Adult Day Care Facility Survey Tools, Forms and Guidelines
Survey Tools:
The survey tool consists of the applicable ARMs and MCAs. It is formatted in a table for easier understanding and application. This is the same form surveyors use to determine compliance when they visit your facility. The additional forms used during an on-site survey are also provided.
- All Health Care Facility ARM Survey Tool
- Adult Day Care Facility ARM Survey Tool:
- Restraint and Safety Device Survey Tool:
- Restraint and Safety Device ARM 37.106.2902 Definitions
- Employee File Review (Excel Format only)
- Resident File Review (Excel Format only)
- General Information
- Statement of Deficiencies and Plan of Correction Form
Complaint Survey Tools:
When conducting a complaint survey, in addition to the applicable survey tools listed above, the health care facility surveyor will also use the following tools to organize and analyze the collected data. This procedure may also be beneficial for the provider/administrator when conducting a facility investigation and/or follow-up on an incident/accident report.
- Investigation Log
- Complaint Analysis Tool
