TX HHS Form 5404. Facility Observation Program

The TX HHS Form 5404, Facility Observation Program, is a checklist designed to help newly hired Regulatory Services surveyors conduct comprehensive observations of long-term care facilities. This form provides a framework for identifying key areas of focus, ensuring that all aspects of facility operations are evaluated.

This form is used in situations where a thorough assessment of a facility's operations is necessary, such as during the initial hiring process or during regular inspections. The checklist covers various topics, including administration, human resources, medical records, resident rights and protection, admission and discharge processes, and abuse, neglect, and exploitation procedures.

The form requires information on employee ID numbers, dates of observation, facility name and address, governing body and management comments, and more. By using this checklist, surveyors can ensure that all necessary areas are covered, providing a comprehensive picture of the facility's operations. Key points to note include:

• Required information includes employee ID numbers, dates of observation, and facility name and address.
• The form is used for initial hiring processes or regular inspections.
• The checklist covers various topics related to facility operations.