DESTINY MANAGEMENT Comprehensive Safety & Health Inspection Checklist - AFLs

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Anabel Elfrieda Jacobs
5 years ago
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1 Date: Site: 1. DMI will complete this checklist annually at each AFL site. 2. The AFL staff is responsible for correcting any deficiencies/problems/concerns. 3. On an annual basis, the appropriate MCO will complete an "Unlicensed AFL Health and Safety Review. This check list can be obtained from the DMI website: Notes: DMI Reviewer Risk Management/Safety Committee Review - Signature On-Site Inspection Review Revised: March 2013 Page 1 of 8

2 Emergency Drill completed monthly Hot water temp checked monthly at all water outlets accessed by client (Water Temperature / Thermometer Calibration Chart) Medication Storage Checklist completed monthly Medication Package Checklist completed for new and refilled prescription medications First Aid Kit / Blood Borne Pathogens Kit / Disaster Supply Kit Checklist completed monthly Back-up Staffing Plan in AFL Manual or client record data Clients who self medicate: N/A a. Physician's authorization for client to self medicate b. Medications are stored in a locked storage area/container and key separate from container Criminal background check updated annually: Staff name: Date: Any other individual living in household who provides caregiver services to the client i.e. back-up staff, spouse of staff person, etc... Name: Date: Name: Date: CPR certification current - Date: First Aid / Seizure Management certification current - Date: Medication Administration certification current for staff who administer medications or monitor client's self administration - Date: Crisis Services training Date: Incident Reporting training Date: Item General 1. Address number displayed on house and/or mailbox 2. Emergency Medical Plan/phone # s and Client Emergency Information located near telephone and in vehicle(s) Revised: March 2013 Page 2 of 8

3 3. Fire/ Evacuation Plans Posted one must be in client s bedroom or on their door (client must be able to see the plan, whether they can read or not) 4. Fire / Disaster Plan available 5. Disaster Supply - Three day supply of non-perishable food and water 6. Meals, food, and water available. Meals meet nutritional needs as identified in ISP e.g. low fat, diabetic etc Work Areas Conducive to Performance. 8. Facility Temperature (68-80 F) 9. Space for client privacy / visitation 10. Fire Inspection on file and current (licensed programs only) NA 11. Transportation - vehicle(s) has handicapped equipment to meet client NA needs 12. First Aid Kits accessible & stocked. a) Facility b) Vehicle (Agency) c) Supplies are within expiration date 13. Bloodborne Pathogen (PPE) Kits are stocked. a) Facility b) Vehicle (Agency) 14. Facility a. Large Enough to Accommodate Number of Clients Being Served, Architecturally b. Client bedroom allows for privacy and visitation Revised: March 2013 Page 3 of 8

4 c. Client has storage for personal belongings d. If bedroom is above or below ground entrance, client can move up/down steps independently General Home Environment 15. Housekeeping (Cleanliness) a. Storage neat & orderly b. Needed Repairs c. Adaptations to Meet Special/Anticipated Needs d. Garbage in standard containers/covered e. Garbage containers have no foul odors f. Outside garbage storage area clean g. Refrigerator/Microwave etc. clean h. Hot water temp deg F at each outlet accessed by client Temp: i. Refrigerator temp 45 deg F or below Temp: j. Refrigerator thermometer in place i. Freezer thermometer in place l. Freezer temperature-make sure items are frozen 16. Food area clean 17. Client bathroom clean 18. Client bathrooms has ventilation fan or window that operates 19. Client bathroom allows client easy access to toilet, sink, and tub/shower Revised: March 2013 Page 4 of 8

5 20. Client bathroom allows for privacy during toileting and bathing 21. Health/Sanitation: a. Soap & hand towels available b. Drinking cups c. Adequate hot & cold water d. Staff & clients wash hands after using restroom 22. Appearance a. Building Structurally Sound b. Facility/grounds are free of insects & rodents c. Facility/grounds are free from offensive odors Exterior of Building 23. Exterior illumination adequate at entrance / exit 24. All exterior lights functional 25. Outdoor equipment in good condition e.g. grills, patio furniture, hot tubs NA etc 26. Pools and other bodies of water are secured 27. Outside walking surfaces in good repair 28. Outside walking surfaces are clear of debris NA 29. Deadbolt locks needing a key on inside are not used 30. Walls and ceilings in good repair 31. Walls and ceilings clean 32. Stairs, steps, handrails & landings in good condition & are unobstructed and Revised: March 2013 Page 5 of 8

6 free of trip hazards 33. Stair landings are at each door opening 34. Balconies or raised floor areas above ground have sturdy railings present Interior 35. Interior lighting is adequate 36. All interior lights functional no missing bulbs 37. Electrical outlets checked No exposed live electrical parts on cords & receptacles, extension cords are not frayed, cut or damaged, ground pin not missing from cord, and outlets are not overloaded, power strips kept to a minimum. 38. Electrical outlets in bathrooms, kitchen counters, wet bars, garages, outdoors, and other areas exposed to water are on GFIC protected outlets AND work 39. Electrical cords are not attached to building surface or run through door/ceiling/wall 40. Hallways, ramps, doorways, entrances, steps, and corridors are free from obstructions 41. Exits are accessible, operable, and do not require a key or tool to open from inside 42. Hazardous/toxic supplies e.g. bleach, Revised: March 2013 Page 6 of 8

7 ammonia, are in an area that can be locked up when not being used. 43. Flammables in excess of 25 gallons (excluding fuel oil for heating) are not kept in the facility or in an attached/detached garage 44. No storage within 3 ft of heater/heat source 45. Chemicals have original label with name/hazards 46. Appliances are in working order & clean 47. Mats or rugs are secure or in a non-slip positioning 48. Fire Extinguisher - minimum of one (minimum 5 lb ABC) for each level of facility 49. Fire Extinguisher - each one UL approved 50. Fire Extinguishers are charged as indicated on the gauge. a) Home b) Vehicle 51. Fire extinguishers unblocked/accessible 52. Smoke detectors are located in client's bedroom, outside of bedroom, and on each level of home 53. Smoke detectors are working properly (Test to check battery). 54. If natural heat sources (including water heater) such as wood, gas, kerosene are used, carbon monoxide detector is installed and working 55. Toilet seats are secure. Revised: March 2013 Page 7 of 8

8 56. Windows have no cracks or breaks 57. Furniture is stable/in good repair. 58. Weapons (knives, guns etc.) are adequately secured / locked Revised: March 2013 Page 8 of 8

Home Safety Checklist

Home Safety Checklist This Home Safety Checklist is to help identify home hazards, make recommended safety changes, and prevent injuries in the home. Start in the main room of your home and walk through,