10-3567 STATE HOME INSPECTION - STAFFING PROFILE-2026

1. Click ‘Get Form’ to open the 10-3567 STATE HOME INSPECTION - STAFFING PROFILE in the editor.
2. Begin with Part I, entering the total number of operating beds and participant slots for each level of care: nursing home, domiciliary, and adult day health care (ADHC). Ensure you accurately note the patient census, including both veterans and non-veterans.
3. In Part II, enumerate total FTEE positions. Break down the assigned FTEE for each level of care. For example, if there are 12 R.N.s, specify how many are allocated to each care type.
4. Proceed to Parts III through V to complete the nursing staffing patterns. Select four random one-week worked schedules from the past year, ensuring one includes a holiday. Calculate average hours for direct care nursing staff (RN, LPN, CNA) on each shift.
5. For each table in Parts III through V, sum the hours from your selected schedules and divide by four to find averages. If multiple buildings exist for a level of care, use separate forms for accurate data collection.

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