Quality of Care Assessment and Rounds Forms
This file contains forms and checklists for assessing and monitoring quality of care in long-term care facilities. It provides tools for daily, weekly, or monthly use to ensure compliance with standards. Use these forms to document deficiencies and corrective actions.
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How do I fill this out?
To fill out this file, identify the specific area or department to be assessed or monitored. Use the given checklists and forms to evaluate the current status and mark satisfactory or unsatisfactory ratings. Document any comments and corrective actions needed.

How to fill out the Quality of Care Assessment and Rounds Forms?
1
Identify the area or department to be assessed.
2
Use the relevant checklist from the file.
3
Mark ratings as satisfactory or unsatisfactory for each item.
4
Document comments and any corrective actions required.
5
Report findings in Quality Assurance meetings.
Who needs the Quality of Care Assessment and Rounds Forms?
1
Nursing Home Administrators: To ensure compliance with care standards.
2
Quality Assurance Officers: To monitor and improve care quality.
3
Facility Managers: To identify and document areas needing maintenance.
4
New Employees: To learn about the assessment process.
5
Consultants: To provide recommendations for care improvement.
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What are the instructions for submitting this form?
To submit this form, complete all the relevant sections and ensure all ratings, comments, and corrective actions are documented. Send the completed form via email to qa@longtermcare.com or fax it to (123) 456-7890. Alternatively, you can use our online submission form available on our website or mail the physical copy to Long Term Care Facility, 123 Care Road, Healthcity, HC 12345. Ensure all submissions are made promptly to maintain compliance and care standards.
What is the purpose of this form?
The purpose of this form is to ensure continuous monitoring and assessment of quality care within long-term care facilities. It helps administrators and quality assurance officers identify areas that require attention and document the necessary actions to meet compliance standards. Regular use of these forms ensures that facilities are always survey-ready and maintain a high standard of care for residents.

Tell me about this form and its components and fields line-by-line.

- 1. Physical Plant & Environment: Evaluates the maintenance and cleanliness of the facility's physical environment.
- 2. Entrances/Lobbies: Checks the condition and cleanliness of entrances and lobby areas.
- 3. Corridors/Common Areas: Assesses the cleanliness and maintenance of hallways and common areas.
- 4. Clinical Visits Assessments: Tracks and evaluates clinical visits and care plans.
- 5. Dietary Infection Control: Monitors infection control practices in the dietary department.
- 6. Housekeeping: Assesses the effectiveness of housekeeping practices.
- 7. Rehabilitation Department: Evaluates the services and practices of the rehabilitation department.
- 8. Nursing Department: Monitors the quality of care provided by the nursing staff.
- 9. Laundry: Checks the cleanliness and maintenance of the laundry area.
What happens if I fail to submit this form?
Failing to submit this form can result in serious consequences for the facility. Compliance issues and unmet care standards may arise.
- Non-Compliance: The facility may not meet federal and state regulations.
- Quality of Care: Care standards may decline, affecting resident well-being.
- Legal Issues: The facility may face legal actions for failing to document and rectify deficiencies.
How do I know when to use this form?

- 1. Daily Rounds: Perform daily rounds to monitor critical areas.
- 2. Weekly Assessments: Use for weekly quality assurance assessments.
- 3. Monthly Reviews: Conduct monthly reviews to document ongoing compliance.
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