Print one sheet for each home you visit, and a page of what matters to the person moving in.
Covelight CareVisit checklist
What matters to the person moving in. Fill it in together, first.
This column belongs to the person moving. Fill it in together, before the tours — then hold every home’s answers up against it.
Question
Notes
My daily rhythmWhen do I like to wake, eat, nap, go to bed? Which parts of my day are non-negotiable?HSC §1569.269(a)(8)
Food that matters to meWhat do I actually like to eat? What would I miss? (Ask each home what was on the table this week.)
What I’m bringingMy chair, my quilt, my radio, my photos — which everyday things come with me?HSC §1569.269(a)(30)
Who visits meWho comes by, and when? Can they visit the way we’re used to?HSC §1569.269(a)(24)
My room, my roommateDo I want my own room? If shared, who would I share with — and could I meet them first?HSC §1569.269(a)(16)–(18)
Services I don’t wantWhich activities or services would I rather skip? (Declining is my right.)HSC §1569.269(a)(31)
What would make me have to leaveAsk each home to show this list from its admission agreement — in writing, before signing.HSC §1569.269(a)(15)
Six things to notice while you’re there
Whether the current license is posted where you can see it, and the name on it.
How staff speak to residents when they don’t know you’re listening.
What residents are doing mid-afternoon — activity, company, or a television.
How the home smells, in the common room and near the bedrooms.
Whether the posted menu matches what is actually being served.
How you are shown the room: freely, or steered.
Covelight CareVisit checklist
Familycare Cottage IV
License 565801978 · 6 beds, small home · Thousand Oaks
Phone: (805) 380-4108, from the state record
Date of visit:Who we met:
covelightcare.com/f/565801978
On the state record:Non-ambulatory (fire clearance) ✓on the state recordDementia designation not on fileHospice care waiver ✓on the state recordBedridden (fire clearance) ✓on the state record
Before you call
☐Do you have an opening now, or when do you expect one?
☐What is the base monthly rate, and what does it include?
☐What does each extra cost: a higher care level, medicines help, incontinence supplies, transport?
☐Do you accept the SSI rate, or Medi-Cal’s Assisted Living Waiver, if their savings run out?
On the visit
☐Who is the administrator, and how long have they run this home?
☐How many caregivers are on duty during the day? Who is in the building at night, and are they awake?
☐May we see your most recent state inspection report together?
☐Do you care for residents with dementia? May we see your written description of your dementia program?
☐May we visit again without an appointment, at another time of day?
Before you sign
☐May we take the admission agreement home to read before signing? (Look for rate increases, refund terms and arbitration clauses.)
☐May we have your rate-increase disclosure for the last three years?
☐What would make you ask a resident to move out? Please put it in writing.
☐Can you put the full monthly cost for these care needs in writing?
What would make me have to leaveHSC §1569.269(a)(15)
Not on file: the home’s own list of what could end a stay. Not on file is not a no — most homes have not yet been asked. Ask for it in writing. It is in the admission agreement, and you may have a blank copy before signing.
After the visit, together
What did the person moving in notice that nobody else did?
Notes
Familycare Cottage IV
Thousand Oaks · License 565801978
Six things to notice while you’re there
Whether the current license is posted where you can see it, and the name on it.
How staff speak to residents when they don’t know you’re listening.
What residents are doing mid-afternoon — activity, company, or a television.
How the home smells, in the common room and near the bedrooms.
Whether the posted menu matches what is actually being served.
How you are shown the room: freely, or steered.
Your ticks and notes stay on this phone. When the home is in your saved homes, its notes also go to its note there.