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HCS437_r4_facility_study_form.doc

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University of Phoenix Material

Facility Study Form

Use this form to record your observations of the instructor-approved facility. You will be required to submit the completed form with the final learning team assignment in Week Five.

Long-Term Care Facility Checklist

Part I: Basic Information

Name of long-term care facility Alden of waterford
Address 2021 randi drive aurora il
Phone 630 692 0450
Cultural or religious affiliation, if any
	Yes	No
1. Is the facility Medicaid certified?	_y___	____
2. Is the facility Medicare certified?	_y___	____
3. Is private insurance accepted?	_y___	____
4. Are other forms of payment accepted? If so, what is accepted?
Answer: Medicaid, Medicare, private payment, and state assistance
Part II: Licensure and Accreditation
	Yes	No
1. Is the facility licensed by the Department of Public Health?	_y___	____
2. Is there a current license displayed in the facility?	_y___	____
3. Is the administrator licensed or certified according to state standards?	_y___	____
4. Does the facility hold any accreditations?	_y___	____
5. How long has this facility been in business? Is it part of a larger organization?
Answer: 17years a larger chain of care facitlies
*Long-Term Care Facility Checklist – Continued* Part III: Staff	Yes	No
1. Is there a registered nurse on duty during the day and a licensed practical nurse on duty at all times?	__y__	____
2. What are the hiring procedures and requirements for eligibility?
Answer: background check , drug test, and a screening process
3. How long has the current administrator been there?
Answer: 5 years
4. What is the staff-to-patient ratio during the day? At night? On weekends?
Answer: days 4 to 1 nights 6 to 1 and weekends 5 to 1
5. How are staff trained? Is there ongoing training or development?
Answer: yes, there is ongoing training all year long from care training to learning new equipment.
Part IV: Public Perception
	Yes	No
1. Does the facility have a good reputation?	___y_	____
2. Is the facility attractive? Well-maintained?	_y___	____
3. Does there appear to be positive interaction between staff and residents?	__y__	____
4. Do the residents appear content with their surroundings and quality of life?	__y__	____
5. Are visits allowed and/or encouraged at any time?	____	_n___

*Long-Term Care Facility Checklist – Continued* Part V: Other Concerns
	Yes	No
1. Has the facility experienced any complaints or corrective actions? Are they willing to discuss past problems and how they were resolved?	__y__	____
2. Do residents have a means of expressing their opinions and ideas, such as a council or organization?	__y__	____
3. Are there any survey reports and/or lists of resident rights posted?	__y__	____
4. (Your concern) this place gives care on many levels there is always places that all that could lack in my opinion.
5. (Your concern) resident council happens weekly with social worker so all complains are put in writing.
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