My Senior Solution Facility Search & Compare Form
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Use our handy form when visiting different facilities. It's a great reference. Print out and take with you. |
Facility 1 ______________________________________ |
Location ___________________________________________ |
Phone ___________ |
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Facility 2 ______________________________________ |
Location ___________________________________________ |
Phone ___________ |
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Facility 3 ______________________________________ |
Location ___________________________________________ |
Phone ___________ |
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Facility 1 |
Facility 2 |
Facility 3 |
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Yes/No |
Yes/No |
Yes/No |
1. Physical Structure |
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Facility presentable, in good repair & kept up? |
_____/_____ |
_____/_____ |
_____/_____ |
Is the facility clean and neat? |
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_____/_____ |
_____/_____ |
_____/_____ |
Is the facility quiet? |
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_____/_____ |
_____/_____ |
_____/_____ |
Are the halls free of clutter? |
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_____/_____ |
_____/_____ |
_____/_____ |
Does it have obvious odors? |
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_____/_____ |
_____/_____ |
_____/_____ |
It the temperature comfortable? |
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_____/_____ |
_____/_____ |
_____/_____ |
Residents regulate the heat in their room? |
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_____/_____ |
_____/_____ |
_____/_____ |
Is there a disaster evacuation plan? |
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_____/_____ |
_____/_____ |
_____/_____ |
Are there drills for disaster? |
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_____/_____ |
_____/_____ |
_____/_____ |
Safe area outside to sit in the warm weather? |
_____/_____ |
_____/_____ |
_____/_____ |
Is there an area for activities? |
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_____/_____ |
_____/_____ |
_____/_____ |
Are the resident rooms well ventilated? |
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_____/_____ |
_____/_____ |
_____/_____ |
Is there daily housekeeping service? |
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_____/_____ |
_____/_____ |
_____/_____ |
Rooms conveniently located in the facility? |
_____/_____ |
_____/_____ |
_____/_____ |
Is there sufficient closet space? |
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_____/_____ |
_____/_____ |
_____/_____ |
Is there a bathroom close by? |
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_____/_____ |
_____/_____ |
_____/_____ |
Do hand grips for safety in the bathroom? |
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_____/_____ |
_____/_____ |
_____/_____ |
Is there a call bell in the bathroom? |
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_____/_____ |
_____/_____ |
_____/_____ |
Is the shower easy to get in and out of? |
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_____/_____ |
_____/_____ |
_____/_____ |
Are the rooms comfortably furnished? |
_____/_____ |
_____/_____ |
_____/_____ |
Is there amenities such as a beauty shop or fitness area? |
_____/_____ |
_____/_____ |
_____/_____ |
Is there a smoking area? |
_____/_____ |
_____/_____ |
_____/_____ |
Are activities posted and age appropriate? |
_____/_____ |
_____/_____ |
_____/_____ |
Do residents participate in outings and social events? |
_____/_____ |
_____/_____ |
_____/_____ |
Does the facility provide assistance with bathing and grooming? |
_____/_____ |
_____/_____ |
_____/_____ |
Does the facility encourage involvement in community activities? |
_____/_____ |
_____/_____ |
_____/_____ |
Is the kitchen clean? |
_____/_____ |
_____/_____ |
_____/_____ |
Doors to kitchen lock & medication areas? |
_____/_____ |
_____/_____ |
_____/_____ |
Can residents use the kitchen? |
_____/_____ |
_____/_____ |
_____/_____ |
Is the dining area pleasant and comfortable? |
_____/_____ |
_____/_____ |
_____/_____ |
Can the resident make a suggestion for dinner plan or snack? |
_____/_____ |
_____/_____ |
_____/_____ |
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Facility 1 |
Facility 2 |
Facility 3 |
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Yes/No |
Yes/No |
Yes/No |
2. Staff |
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Is the home current with licensure/certifications and registration? |
_____/_____ |
_____/_____ |
_____/_____ |
Does the staff know the residents names? |
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_____/_____ |
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Does the staff take an interest and show respect to the residents? |
_____/_____ |
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Is there a respect for resident privacy? |
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_____/_____ |
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Do residents look clean, neat and cared for? |
_____/_____ |
_____/_____ |
_____/_____ |
Do the other residents look happy? |
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_____/_____ |
_____/_____ |
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Is the appearance of staff clean and neat? |
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_____/_____ |
_____/_____ |
_____/_____ |
Is there enough staff per resident ratio? |
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_____/_____ |
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Is there a resident call bell system? |
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_____/_____ |
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_____/_____ |
Is there a nurse on staff or on call? |
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_____/_____ |
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Facility control the residents medications? |
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_____/_____ |
_____/_____ |
_____/_____ |
Facility make needed Dr appointments? |
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_____/_____ |
_____/_____ |
_____/_____ |
Does the facility have a transport system? |
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_____/_____ |
_____/_____ |
_____/_____ |
Staff trained in emergency care or first aide? |
_____/_____ |
_____/_____ |
_____/_____ |
Facility 1 ______________________________________ |
Yes ________ |
No ________ |
Comments _____________________ |
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Facility 2 ______________________________________ |
Yes ________ |
No ________ |
Comments _____________________ |
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Facility 3 ______________________________________ |
Yes ________ |
No ________ |
Comments _____________________ |
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