Physical

Previous Quality Review

Were the previous findings reviewed with the Designated Manager?

Are all maintenance entered into Landport?

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

Meadows
Outside
General Cleanliness

Yard free of weeds/debris

Tree trimmed, free of overhangs

Driveway free of weeds/debris

Gutters clean and in place

Mailbox intact/clear of obstructions

Cigarette butt can is available and being emptied

Summer

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

The property is free of beehives/wasp nests

The property is free of burrows of rodents or small animals

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

Plants around the property are trimmed and healthy

Winter

Salt on site

Shovel on site

Driveway plowed/shoveled and de-iced

Walkways shoveled and de-iced

Front Hallway
General Cleanliness

Railings are intact and secure

Flooring is in good condition

Working light bulbs

Closets organized

Back Hallway
General Cleanliness

Railings are intact and secure

Flooring is in good condition

Working light bulbs

Closets organized

Laundry Room
General Cleanliness

Clear of clothes on the floor

Fire extinguisher present (serviced within last 12 months)

New/Serviced/Recharged Date

Lint trap clean

There is a lint catcher on the washing machine exhaust hose

Working light bulbs

Boiler inspection current

Date of most recent boiler inspection/repair

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

Date of manufacture

Meadows #2

Smell is acceptable

Room 1
General Cleanliness

Is the bed being used?

Working light bulbs

Mirror

Escape Plan

Closet is clean and organized

Windows intact and operational

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

Date of manufacture

Room 2
General Cleanliness

Is the bed being used?

Working light bulbs

Mirror

Escape Plan

Closet is clean and organized

Windows intact and operational

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

Date of manufacture

Bathroom
General Cleanliness

Sink, shower and toilet are clean and operational

Floor clean, clear of mold and residue

Working/matching light bulbs

Hallway
General Cleanliness

Working light bulbs

Fuse box is operational, labeled

Thermostat is working, behind lockbox

Closet is clean and organized

Kitchen
General Cleanliness

Cabinets are clean and organized

Oven is clean

Microwave is clean

Sink is clean

Refrigerator/Freezer is clean

Recipes available

Working light bulbs

Dining Room
General Cleanliness

Table and chairs are intact and clean

Working light bulbs

Windows intact and operational

Living Room
General Cleanliness
Furniture Cleanliness

Pictures/Artwork on walls

Operable TV

Games

Working light bulbs

Closet is clean and organized

Windows intact and operational

A/C unit is operational, filter is clean

Meadows #3

Smell is acceptable

Room 1
General Cleanliness

Is the bed being used?

Working light bulbs

Mirror

Escape Plan

Closet is clean and organized

Windows intact and operational

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

Date of manufacture

Room 2
General Cleanliness

Is the bed being used?

Working light bulbs

Mirror

Escape Plan

Closet is clean and organized

Windows intact and operational

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

Date of manufacture

Bathroom
General Cleanliness

Sink, shower and toilet are clean and operational

Floor clean, clear of mold and residue

Working/matching light bulbs

Hallway
General Cleanliness

Working light bulbs

Fuse box is operational, labeled

Thermostat is working, behind lockbox

Closet is clean and organized

Kitchen
General Cleanliness

Cabinets are clean and organized

Oven is clean

Microwave is clean

Sink is clean

Refrigerator/Freezer is clean

Recipes available

Working light bulbs

Dining Room
General Cleanliness

Table and chairs are intact and clean

Working light bulbs

Windows intact and operational

Living Room
General Cleanliness
Furniture Cleanliness

Pictures/Artwork on walls

Operable TV

Games

Working light bulbs

Closet is clean and organized

Windows intact and operational

A/C unit is operational, filter is clean

Meadows #4

Smell is acceptable

Room 1
General Cleanliness

Is the bed being used?

Working light bulbs

Mirror

Escape Plan

Closet is clean and organized

Windows intact and operational

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

Date of manufacture

Room 2
General Cleanliness

Is the bed being used?

Working light bulbs

Mirror

Escape Plan

Closet is clean and organized

Windows intact and operational

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

Date of manufacture

Bathroom
General Cleanliness

Sink, shower and toilet are clean and operational

Floor clean, clear of mold and residue

Working/matching light bulbs

Hallway
General Cleanliness

Working light bulbs

Fuse box is operational, labeled

Thermostat is working, behind lockbox

Closet is clean and organized

Kitchen
General Cleanliness

Cabinets are clean and organized

Oven is clean

Microwave is clean

Sink is clean

Refrigerator/Freezer is clean

Recipes available

Working light bulbs

Dining Room
General Cleanliness

Table and chairs are intact and clean

Working light bulbs

Windows intact and operational

Living Room
General Cleanliness
Furniture Cleanliness

Pictures/Artwork on walls

Operable TV

Games

Working light bulbs

Closet is clean and organized

Windows intact and operational

A/C unit is operational, filter is clean

Office

Is there a calendar or Procentive schedule posted for ARMHS and therapy appointments?

Laptop is charged

Outer Office
General Cleanliness
General Organization

The front closet is organized

Conference table and chairs are clean and intact

Windows intact and operational

A/C unit is operational, filter is clean

Inner Office
General Cleanliness
General Organization

All required HR items posted

Missing items

Inner office door was closed and locked upon inspection

Client personal needs money effectively managed (if applicable)

Is the Communication Book being filled out and used daily?

Is the cleaning checklist being fully completed daily?

Bathroom
General Cleanliness

Sink, shower and toilet are clean and operational

Floor clean, clear of mold and residue

Working/matching light bulbs

Kitchen
General Cleanliness

Cabinets are clean and organized

Oven is clean

Microwave is clean

Sink is clean

Refrigerator/Freezer is clean

Recipes available

Working light bulbs

Licensing

Meadows #2

Fire extinguisher (serviced within last 12 months)

New/Serviced/Recharged Date

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

First Aid Kit

Operational Flashlight

All bulletin board items present

Missing items

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

Manufacture date

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

Manufacture date

Meadows #3

Fire extinguisher (serviced within last 12 months)

New/Serviced/Recharged Date

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

First Aid Kit

Operational Flashlight

All bulletin board items present

Missing items

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

Manufacture date

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

Manufacture date

Meadows #4

Fire extinguisher (serviced within last 12 months)

New/Serviced/Recharged Date

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

First Aid Kit

Operational Flashlight

All bulletin board items present

Missing items

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

Manufacture date

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

Manufacture date

Office

CO alarm in hallway (under 5 years with manufacture date written on outside)

Manufacture date

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

Manufacture date

Licensing Book (All of B&M)

Are all Fire Drills (assigned via email) up to date in the Licensing Book?

Missing fire drills in site's licensing book:

Are Tornado Drills (assigned via email) up to date in the Licensing Book?

Missing tornado drills in site's licensing book:
Server and Trackers (All of B&M)

All fire drills (assigned via email) are current and uploaded to the server

Missing fire drills on the server:

All tornado drills (assigned via email) are current and uploaded to the server

Missing tornado drills on the server:

Programmatic paperwork is in compliance (Client Paperwork Compliance Master)

The site has no overdue staff orientations (Orientation Checklist Tracker)

Person-specific trainings are complete and up to date (Person-Specific Training Master)

Medical (All of B&M)

Medical

Do all medications appear to have been given correctly?

Are the backs of the med packs fully initialed, dated and timed?

Second Checks

Second check sheet completion
0: 0% complete
1: At least 25% complete
2: At least 50% complete
3: At least 75% complete
4: 100% complete

Was medication closet closed and locked, and were all narcotics stored in a locked box, upon inspection?

Are narc counts accurate and being completed daily and during each administration?

Are all narc counts double signed (shift change only)?

Is a supervisor completing narc counts daily (excluding weekends)?

Is a Program Manager completing narc counts at least weekly?

Is there at least a week of meds on backup?

Are liquid and solid medications kept in separate bins, or separated by an airtight plastic bag?

Is there an assigned med passer for every shift for at least the current week?

Are HPN's being completed on CaraSolva at a minimum of weekly?

Documentation (All of B&M)

Documentation

Were all DPN's created for each day and for each client since the last audit?

Rating scale
0: 0% complete
1: At least 24% complete
2: At least 50% complete
3: At least 75% compelte
4: 100% complete

Staff completion (daily)

Number of completed notes:

Supervisor Review

Supervisor review (daily, excluding days off)

Number of notes opened and reviewed/completed within deadline:

Program Manager Review

Program Manager review (weekly, 3 business days if no SS)

Number of notes opened and reviewed/completed within deadline:

Signature and Comments

Auditor Signature
Comments

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.