Site Audit - Meadows (2018)

• Audit Title

Previous Quality Review

• Were the previous findings reviewed with the Designated Manager?

  Yes

  No

  N/A

• Are all maintenance 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

Meadows

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 are covering 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

• Fire extinguisher present (serviced within last 12 months)

  Yes

  No

• New/Serviced/Recharged Date

• 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

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

  Yes

  No

• Date of manufacture

Meadows #2

• Smell is acceptable

  Yes

  No

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 manufacture date written on the 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 manufacture date written on the 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

• Recipes 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

Meadows #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 manufacture date written on the 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 manufacture date written on the 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

• Recipes 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

Meadows #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 manufacture date written on the 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 manufacture date written on the 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

• Recipes 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

Office

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

  Yes

  No

  N/A

• Laptop is charged

  Yes

  No

  N/A

Outer Office

• General Cleanliness

• General Organization

• The front closet is organized

  Yes

  No

  N/A

• Conference table and chairs are clean and intact

  Yes

  No

  N/A

• Windows intact and operational

  Yes

  No

  N/A

• A/C unit is operational, filter is clean

  Yes

  No

  N/A

Inner Office

• General Cleanliness

• General Organization

• All required HR items posted

  Yes

  No

• Missing items

  Select Age Discrimination, April 2012 Minimum Wage and Overtime, July 2016 Safety and Health on the Job, October 2015 Unemployed, September 2015 Worker's Compensation, April 2012 Employee Polygraph Protection Act (EPPA), July 2016 Equal Employment Opportunity (EEO), November 2009 National Labor Relations Act, September 2011 Family and Medical Leave Act (FMLA), April 2016 Occupational Safety and Health Act (OSHA), 2015 Uniformed Services Employment and Reemployment Rights Act (USERRA), October 2008 OSHA Log

  • Age Discrimination, April 2012
  • Minimum Wage and Overtime, July 2016
  • Safety and Health on the Job, October 2015
  • Unemployed, September 2015
  • Worker's Compensation, April 2012
  • Employee Polygraph Protection Act (EPPA), July 2016
  • Equal Employment Opportunity (EEO), November 2009
  • National Labor Relations Act, September 2011
  • Family and Medical Leave Act (FMLA), April 2016
  • Occupational Safety and Health Act (OSHA), 2015
  • Uniformed Services Employment and Reemployment Rights Act (USERRA), October 2008
  • OSHA Log

• Inner office door was closed and locked upon inspection

  Yes

  No

• Client personal needs money effectively managed (if applicable)

  Yes

  No

• Is the Communication Book being filled out and used daily?

  Yes

  No

  N/A

• Is the cleaning checklist being fully completed daily?

  Yes

  No

  N/A

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

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

• Recipes available

  Yes

  No

  N/A

• Working light bulbs

  Yes

  No

Meadows #2

• Fire extinguisher (serviced within 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 with manufacture date written on outside - 10ft from sleeping)

  Yes

  No

• Manufacture date

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

  Yes

  No

• Manufacture date

Meadows #3

• Fire extinguisher (serviced within 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 with manufacture date written on outside - 10ft from sleeping)

  Yes

  No

• Manufacture date

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

  Yes

  No

• Manufacture date

Meadows #4

• Fire extinguisher (serviced within 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 with manufacture date written on outside - 10ft from sleeping)

  Yes

  No

• Manufacture date

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

  Yes

  No

• Manufacture date

Office

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

  Yes

  No

• Manufacture date

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

  Yes

  No

• Manufacture date

Licensing Book (All of B&M)

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

  Yes

  No

• Missing fire drills in site's licensing book:

  Select 01/2017 02/2017 03/2017 04/2017 05/2017 06/2017 07/2017 08/2017 09/2017 10/2017 11/2017 12/2017 02/2018 02/2018 (2) 03/2018 04/2018 05/2018 06/2018 07/2018 08/2018 09/2018 10/2018 11/2018 12/2018

  • 01/2017
  • 02/2017
  • 03/2017
  • 04/2017
  • 05/2017
  • 06/2017
  • 07/2017
  • 08/2017
  • 09/2017
  • 10/2017
  • 11/2017
  • 12/2017
  • 02/2018
  • 02/2018 (2)
  • 03/2018
  • 04/2018
  • 05/2018
  • 06/2018
  • 07/2018
  • 08/2018
  • 09/2018
  • 10/2018
  • 11/2018
  • 12/2018

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

  Yes

  No

• Missing tornado drills in site's licensing book:

  Select 01/2017 02/2017 03/2017 04/2017 05/2017 06/2017 07/2017 08/2017 09/2017 10/2017 11/2017 12/2017 02/2018 02/2018 (2) 03/2018 04/2018 05/2018 06/2018 07/2018 08/2018 09/2018 10/2018 11/2018 12/2018

  • 01/2017
  • 02/2017
  • 03/2017
  • 04/2017
  • 05/2017
  • 06/2017
  • 07/2017
  • 08/2017
  • 09/2017
  • 10/2017
  • 11/2017
  • 12/2017
  • 02/2018
  • 02/2018 (2)
  • 03/2018
  • 04/2018
  • 05/2018
  • 06/2018
  • 07/2018
  • 08/2018
  • 09/2018
  • 10/2018
  • 11/2018
  • 12/2018

Server and Trackers (All of B&M)

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

  Yes

  No

  N/A

• Missing fire drills on the server:

  Select 01/2017 02/2017 03/2017 04/2017 05/2017 06/2017 07/2017 08/2017 09/2017 10/2017 11/2017 12/2017 02/2018 02/2018 (2) 03/2018 04/2018 05/2018 06/2018 07/2018 08/2018 09/2018 10/2018 11/2018 12/2018

  • 01/2017
  • 02/2017
  • 03/2017
  • 04/2017
  • 05/2017
  • 06/2017
  • 07/2017
  • 08/2017
  • 09/2017
  • 10/2017
  • 11/2017
  • 12/2017
  • 02/2018
  • 02/2018 (2)
  • 03/2018
  • 04/2018
  • 05/2018
  • 06/2018
  • 07/2018
  • 08/2018
  • 09/2018
  • 10/2018
  • 11/2018
  • 12/2018

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

  Yes

  No

  N/A

• Missing tornado drills on the server:

  Select 01/2017 02/2017 03/2017 04/2017 05/2017 06/2017 07/2017 08/2017 09/2017 10/2017 11/2017 12/2017 02/2018 02/2018 (2) 03/2018 04/2018 05/2018 06/2018 07/2018 08/2018 09/2018 10/2018 11/2018 12/2018

  • 01/2017
  • 02/2017
  • 03/2017
  • 04/2017
  • 05/2017
  • 06/2017
  • 07/2017
  • 08/2017
  • 09/2017
  • 10/2017
  • 11/2017
  • 12/2017
  • 02/2018
  • 02/2018 (2)
  • 03/2018
  • 04/2018
  • 05/2018
  • 06/2018
  • 07/2018
  • 08/2018
  • 09/2018
  • 10/2018
  • 11/2018
  • 12/2018

• Programmatic paperwork is in compliance (Client Paperwork Compliance Master)

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Medical

• Do all medications appear to have been given correctly?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Second Checks

  Off

  On

• 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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is a Program Manager completing narc counts at least weekly?

  Yes

  No

  N/A

• Is there at least a week of meds on backup?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Documentation

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

  Yes

  No

  N/A

• 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

  Off

  On

• Supervisor review (daily, excluding days off)

• Number of notes opened and reviewed/completed within deadline:

• Program Manager Review

  Off

  On

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

• Number of notes opened and reviewed/completed within deadline:

• Auditor Signature

  Sign

Comments