry Room

• General Cleanliness

• Clear of clothes on the floor

  Yes

  No

• Lint trap clean

  Yes

  No

• There is a lint catcher on the washing machine exhaust hose

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

• Boiler inspection current

  Yes

  No

• Date of most recent boiler inspection/repair

  Date

• Fire extinguisher present (serviced within last 12 months)

  Yes

  No

  N/A

• New/Serviced/Recharged Date

• Smoke Alarm (under 10 years old, with date of manufacture written on outside)

  Yes

  No

• Date of manufacture

Brook #1

• Smell is acceptable

  Yes

  No

  N/A

Room 1

• General Cleanliness

• Is the bed being used?

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

  N/A

• Mirror

  Yes

  No

  N/A

• Escape Plan

  Yes

  No

• Closet is clean and organized

  Yes

  No

  N/A

• Windows intact and operational

  Yes

  No

  N/A

• Smoke Alarm (under 10 years old, with date of manufacture written on outside)

  Yes

  No

• Date of manufacture

Bathroom

• General Cleanliness

• Sink, shower and toilet are clean and operational

  Yes

  No

  N/A

• Floor clean, clear of mold and residue

  Yes

  No

• Working/matching light bulbs

  Yes

  No

Hallway

• General Cleanliness

• Working light bulbs

  Yes

  No

  N/A

• Fuse box is operational, labeled

  Yes

  No

  N/A

• Thermostat is working, behind lockbox

  Yes

  No

  N/A

Kitchen

• General Cleanliness

• Cabinets are clean and organized

  Yes

  No

  N/A

• Oven is clean

  Yes

  No

• Microwave is clean

  Yes

  No

• Sink is clean

  Yes

  No

• Refrigerator/Freezer is clean

  Yes

  No

• Food options/menus available

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

Dining Room

• General Cleanliness

• Table and chairs are intact and clean

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

• Windows intact and operational

  Yes

  No

  N/A

Living Room

• General Cleanliness

• Furniture Cleanliness

• Pictures/Artwork on walls

  Yes

  No

• Operable TV

  Yes

  No

• Games

  Yes

  No

• Working light bulbs

  Yes

  No

• Closet is clean and organized

  Yes

  No

  N/A

• Windows intact and operational

  Yes

  No

  N/A

• A/C unit is operational, filter is clean

  Yes

  No

  N/A

Brook #2

• Smell is acceptable

  Yes

  No

  N/A

Room 1

• General Cleanliness

• Is the bed being used?

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

  N/A

• Mirror

  Yes

  No

  N/A

• Escape Plan

  Yes

  No

• Closet is clean and organized

  Yes

  No

  N/A

• Windows intact and operational

  Yes

  No

  N/A

• Smoke Alarm (under 10 years old, with date of manufacture written on outside)

  Yes

  No

• Date of manufacture

Room 2

• General Cleanliness

• Is the bed being used?

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

  N/A

• Mirror

  Yes

  No

  N/A

• Escape Plan

  Yes

  No

• Closet is clean and organized

  Yes

  No

  N/A

• Windows intact and operational

  Yes

  No

  N/A

• Smoke Alarm (under 10 years old, with date of manufacture written on outside)

  Yes

  No

• Date of manufacture

Bathroom

• General Cleanliness

• Sink, shower and toilet are clean and operational

  Yes

  No

  N/A

• Floor clean, clear of mold and residue

  Yes

  No

• Working/matching light bulbs

  Yes

  No

Hallway

• General Cleanliness

• Working light bulbs

  Yes

  No

  N/A

• Fuse box is operational, labeled

  Yes

  No

  N/A

• Thermostat is working, behind lockbox

  Yes

  No

  N/A

• Closet is clean and organized

  Yes

  No

  N/A

Kitchen

• General Cleanliness

• Cabinets are clean and organized

  Yes

  No

  N/A

• Oven is clean

  Yes

  No

• Microwave is clean

  Yes

  No

• Sink is clean

  Yes

  No

• Refrigerator/Freezer is clean

  Yes

  No

• Food options/menus available

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

Dining Room

• General Cleanliness

• Table and chairs are intact and clean

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

• Windows intact and operational

  Yes

  No

  N/A

Living Room

• General Cleanliness

• Furniture Cleanliness

• Pictures/Artwork on walls

  Yes

  No

• Operable TV

  Yes

  No

• Games

  Yes

  No

• Working light bulbs

  Yes

  No

• Closet is clean and organized

  Yes

  No

  N/A

• Windows intact and operational

  Yes

  No

  N/A

• A/C unit is operational, filter is clean

  Yes

  No

  N/A

Brook #3

• Smell is acceptable

  Yes

  No

  N/A

Room 1

• General Cleanliness

• Is the bed being used?

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

  N/A

• Mirror

  Yes

  No

  N/A

• Escape Plan

  Yes

  No

• Closet is clean and organized

  Yes

  No

  N/A

• Windows intact and operational

  Yes

  No

  N/A

• Smoke Alarm (under 10 years old, with date of manufacture written on outside)

  Yes

  No

• Date of manufacture

Room 2

• General Cleanliness

• Is the bed being used?

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

  N/A

• Mirror

  Yes

  No

  N/A

• Escape Plan

  Yes

  No

• Closet is clean and organized

  Yes

  No

  N/A

• Windows intact and operational

  Yes

  No

  N/A

• Smoke Alarm (under 10 years old, with date of manufacture written on outside)

  Yes

  No

• Date of manufacture

Bathroom

• General Cleanliness

• Sink, shower and toilet are clean and operational

  Yes

  No

  N/A

• Floor clean, clear of mold and residue

  Yes

  No

• Working/matching light bulbs

  Yes

  No

Hallway

• General Cleanliness

• Working light bulbs

  Yes

  No

  N/A

• Fuse box is operational, labeled

  Yes

  No

  N/A

• Thermostat is working, behind lockbox

  Yes

  No

  N/A

• Closet is clean and organized

  Yes

  No

  N/A

Kitchen

• General Cleanliness

• Cabinets are clean and organized

  Yes

  No

  N/A

• Oven is clean

  Yes

  No

• Microwave is clean

  Yes

  No

• Sink is clean

  Yes

  No

• Refrigerator/Freezer is clean

  Yes

  No

• Food options/menus available

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

Dining Room

• General Cleanliness

• Table and chairs are intact and clean

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

• Windows intact and operational

  Yes

  No

  N/A

Living Room

• General Cleanliness

• Furniture Cleanliness

• Pictures/Artwork on walls

  Yes

  No

• Operable TV

  Yes

  No

• Games

  Yes

  No

• Working light bulbs

  Yes

  No

• Closet is clean and organized

  Yes

  No

  N/A

• Windows intact and operational

  Yes

  No

  N/A

• A/C unit is operational, filter is clean

  Yes

  No

  N/A

Brook #4

• Smell is acceptable

  Yes

  No

  N/A

Room 1

• General Cleanliness

• Is the bed being used?

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

  N/A

• Mirror

  Yes

  No

  N/A

• Escape Plan

  Yes

  No

• Closet is clean and organized

  Yes

  No

  N/A

• Windows intact and operational

  Yes

  No

  N/A

• Smoke Alarm (under 10 years old, with date of manufacture written on outside)

  Yes

  No

• Date of manufacture

Room 2

• General Cleanliness

• Is the bed being used?

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

  N/A

• Mirror

  Yes

  No

  N/A

• Escape Plan

  Yes

  No

• Closet is clean and organized

  Yes

  No

  N/A

• Windows intact and operational

  Yes

  No

  N/A

• Smoke Alarm (under 10 years old, with date of manufacture written on outside)

  Yes

  No

• Date of manufacture

Bathroom

• General Cleanliness

• Sink, shower and toilet are clean and operational

  Yes

  No

  N/A

• Floor clean, clear of mold and residue

  Yes

  No

• Working/matching light bulbs

  Yes

  No

Hallway

• General Cleanliness

• Working light bulbs

  Yes

  No

  N/A

• Fuse box is operational, labeled

  Yes

  No

  N/A

• Thermostat is working, behind lockbox

  Yes

  No

  N/A

• Closet is clean and organized

  Yes

  No

  N/A

Kitchen

• General Cleanliness

• Cabinets are clean and organized

  Yes

  No

  N/A

• Oven is clean

  Yes

  No

• Microwave is clean

  Yes

  No

• Sink is clean

  Yes

  No

• Refrigerator/Freezer is clean

  Yes

  No

• Food options/menus available

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

Dining Room

• General Cleanliness

• Table and chairs are intact and clean

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

• Windows intact and operational

  Yes

  No

  N/A

Living Room

• General Cleanliness

• Furniture Cleanliness

• Pictures/Artwork on walls

  Yes

  No

• Operable TV

  Yes

  No

• Games

  Yes

  No

• Working light bulbs

  Yes

  No

• Closet is clean and organized

  Yes

  No

  N/A

• Windows intact and operational

  Yes

  No

  N/A

• A/C unit is operational, filter is clean

  Yes

  No

  N/A

Brook #1

• Fire extinguisher (serviced within the last 12 months)

  Yes

  No

• New/Serviced/Recharged Date

• Weather radio (stays on when unplugged, has working batteries, tuned in)

  Yes

  No

• First Aid Kit

  Yes

  No

• Operational Flashlight

  Yes

  No

• All bulletin board items present

  Yes

  No

• Missing items

  Select Vulnerable Adult Act Emergency On-call Grievance Procedure 245D Facility/Program Abuse Prevention Plan HIPAA Current License

  • Vulnerable Adult Act
  • Emergency On-call
  • Grievance Procedure
  • 245D
  • Facility/Program Abuse Prevention Plan
  • HIPAA
  • Current License

• CO alarm in hallway (under 5 years old, with date of manufacture written on outside - 10 ft from sleeping)

  Yes

  No

• Date of manufacture

• Smoke alarm in hallway (under 10 years old, with date of manufacture written on outside)

  Yes

  No

• Date of manufacture

Brook #2

• Fire extinguisher (serviced within the last 12 months)

  Yes

  No

• New/Serviced/Recharged Date

• Weather radio (stays on when unplugged, has working batteries, tuned in)

  Yes

  No

• First Aid Kit

  Yes

  No

• Operational Flashlight

  Yes

  No

• All bulletin board items present

  Yes

  No

• Missing items

  Select Vulnerable Adult Act Emergency On-call Grievance Procedure 245D Facility/Program Abuse Prevention Plan HIPAA Current License

  • Vulnerable Adult Act
  • Emergency On-call
  • Grievance Procedure
  • 245D
  • Facility/Program Abuse Prevention Plan
  • HIPAA
  • Current License

• CO alarm in hallway (under 5 years old, with date of manufacture written on outside - 10 ft from sleeping)

  Yes

  No

• Date of manufacture

• Smoke alarm in hallway (under 10 years old, with date of manufacture written on outside)

  Yes

  No

• Date of manufacture

Brook #3

• Fire extinguisher (serviced within the last 12 months)

  Yes

  No

• New/Serviced/Recharged Date

• Weather radio (stays on when unplugged, has working batteries, tuned in)

  Yes

  No

• First Aid Kit

  Yes

  No

• Operational Flashlight

  Yes

  No

• All bulletin board items present

  Yes

  No

• Missing items

  Select Vulnerable Adult Act Emergency On-call Grievance Procedure 245D Facility/Program Abuse Prevention Plan HIPAA Current License

  • Vulnerable Adult Act
  • Emergency On-call
  • Grievance Procedure
  • 245D
  • Facility/Program Abuse Prevention Plan
  • HIPAA
  • Current License

• CO alarm in hallway (under 5 years old, with date of manufacture written on outside - 10 ft from sleeping)

  Yes

  No

• Date of manufacture

• Smoke alarm in hallway (under 10 years old, with date of manufacture written on outside)

  Yes

  No

• Date of manufacture

Brook #4

• Fire extinguisher (serviced within the last 12 months)

  Yes

  No

• New/Serviced/Recharged Date

• Weather radio (stays on when unplugged, has working batteries, tuned in)

  Yes

  No

• First Aid Kit

  Yes

  No

• Operational Flashlight

  Yes

  No

• All bulletin board items present

  Yes

  No

• Missing items

  Select Vulnerable Adult Act Emergency On-call Grievance Procedure 245D Facility/Program Abuse Prevention Plan HIPAA Current License

  • Vulnerable Adult Act
  • Emergency On-call
  • Grievance Procedure
  • 245D
  • Facility/Program Abuse Prevention Plan
  • HIPAA
  • Current License

• CO alarm in hallway (under 5 years old, with date of manufacture written on outside - 10 ft from sleeping)

  Yes

  No

• Date of manufacture

• Smoke alarm in hallway (under 10 years old, with date of manufacture written on outside)

  Yes

  No

• Date of manufacture

• Auditor Signature

  Sign

Comments

• NOTE: Medical and documentation scores, office assessment and some aspects of licensing score such as drills and server trackers are done for both Brook and Meadows sites simultaneously and given in the most recent Meadows audit.