LTC Resident Assessment Checklist - FREE PDF

Complete resident assessment for care planning.

  • Industry: Long-Term Care
  • Frequency: Admission / Quarterly / Annual
  • Estimated Time: 2-4 hours
  • Role: MDS Coordinator / Nursing
  • Total Items: 32
  • Compliance: CMS RAI, MDS 3.0, State Survey

Compliance Review

Review CMS RAI requirements.

  • Policy and procedure followed?
  • Documentation complete and accurate?
  • Regulatory requirements met?

Process Verification

Verify process implementation.

  • Staff competent in process?
  • Required equipment/supplies available?
  • Process effective for patient safety?

Patient/Resident Impact

Assess impact on patient care.

  • Patient safety maintained?
  • Patient dignity and rights respected?
  • Patient satisfaction addressed?

Findings & Corrective Actions

Document audit findings.

  • Audit Result
  • Deficiencies Found
  • Corrective Actions Required
  • Follow-up Required?
  • Auditor Signature

Pre-Assessment Information

Initial assessment documentation and patient/facility identification

  • Assessor Name / Credentials
  • Assessment Date
  • Department / Unit
  • Assessment Type (Routine/Annual/Complaint)
  • Previous assessment findings reviewed?

Infection Prevention & Control

Verify infection control practices per CDC and Joint Commission standards

  • Hand hygiene compliance observed?
  • Appropriate PPE available and properly used?
  • Isolation precautions properly implemented?
  • Sharps containers available and not overfilled?
  • High-touch surfaces properly disinfected?

Patient Safety & Identification

Verify patient safety protocols and identification procedures

  • Two patient identifiers used before procedures?
  • Fall risk assessment completed?
  • Call light within patient reach?
  • Bed in lowest position with brakes locked?

Medication Safety & Management

Verify medication handling and administration practices

  • Medications stored securely and at proper temperature?
  • Controlled substances properly secured and counted?
  • No expired medications in stock?
  • High-alert medications properly labeled?

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Why Use This LTC Resident Assessment Checklist?

This ltc resident assessment checklist helps long-term care teams maintain compliance and operational excellence. Designed for mds coordinator / nursing professionals, this checklist covers 32 critical inspection points across 8 sections. Recommended frequency: admission / quarterly / annual.

Ensures compliance with CMS RAI, MDS 3.0, State Survey. Regulatory-aligned for audit readiness and inspection documentation.

Frequently Asked Questions

What does the LTC Resident Assessment Checklist cover?

This checklist covers 32 inspection items across 8 sections: Compliance Review, Process Verification, Patient/Resident Impact, Findings & Corrective Actions, Pre-Assessment Information, Infection Prevention & Control, Patient Safety & Identification, Medication Safety & Management. It is designed for long-term care operations and compliance.

How often should this checklist be completed?

This checklist should be completed admission / quarterly / annual. Each completion takes approximately 2-4 hours.

Who should use this LTC Resident Assessment Checklist?

This checklist is designed for MDS Coordinator / Nursing professionals in the long-term care industry. It can be used for self-assessments, team audits, and regulatory compliance documentation.

Can I download this checklist as a PDF?

Yes, this checklist is available as a free PDF download. You can also use it digitally in the POPProbe mobile app for real-time data capture, photo documentation, and automatic reporting.

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