Assisted Living Performance Measures Questions Survey

1. Please identify how your assisted living community measures resident and family satisfaction. Mark all that apply.

Please identify how your assisted living community measures resident and family satisfaction. Mark all that apply. My InnerView

Different outside organization

Internal satisfaction survey

Do not currently measure satisfaction

2. Please identify how your assisted living community measures employee satisfaction. Mark all that apply.

Please identify how your assisted living community measures employee satisfaction. Mark all that apply. My InnerView

Different outside organization

Internal satisfaction survey

Do not currently measure satisfaction

3. What was your the average census/occupancy rate for December 2009, rounded to the nearest whole percent?

What was your the average census/occupancy rate for December 2009, rounded to the nearest whole percent? 96-100%

91-95%

85-90%

80-84%

Less than 80 %

4. Does your community have a resident council that meets at least quarterly and encourages resident participation?

Does your community have a resident council that meets at least quarterly and encourages resident participation? Yes

No

5. Does your community leadership meet regularly with the leaders of the resident council?

Does your community leadership meet regularly with the leaders of the resident council? Yes

No

6. Does your community have a family council that meets at least quarterly and encourages family participation?

Does your community have a family council that meets at least quarterly and encourages family participation? Yes

No

7. Does your community leadership meet regularly with the leaders of the family council?

Does your community leadership meet regularly with the leaders of the family council? Yes

No

8. Does your community have a mission statement?

Does your community have a mission statement? Yes

No

9. Is your staff trained on the mission statement?

Is your staff trained on the mission statement? Yes

No

10. Does your community have a vision statement?

Does your community have a vision statement? Yes

No

11. Is your staff trained on the vision statement?

Is your staff trained on the vision statement? Yes

No

12. Do you have a strategic plan that incorporates these statements?

Do you have a strategic plan that incorporates these statements? Yes

No

13. Does your strategic plan incorporate performance data collected by the community?

Does your strategic plan incorporate performance data collected by the community? Yes

No

14. Is your staff trained on the goals of the strategic plan?

Is your staff trained on the goals of the strategic plan? Yes

No

15. Does your community review incident reports for residents?

Does your community review incident reports for residents? Yes

No

16. Does your community review incident reports for staff?

Does your community review incident reports for staff? Yes

No

17. Does your community track incident reports for family members and/or volunteers?

Does your community track incident reports for family members and/or volunteers? Yes

No

18. Does your community have a safety committee?

Does your community have a safety committee? Yes

No

19. If you answered "yes" to 18, does your safety committee meet at least quarterly to review incident reports and available data to identify trends and patterns of risk?

If you answered "yes" to 18, does your safety committee meet at least quarterly to review incident reports and available data to identify trends and patterns of risk? Yes

No

Not applicable

20. If you answered "yes" to 19, do you conduct staff training as a result of that analysis?

If you answered "yes" to 19, do you conduct staff training as a result of that analysis? Yes

No

Not applicable

21. Do you have a licensed nurse available to the staff and residents 24 hours a day?

Do you have a licensed nurse available to the staff and residents 24 hours a day? Yes

No

22. If you answered "yes" to 21, please indicate how the licensed nurse is made available. Please mark all that apply.

If you answered "yes" to 21, please indicate how the licensed nurse is made available. Please mark all that apply. On-site

Pager

Beeper

Telephone

Not applicable

23. Does your community conduct criminal background checks on all new employees?

Does your community conduct criminal background checks on all new employees? Yes

No

24. What is the size of your community?

What is the size of your community? 0-25 beds

26-50 beds

51-100 beds

>100 beds

*

25. Please enter your community's name and address below.

Please enter your community's name and address below. Community:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:

26. Person completing survey:

Person completing survey: Name:
Email Address:
Phone Number: