Worksheet for Choosing a Residential Care Facility
 

 

 Choosing a residential care facility for your senior may well be the most important decision you and your senior make in many years. We have prepared this worksheet to assist you when you are selecting your senior's new home. Answer each question from 0-3, with 3 being the highest.. Please feel free to bring this worksheet with you when you visit our home. Print out extra copies and take them with you when you visit other facilities. Then, if possible, sit down with your senior and make a decision together. This worksheet may help you think of other questions or information that you may like to ask. We welcome all of your questions. - PLEASE NOTE - This worksheet is also available as a Microsoft® Word® document (2 pages) for easy download and printout by clicking here. (Worksheet as a PDF  ) The document is an Adobe PDF. Acrobat Reader is free for downloading by clicking on the icon above.

         
First Impressions
0 1 2 3  
ٱ ٱ ٱ ٱ Is the staff pleasant, friendly, and helpful?
ٱ ٱ ٱ ٱ Do the people who live there seem comfortable and happy?
ٱ ٱ ٱ ٱ Is the building clean and odor free?
ٱ ٱ ٱ ٱ Is there a place for private conversation?
ٱ ٱ ٱ ٱ Is there an outside patio or garden area?
ٱ ٱ ٱ ٱ Is there a private area for visiting with family and friends?
ٱ ٱ ٱ ٱ Is my loved one's language spoken at the facility? If not, how will they communicate with my loved one?
ٱ ٱ ٱ ٱ Is my language spoken at the facility? If not, how will the staff communicate with me?
ٱ ٱ ٱ ٱ Is the facility in a good location (close enough for friends and family to visit)? Is there a bus stop and stores nearby?
ٱ ٱ ٱ ٱ Is there parking for visitors?
ٱ ٱ ٱ ٱ Are family and friends encouraged to visit?
General Policies
0 1 2 3  
ٱ ٱ ٱ ٱ Can my loved one bring his/her own belongings, pictures to hang, keepsakes, etc.?
ٱ ٱ ٱ ٱ Will my loved one be sharing a room? Is there an extra charge for a private room?
ٱ ٱ ٱ ٱ Can my loved one have his/her own telephone and/or television?
ٱ ٱ ٱ ٱ What are the rules about visiting? Hours? Children? Pets?
ٱ ٱ ٱ ٱ What are the rules about leaving the care facility for a short period of time? (vacation, home visits, hospitalization, holidays)
Resident Bedrooms
1 2 3 4  
ٱ ٱ ٱ ٱ Is the room cheerful, clean, and well-decorated?
ٱ ٱ ٱ ٱ Is there a window to look out of ? What is the view?
ٱ ٱ ٱ ٱ Are the bed and chair comfortable?
ٱ ٱ ٱ ٱ Is there enough space to move a wheelchair around, if needed?
ٱ ٱ ٱ ٱ How much storage and closet space is available?
ٱ ٱ ٱ ٱ Is there a locked cupboard or drawer?
ٱ ٱ ٱ ٱ Is there adequate lighting?
ٱ ٱ ٱ ٱ Is there a call system?
ٱ ٱ ٱ ٱ Can my loved one's personal physician care for me after he/she is living in the facility?
ٱ ٱ ٱ ٱ How many staff are on duty at night?
ٱ ٱ ٱ ٱ What is the staff/resident ratio during the day and evening?
ٱ ٱ ٱ ٱ Is the care facility connected with a pharmacy for medications?
ٱ ٱ ٱ ٱ What are the rules about showers and baths?
ٱ ٱ ٱ ٱ Does a foot doctor visit the facility on a regular schedule? What is the schedule?
ٱ ٱ ٱ ٱ Are items familiar to the resident's past part of his or her room?
ٱ ٱ ٱ ٱ Does the facility have a Social Worker that can help my loved one or me if needed?
Personal Services
0 1 2 3  
ٱ ٱ ٱ ٱ What clothing can be sent to the laundry?
ٱ ٱ ٱ ٱ How often does the housekeeping staff clean the bedroom?
ٱ ٱ ٱ ٱ Is the staff available to take my loved one to medical appointments?
Food Service
0 1 2 3  
ٱ ٱ ٱ ٱ How is the food prepared?
ٱ ٱ ٱ ٱ Is the dining room clean and pleasant?
ٱ ٱ ٱ ٱ What are the dining times? Can my loved one's breakfast hour be changed?
ٱ ٱ ٱ ٱ Are there snacks between meals?
ٱ ٱ ٱ ٱ May guests be invited to stay for a meal?
Activities and Programs
0 1 2 3  
ٱ ٱ ٱ ٱ Can my loved one pursue his/her own hobbies in the care facility?
ٱ ٱ ٱ ٱ Are there church services held in the care facility? Will a minister or rabbi visit if desired?
The Physical Environment
0 1 2 4  
ٱ ٱ ٱ ٱ Is there enough room for residents to walk and move about freely?
ٱ ٱ ٱ ٱ Is there a safe and secure outside area?
ٱ ٱ ٱ ٱ Are the residents' bedrooms private?
ٱ ٱ ٱ ٱ Are there separate areas for dining and activities? Do these areas look as "normal" as they would in a home.
The Approach to Care
0 1 2 3  
ٱ ٱ ٱ ٱ Are care routines flexible? Is the staff willing and able to adjust their timing of care to fit the needs of the resident?
ٱ ٱ ٱ ٱ Does the staff use a resident care program that provides them with specific information about each resident's routine, background, preferences, etc.?
ٱ ٱ ٱ ٱ Is the client's family considered a key part of the care process? Are they welcomed and in encouraged to be involved in care decisions? Are they kept informed?
 
Quail Garden | 813 South J Street | Livermore, CA 94550 | (925) 449-4411 | info@quailgarden.com