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Resident Living Accommodations Yes <br />No <br />N/A <br />Comments/Other Observations <br />(please number comments) <br /> 8. Did residents describe their living environment as homelike? No 9. See note 1, above. A heavy perfume <br />odor upon entry to the facility was still <br />present. <br />10c. All restricted access rooms were <br />secured. <br /> <br />. <br /> 9. Did you notice unpleasant odors? Yes <br />10. Did you see items that could cause harm or be hazardous? No <br />10a. Were unattended med carts locked? Yes <br />10b. Were bathrooms clean, odor-free and free from hazards? Yes <br />10c. Were rooms containing hazardous materials locked? Yes <br />11. Did residents feel their living areas were kept at a reasonable <br />noise level? <br />Yes <br />12. Does the facility accommodate smokers? No <br />12a. Where? (Outside / inside / both) N/A <br />13. Were residents able to reach their call bells with ease? N/A <br />14. Did staff answer call bells in a timely & courteous manner? N/A <br />14a. If no, did you share this with the administrative staff? N/A <br /> <br />Resident Services Yes <br />No <br />N/A <br />Comments/Other Observations <br />(please number comments) <br />15. Were residents asked their preferences or opinions about the <br />activities planned for them at the facility? <br />Yes 15. One resident indicated that she had <br />no idea that there were any activities <br />offered at the facility. <br />15a. One resident indicated that <br />someone periodically comes to <br />play the piano and that they had <br />BINGO that day. There were no <br />activities during the visit. <br /> <br />17. One resident indicated that they are <br />provided snacks in the morning, <br />afternoon and night. <br />17b. Two residents agreed that they are <br />unable to get more than one cup of <br />coffee or tea during meals. They also <br />stated that they have to arrive in the <br />dining hall at 5:00 PM but are not <br />served until 5:45PM. <br />17c. There is no fresh ice water <br />available. <br />15a. Was a current activity calendar posted in the facility? No <br />15b. Were activities scheduled to occur at the time of your visit <br />actually occurring? <br />No <br />16. Do residents have the opportunity to purchase personal items of <br />their choice using their monthly needs funds? <br />Yes <br />16a. Can residents access their monthly needs funds at their <br />convenience? (#16 and 16a pertain only to residents on <br />Medicaid/Special Assistance. NHs $30 per month. ACHs $66 <br />minus medication co-pay and full cost OTC drugs) <br />Yes <br />17. Are residents asked their preferences about meal & snack <br />choices? (Adult Care Home residents should receive snacks <br />3X per day. Nursing Home residents should be offered snacks <br />at bedtime.) <br />No <br />17a. Are they given a choice about where they prefer to dine? Yes <br />17b. Did residents express positive opinions regarding their dining <br />experience (the food provided)? <br />Yes <br />17c. Is fresh ice water available and provided to residents? N/A <br />18. Do residents have privacy in making and receiving phone calls? Yes <br />19. Is there evidence of community involvement from other civic, <br />volunteer or religious groups? <br />No <br />20. Does the facility have a functioning: Resident’s Council? <br /> Family Council? <br />Yes <br />No <br /> <br /> <br /> <br /> <br /> <br /> <br />