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WHCA 2026 Survey Survey
*
1.
Select your care setting:
(Required.)
Assisted living
Skilled nursing
*
2.
DSHS region
(Required.)
1
2
3
3.
Date(s) of full inspection/survey
*
4.
Number of citations (total) – identify in each area
(Required.)
Nursing/wellness
Housekeeping
Maintenance
Dining
Staff - training, performance
Infection control
Other
5.
Experience with the surveyors/licensors
1 star
2 stars
3 stars
4 stars
5 stars
6.
Upload your SOD/2567
Choose File
No file chosen
*
7.
What went well with the survey/inspection process?
(Required.)
*
8.
What things could be improved based on your experience with the state agency staff and the survey/inspection process?
(Required.)
9.
OPTIONAL: May we contact you with questions? (If yes, complete information below)
Name
Facility
Phone Number
Email
10.
Other comments
For SNF Questions: Email
Elena Madrid
For AL Questions: Email
Vicki McNealley
