D.7 QUARTERLY ENVIRONMENTAL REVIEW.pdf

HCHV Grant and Per Diem Program Quarterly Inspection

Inspection Date: FY Quarter

Location: Completed By:

Item Yes No N/A

A) Do residents have enough space and security for themselves and their belongings I) Are monthly room inspections being completed?

2) Are rooms free of excessive clutter and furniture (free access to exit)?

3) Are there secure locked containers for medications in all rooms?

B) Does each resident have an acceptable place to sleep?

1) Does daily log reflect nightly room checks, etc?

2) Do beds have plastic covers on mattresses?

3) Are fire extinguishers, etc being inspected monthly?

C) Are there sufficient sanitary facilities that are in proper operational condition?

1) Is there sufficient hot water?

2) Are bathrooms clean?

3) Is there hand soap and toilet paper available in all bathrooms?

D) Are there sanitary facilities that can be used in privacy?

1) Are bathrooms adequately lighted?

Item Yes No N/A

E) Are there adequate facilities and supplies for hand washing?

1) Is there hand soap and paper towels available in kitchen areas?

F) Is there adequate heating/cooling in proper operating condition?

1) Are furnaces in proper working order?

2) Are furnace rooms clear of combustibles and excessive clutter?

3) Do windows open in all rooms and are there screens in these windows?

G) Is there adequate illumination to permit normal indoor activities?

1) Are bulbs operational in all light sockets?

H) Do the food preparation areas have suitable space and equipment for preparing meals in a sanitary manner?

1) Is kitchen free of expired produce and bread?

2) Are weekly menus reflecting nutritious meals posted and current?

3) ls kitchen stove cleaned?

4) Are kitchen counter tops and other surfaces clean?

5) Is kitchen floor clean?

6) Are empty beverage bottles and cans being removed regularly?

7) Is kitchen sink empty and clean?

Item Yes No N/A

8) Do all garbage receptacles in common areas have lids on them?

9) Are garbage cans clean?

I) Are the food items kept in the refrigerator within their expiration dates?

1) Do refrigerator logs reflect daily temperature readings?

2) Is food in fridge dated?

3) Are leftovers labeled (i.e. name who they belong to)?

4) Are leftovers over one week old thrown out?

5) Are fridges and freezers clean?

6) Do freezer logs reflect daily temperature readings?

7) Is food in freezer dated?

8) Has freezer been defrosted recently?

9) Are canned foods in pantries being rotated according to expiration dates?

10) Are all food related items in pantries off the floor ( esp.

cardboard)?

11) Are food pantries floors are swept/mopped as needed?

J) Are residents with disabilities provided facilities to meet their needs?

K) Is patient confidentiality maintained?

Director of:

Name: Liaison Name:

Signature: Signature:

Item Yes No N/A

I) Are filing cabinets (holding patient files) locked?

2) Is daily log in a secure area?

L) Are the residents provided with a clean and sober environment?

I) Are both residences free of drug/alcohol paraphernalia?

M) Are the hours of operation and emergency contacts clearly posted?

I) Are hours of operation posted in an area that is accessible to Veterans?

2) Are the emergency contacts are posted (including crisis services)?

N) Are the exits accessible?

1) Are all egresses throughout either house clear of storage and other items?

2) Are Exit lights illuminated?