Care Quality Compliance Checklist Form
Complete this checklist to document a routine review of care quality compliance. Select the most accurate response for each item.
Overall cleanliness of the facility
*
1
2
3
4
5
Staff adherence to hygiene protocols
*
Fully compliant
Partially compliant
Non-compliant
Resident safety measures in place
*
All measures in place
Some measures in place
Measures lacking
Medication management compliance
*
Compliant
Minor issues
Non-compliant
Documentation accuracy and completeness
*
1
2
3
4
5
Staff responsiveness to resident needs
*
1
2
3
4
5
Resident satisfaction with care
*
1
2
3
4
5
Checklist of compliance items
*
Rows
Completed
Emergency exits accessible
1
Hand hygiene supplies available
2
Incident reports up to date
3
Food safety protocols followed
4
Are there any immediate action items required?
*
Yes
No
Additional comments or observations
Submit Checklist
Should be Empty: