Questions about Living Facilities and Agencies

This handout describes some questions you may wish to ask about any agency or living facility you are visiting.  It can also serve as an outline for a report on an agency or living facility.  Students writing Facility Visit Reports should see the note below.

Your name:

Course # and section:

Date:

Name of agency or facility:

Address and location:

Name of contact person:

Title:

Telephone number:

Summary description of agency or facility:

History of facility (when established, etc.):

What is goal of facility or Mission Statement of facility?

Scheduled activities / recreation / events?

Inpatient (residential) or outpatient (day care)?

Number of residents or clients:

Number of beds or rooms:

Special rooms, facilities, etc. (e.g. exercise rooms, eating rooms, dining rooms, cafeterias, day rooms, meeting rooms, etc.)

Funding for facility.  Public or private?  Government?  County, State, Federal?

Costs to clients:

Sliding fee scale?

How do most clients pay?  Medicare, medical insurance, private pay, etc

Number of staff:

Education and Training of staff:

What is your general impression?  Cleanliness, atmosphere, etc.?  Would you send your parents to this facility?  Why or why not?  Describe and discuss any other aspects of the agency or facility that are important or that made a particular impact on you.

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Note for students writing Facility Visit Reports.  Your agency report should be based on this form.  You have two options:

1. Fill in this form but expand the last section to include approximately one full page of narrative. 

2. Write a narrative report.   The narrative should describe your visit to the agency and should include key information such as the name of the agency, when you visited it, etc.  It then may go on to to describe what you saw, what the agency or facility is like, etc.  The narrative should be about two pages, and you should include this form as an attachment (staple the report and this form together).  You should fill out key parts of this form, but for longer sections of the form that you have covered in the report, you can just write "see report."