Property performance review checklist
What does this form include?
This form contains 49 sections:
Community
Address Address
Phone #
Website
Capacity (Total Units)
Today's Census
Administrator
Hire/Promotion Date Date
Email
Mobile Phone
Name
Title
Critical Factors/Compliance
- Incident Reports: Incident Report procedure is being followed consistently per RMC policy. (Review Incident Reports and cross reference to Alert Charting, Progress Notices, Service Plan and MAR.)
Resident Identifier
Incident Report Date Date
Employee Name
Date of Incident Date
Cause of Incident
Type of Injury
Comments
Employee Identifier
Date of last performance appraisal. Date
Title/Position
Marketing
- YGL Utilization: YGL is up-to-date and evidence of meaningful relationships being built. (Review number of hot, warm and cold leads. Review number of deposits & scheduled move-ins. Review number of referral sources.)
- YGL Marketing Calendar: Is complete and updated on-going.(Review marketing calendar for community visits, phone calls, monthly events, and general contact with lead sources.)
Life Enrichment/Activities
- Personal Interest Interviews: Completed within 30 days of move-in. Original kept in Life Enrichment Binder with a copy on bright colored paper placed behind Service Plan.
Staffing
- Staffing Plan. Current staffing plan being followed. (Review staffing plan and compare with schedule and hours recorded on www.swipeclock.com.)
Memory Care
- Service Plans indicate interventions (using validation techniques) are adequately addressed, PRN medication indications are documented, and include monitoring of weight and nutrition. (Review MAR for PRN medications, and assure PRN parameters are indicated on service plan and MAR. Additionally, review service plans for evidence of documentation of validation attitudes and methods. Staff should be reading and updating daily. Check for fall interventions, presence of medications signs and symptoms, resident's social history info is present, cognitive interventions are listed if necessary, and behavioral interventions are listed to support resident during challenging times.)
- Environment. Courtyard/outdoor areas are accessible and free from hazards. Community is clean and odor free. No internal hazards present. (Inspect to ensure that no chemicals are accessible to residents, storage areas are locked, food in refrigerator is covered, labeled, dated and is not kept for more than three days.)
- Caregivers engaged with Elders, using Elder-directed strategies and validating attitudes. (Observe caregivers with residents. Caregivers should be interacting, guiding, and supporting the residents through their ADL's, mealtimes, and engaging in conversation with them using person-directed techniques and speaking with residents with validating attitudes as indicated in training.)
- Life Story Books and Social Histories: Completed for each Elder within 30 days of move-in and are utilized as part of the programming.
- Activity Calendar: Posted and mailed to family members monthly. Meets expectations for group and individual enrichment. (Observe activities - are activities done as scheduled? Is the Life Enrichment Program person-centered?)
- Residents: Residents are clean, well groomed, and happy. The environment reflects a spirit of joy, independence, and wellness.
- Dementia training. Initial and ongoing training and in-services conducted and documented in accordance with RMC and state regulations. Training includes support for employees to prevent burn-out. (Review documentation and cross-reference to state regulations.)
- Support Group offered consistently and meets the needs of the community's residents and family members. (Review support group process. If an internal support group exists, review calendar and attendees. If outside support group attended, review participation.)
Service Plans
- Current Assessment/Service Plans: All residents have current Service Plans.(Review 5 residents Assessment/Service Plans for timeliness, quarterly signatures of family members and other key staff. Service Level Summary Sheets kept in a binder, separate from Service Plans.)
- Care provided matches Service Plan. Evidence of staff documentation in the Service Plan to assure change of condition is noted. (Review 5 Service Plans with care staff and/or resident or family member and interview to determined whether services documented on service plan are actual services provided.)
Service Plan Date Date
Medication QA
- Medication Assistance Protocol: Is being followed per RMC Health Services Manual and state regulation. (Review systems to include health services review audit including MAR and Documentation audits are completed monthly, review of med card for cleanliness and organization, regular audits of the system are in a binder for review. Review MAR, progress notes, 24-hour book, alert charting, and Physician orders.)
- Medication Assistant Training: MAs have taken the state mandated training, if required and have also completed RMC Medication Assistant Training and skills checklist. (Review staff files documentation of training, including skills checklist and certifications. Records should indicate completion of MA skills checklist upon hire and monthly med pass observations.)
Dining Services
- HACCP program and audit tools are bing used per RMC guidelines.(Review audit documentation and protocols. Documentation of temp logs, weekly and monthly audits should be evident and organized in binders. Kitchen should be clean, all food/beverages in walk-in should be covered, labeled, and dated.)
- Food costs, when averaged over last 6 months are within budget. Spend-down sheets are used effectively. $4.85 or less = 20 points$4.85 - $5.00 = 10 points$5.01+ = 0 points
- Resident Food Council meets monthly and actively participates in expressing food/menu preferences. If Dietician consultation is required by state, review documentation/recommendations. (Review Food Council minutes and action items).
- Employee and guest meals are documented and emailed to RMC by the 5th of each month. (Ask Home Office staff is reports are received timely each month. Review process for collecting money for guest meals and depositing daily).
Accounts Payable
- Vendor files organized alphabetically per RMC regulations. Invoices are copied and filed after sending original to Home Office. (Review vendor files.)
Accounts Receivable
- Rents are collected consistently by the 5th of the month (excluding Medicaid). (Review Open Invoice Report)
- Collection process occurs timely and consistently for uncollected AR.(Review any late accounts for collection letter process, documented record of follow up and collection calls.
- Home Office staff indicate that the proper AR process is used consistently and correctly. (Interview HOme Office staff for feedback)
Physical Plant/Maintenance
- Community is clean and odor free.(Front entry way and front desk workspace should be presentable and free of clutter. Observe carpets, walls, doorways, walk-around community inside and outside.)
Financial Performance
- NOI average over previous 3 monthsNOI at or above budget = 60 pointsNOI within 3% of budget = 30 points
- Expenses averaged over past 3 monthsExpenses at or below budget = 60 pointsExpenses within 3% of budget = 30 points
Discussion and Financial Plan
Date of last State Survey Date
State Licensing
- Was a Plan of Correction Required?
- Was the Plan of Correction submitted for review by the Regional Director?
Date of last Medicaid Survey Date
Medicaid
- Was a Plan or Correction Required
- Was the Plan of Correction submitted for review by the Regional Director?
Ombudsman/Elder Protective Services
- Are there any current abuse allegations or protective service investigations?
Other Regulatory Issues
- Resident Call System - Review staff response times.
Total Score
Summary
Goal/Corrective Action Plan
Responsibility of
Timeframe for completion Date
Regional Director Review
Regional Director
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