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Quick Organizational Self-Assessment

Rate where you are on a scale of 1—10, (1 = Never; 10 = Always). Indicate areas you will target for improvement. You can use this self-assessment to have discussions with staff, residents, and families about their perceptions and experiences. Re-assess throughout the year to see how far you've come.

 Facility Name:                                   Completed by (Name and Position):
Organizational Practice
Rate (1-10)
work on
Individualized Care from the MDS Section F  (Web. Five and Seven)
1. Residents choose their own bedtime   
2. Residents choose between a tub bath, shower, bed bath, or sponge bath
3. Residents do their favorite activities   
Individualized Care from QIS Resident Interview (Web. Five and Seven)
4. Residents make decisions regarding food choices/ preferences   
5. Residents choose when to get up   
6. Residents are involved in decisions about their daily care   
Relational Coordination
7. Daily CNA documentation aligns with MDS on Mood, Customary Routines, and Functional Status, and QIS Resident Interview (Web. One)
8. CNAs and nurses have consistent assignments; residents have no more than 10 CNAs taking care of them in a given week (Webs. One and Two)   
9. CNAs participate actively in care plan meetings (Web. Two)    
10. CNAs and nurses have a start of shift huddle (Web. Two)   
11. At shift hand-off, CNAs and nurses from both shifts huddle (Web. Two)   
12. CNAs, nurses, and others on the care team huddle for quality improvement and problem-solving (Web. Three)   
Customary Routines, Quality of Life and Relational Coordination to Inform Quality of Care for:
13. Promoting mobility and reducing falls with injury (Web. Four)   
14. Individualizing dining (Web. Five)   
15. Making smooth transitions in care (Web. Six)   
16. Reducing use of anti-psychotic medications (Web. Nine)   
17. Preventing and healing pressure ulcers (Web. Ten)   
18. Promoting mental health (Web. Eleven)   

Download Quick Organizational Self-Assessment (PDF)

Starter Toolkit Home          Step One          Step Two          Step Three         Self-Assessment
Prepared by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS as the Engine for High Quality Individualized Care. Funded by The Retirement Research Foundation.
All webinars in this series are available as archived recordings at
In addition, the full series is available as packaged DVD set in the Pioneer Network store.