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Interview & Observation Renewal Inspection Questionnaire

Interview & Observation Renewal Inspection Questionnaire

     

 

1.  TYPE OF FACILITY
 
 
 
 
 
 
  
2.   
 
3.  Were you at the facility when the onsite inspection was conducted? 
     
  If yes, are you:
       
 
 
4.  Was the inspection process clearly explained to you upon the arrival of the licensing consultant/staff?
       
4a.   
 
5.  Did the licensing consultant/staff focus primarily on observations and interview of staff and residents to determine if you are in compliance?
     
6.  Which documents were reviewed during the inspection? Please check all that apply.
 
 
 
 
 
 
 
 
  
    
 
7.  Were you treated with courtesy, dignity, and fairness by the licensing consultant/staff?
     
    
 
8.  Did the licensing consultant/staff interact respectfully with facility staff and residents?
     
    
 
9.  Did the licensing consultant/staff offer you positive comments?
     
    
 
10.  Did the inspection interfere with the delivery of resident care?
      
    
 
11.  Using the scale listed below, choose the response that best describes your staffs' comments about the inspection:
 
 
 
 
 
  
    
 
12.  Using the scale listed below, choose the response that best describes your residents' comments about the inspection:
 
 
 
 
 
  
    
 
13.  Did you receive any notices of findings (NOF)?
     
    
 
14.  Did you receive any rule violations?
     
    
 
15.  If rule violations were identified, were you provided with technical assistance to assist you in meeting the requirements of the act and the rules?
       
    
 
16.  Were you offered or provided consultation to assist you in developing methods for the improvement of service?
     
    
 
17.  Were you offered or provided an exit interview to review the inspection findings?
     
    
 
18.  Were you given an opportunity to clarify incorrect or missing information?
       
    
 
19.  Following the exit interview, did you have any unresolved disagreement with the application of the rules?
     
    
 
20.  Was the licensing staff's supervisor involved in resolving the disagreement?
       
    
 
21.   
 
22.  Is there anything else that you believe the licensing consultant/staff should have evaluated?
     
    
 
23.  Do you prefer the current inspection process over the inspection process used in your facility previously?
       
    
 
24.  Based on your renewal inspection, how do you rate the following statement:

"The licensing renewal inspection process was a meaningful, accurate and balanced assessment of our compliance with the rules and our quality of care provided to residents."
 
 
 
 
 
  
   
 
25.  Is there any information that would have been beneficial to have prior to the renewal inspection?
     
    
 
  THE FOLLOWING SECTION IS OPTIONAL