Facility Assessment Tool


UPDATED JUNE 2024! This pdf fill-in-the-blank tool provides a user friendly method for compliance with the Facility Assessment completion requirement. The tool includes a combination of checklist worksheets, fill-in-the blank resource tables, and narrative response fill in items.


View Sample and Table of Contents


A comprehensive template to guide completion of the Facility Assessment in compliance with the RoP regulations. This pdf fill-in includes over 54 pages of tools & resources and was updated in June of 2024. Proactive’s Facility Assessment Tool allows each facility to complete the Assessment elements through a combination of checklist worksheets, fill in the blank resource tables, and narrative response with clarifying guidance on key considerations to clearly address each component. Once completed, the template is a printable Facility Assessment report.

If you have previously purchased the older version of this tool, please email info@proactiveltcexperts.com for information on purchasing the updated version at a discounted rate. 

Toolkit Includes:

      • Comprehensive Facility Assessment Data Collection Template with guided instructions for conducting the facility assessment process
      • Facility Assessment Annual Review Checklist
      • Sample Facility Assessment Policy & Procedure
      • Sample Contingency Plan
      • Sample Recruitment & Retention Plan
      • Sample Acuity Based Staffing Analysis based on PDPM Case Mix Group Assignment
      • Sample Procedure for Using PDPM Case-Mix Nursing Minutes for Staffing
      • Sample Guide to the Facility Assessment Process and Providing Feedback
      • Sample letter to staff and resident/families on Facility Assessment and Annual Review Process