This scorecard guides you through what to observe, what to ask, and how to compare facilities after the tour. Use it on your phone during the visit, or print it before you go.
Pro tip: Visit unannounced when possible — or at least at a time you haven't pre-announced. Arrive near a mealtime (lunch or dinner) or in the early evening. These are when staffing gaps and culture problems show up most clearly.
Facility details
Include memory care section
✓ Good? Unsure✗ Concern
The entrance area is clean, well-lit, and welcoming
Not clinical or institutional-feeling
There is no strong odor of urine, feces, or heavy disinfectant
Persistent odor is the single most reliable indicator of chronic understaffing
Staff you pass acknowledge you and residents warmly
Not just the admissions staff — everyone you walk by
Common areas have residents present and engaged
Residents sitting alone staring at walls is a red flag
The facility feels calm — not chaotic or understaffed
Watch for rushed staff, unanswered call lights, raised voices
You can hear activity — conversation, TV, music — not silence
Silence in a facility often means residents are isolated in rooms
The building is well-maintained — no peeling paint, broken furniture, or hazards
You are greeted promptly when you arrive
How a facility treats visitors reflects how they treat residents' families
✓ Good? Unsure✗ Concern
Staff interact with residents by name and with warmth
Generic or transactional interactions are a warning sign
Staff are moving at a purposeful but not frantic pace
Frantic pace often means short-staffing; sluggish pace means low engagement
You observe staff sitting with or spending unhurried time with residents
Even a brief moment of genuine connection matters
Staff in common areas are engaged with residents, not gathered and chatting with each other
When a resident calls out or needs help, staff respond promptly
Observe this naturally — don't just rely on what staff tell you
The admissions staff answer your questions directly, not evasively
Vague or defensive answers to basic questions should concern you
Staff speak about residents with dignity, not pity or condescension
Listen for language — it reveals culture
✓ Good? Unsure✗ Concern
Residents appear clean, groomed, and dressed in their own clothes
Residents in hospital gowns in the afternoon is a red flag
Residents in common areas appear alert and reasonably comfortable
Not necessarily happy — but not in visible distress or sedated
You observe residents being assisted in a dignified, patient manner
You do not observe residents with visible signs of neglect — soiled clothing, unkempt appearance
Residents who are able to speak respond warmly or naturally when you pass
Residents who appear fearful or withdrawn are a significant concern
Residents have personal items — photos, plants, familiar objects — in their rooms
Personalization of space reflects a culture that honors individuality
✓ Good? Unsure✗ Concern
Hallways and common areas are clean and free of clutter or hazards
Ask to see an unoccupied room as well as a common one
Dining area is clean and set up before mealtime
A disorganized or dirty dining area before a meal is telling
There is no persistent unpleasant odor anywhere in the facility
Check hallways, resident room areas, and near the nursing station
Linens and bedding appear clean and fresh
Bathrooms and shower areas are clean and properly equipped
Check grab bars, shower chairs, non-slip surfaces
✓ Good? Unsure✗ Concern
Handrails are present and secure throughout hallways
Floors are dry, non-slip, and free of fall hazards
Wet floors, loose rugs, or clutter are fall risks
Call light cords are within reach of residents in rooms and bathrooms
Pull one gently — see how long it takes for a response
Emergency exits are clearly marked and unobstructed
The facility has visible protocols for managing wandering residents
Relevant even for non-memory care — residents with dementia may be present in any SNF
✓ Good? Unsure✗ Concern
The therapy gym or rehabilitation area is visible, active, and well-equipped
Especially important for short-term rehabilitation stays
You observe therapy being provided — not just the gym sitting empty
The nursing station is staffed and responsive
A frequently empty or chaotic nursing station is a staffing concern
Medication carts are organized and medications are being administered without rushing
The activity board or schedule shows varied, meaningful programming
Not just bingo — look for music, movement, cognitive engagement, outings
The facility has a visible care plan board or individual care documentation for residents
✓ Good? Unsure✗ Concern
Meal smells appealing and food appears well-prepared
If you visit at a mealtime, use your nose and eyes
Residents are being assisted with eating in a patient, dignified way
Rushed feeding or food being left untouched is a concern
The dining room is pleasant — tables set, social atmosphere
Not all residents eating alone in their rooms
Staff can explain dietary accommodation options clearly
Ask about special diets, allergies, personal food preferences
Ask these questions directly of the admissions coordinator or charge nurse. Write their answers — you will not remember them all. Evasive, vague, or overly polished answers deserve follow-up.
Question 1
What is your CNA (nursing aide) turnover rate in the past 12 months?
National average is ~99%/year. Below 40% is excellent. Above 60% means residents rarely see the same face twice.
Question 2
What is the nurse-to-resident ratio on the night shift and on weekends?
Evenings and weekends are when facilities are most under-resourced. A good facility answers this specifically. A vague answer is a red flag.
Question 3
Can you connect me with two or three families of current residents I could speak with independently?
A facility confident in their care will say yes. Reluctance is a signal. Any family you speak with is more candid than any staff member.
Question 4
What is your process when a family has a concern — who do we contact and what is the escalation path?
You want a clear, specific answer: charge nurse → DON → administrator → ombudsman. A vague answer means no process exists.
Question 5
Does this facility accept Medicaid, and if so, is there a separate Medicaid wing?
Many facilities have private-pay and Medicaid wings with different staffing levels. Know what your loved one will experience if they transition to Medicaid.
Question 6
What is your average response time to call lights, and how do you measure it?
Facilities that measure this are more likely to take it seriously. National guidelines suggest 5 minutes. Ask if they track it.
Question 7
What happens if my loved one's care needs exceed what this facility can provide?
You need to understand the transfer process before it becomes a crisis. A good facility has a clear, compassionate answer.
Question 8
When were you last surveyed by the state, and were any deficiencies cited?
Deficiencies are public record on Medicare's Care Compare. Asking directly — and seeing if the answer matches the record — tells you about transparency.
Overall gut feeling
After everything you've seen — how does this place feel? Trust your instincts. They matter.
Your overall impression
Notes from the visit
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Rate items above to see your summary
Your scorecard will update as you complete each section.