Nursing Home Facility Audit Compliance Form

This Nursing Home Facility Audit Compliance Form is designed to ensure adherence to US regulatory standards. Assess compliance in resident care, facility environment, rights, documentation, staff training, and quality improvement. Emphasize thoroughness to enhance resident safety and well-being.

Facility Information
Nursing Home Name:
Address:
Phone Number:
Email:
Website:

Audit Information
Date of Audit:
Auditor Name:
Auditor Position:

Section 1: Regulatory Compliance

Federal Regulations
Are all federal regulations outlined in the Code of Federal Regulations (CFR) Title 42, Chapter IV, Subchapter G, Part 483 being met?	Yes No
If No, provide details:

State Regulations
Are all state regulations outlined in [State] Administrative Code, Chapter [Chapter Number], being met?	Yes No
If No, provide details:

Section 2: Resident Care

Staffing
Is the facility adequately staffed to provide appropriate care to residents?	Yes No
If No, provide details:

Quality of Care
Is the quality of care provided to residents in compliance with established standards?	Yes No
If No, provide details:

Medical Services
Are medical services, including physician visits and medication management, provided according to residents' needs?	Yes No
If No, provide details:

Section 3: Facility Environment

Cleanliness
Is the facility clean and well-maintained?	Yes No
If No, provide details:

Safety Measures
Are safety measures, such as fall prevention and emergency preparedness, in place and effective?	Yes No
If No, provide details:

Accessibility
Is the facility accessible to residents with mobility impairments?	Yes No
If No, provide details:

Section 4: Resident Rights

Privacy and Dignity
Are residents' privacy and dignity respected?	Yes No
If No, provide details:

Freedom from Abuse and Neglect
Are residents free from abuse and neglect?	Yes No
If No, provide details:

Informed Consent
Are residents provided with adequate information to make informed decisions about their care?	Yes No
If No, provide details:

Section 5: Documentation and Records

Medical Records
Are residents' medical records accurate, complete, and up-to-date?	Yes No
If No, provide details:

Documentation of Care
Is documentation of care provided to residents completed in a timely and thorough manner?	Yes No
If No, provide details:

Section 6: Staff Training and Competency

Training Programs
Are staff members adequately trained to perform their duties?	Yes No
If No, provide details:

Continuing Education
Are staff members provided with opportunities for continuing education and professional development?	Yes No
If No, provide details:

Section 7: Quality Improvement

Quality Assurance Programs
Does the facility have quality assurance programs in place to monitor and improve the quality of care?	Yes No
If No, provide details:

Incident Reporting and Analysis
Are incidents reported and analyzed to prevent future occurrences?	Yes No
If No, provide details:

Section 8: Recommendations and Follow-Up

Recommendations

Follow-Up Action Plan

(Outline steps to be taken to address deficiencies identified during the audit)

Audit Summary
Overall Compliance Rating:	Satisfactory Partially Satisfactory Unsatisfactory

[Month, Day, Year]