A Comprehensive Guide to Performing Unannounced Visits to Nursing Homes

Family member plans unannounced visit to nursing home

Ensuring the well-being of residents and the quality of care in nursing homes is paramount. One of the most effective strategies for monitoring these factors is through unannounced visits. These surprise inspections provide an authentic view of daily conditions and interactions, allowing you to identify potential issues and address concerns promptly. This guide is designed to help you conduct successful unannounced visits and highlights key aspects to observe during your inspections.

Step One: Prepare for Your Visit

Collaborate with Loved Ones:  If possible, have different family members visit at different times to cover more ground and gain diverse perspectives on the care provided. Working together helps you gain a better understanding of your loved one’s living conditions and how they interact with the staff. It also creates a supportive way to monitor their well-being and makes sure all family members share their observations and concerns. Coordinating visits also shows the nursing home staff that providing attentive and quality care is important to you and your family.

Visit at Varied Times: Vary the days and times of your visits to get a true sense of the care your loved one is receiving. Weekends, evenings, and holidays can provide particularly insightful observations, as staffing levels and routines may differ from regular weekdays. Visiting at different times helps you see how care is given during both busy and quiet periods, giving you a fuller picture. It also lets you observe various activities and interactions, such as meals, recreational activities, and staff shifts, providing a complete view of daily life in the nursing home.

Step Two: Assess the Nursing Home

Initial Observations: Upon arrival, observe the overall environment. Is the facility clean and inviting? Take note of any noticeable odors or cleanliness issues, as well as the general atmosphere. Look for signs of maintenance and organization, and assess the level of comfort and safety provided to residents. These initial observations set the tone for your visit and provide important insights into the daily living conditions at the facility.

Cleanliness of Facility: Evaluate the cleanliness and maintenance of communal spaces such as lounges, dining rooms, and hallways. Pay attention to cleanliness standards, furniture condition, and the overall ambiance. Ensure these spaces are welcoming and supportive to residents’ comfort and well-being. Look out for signs of neglect, such as worn-out furniture or poor lighting, which could impact residents’ quality of life. Additionally, observe the availability of seating, accessibility features, and the presence of amenities like reading materials or recreational activities. These observations provide valuable insights into the facility’s commitment to residents’ satisfaction and well-being.

Assessing Staff Engagement: Carefully observe how staff members interact with residents. Do they address residents by name and respond promptly to their needs? Do staff display genuine care and concern for residents’ well-being? Observe their interactions to gauge their level of empathy and commitment to providing attentive care. Evaluate how effectively they handle any concerns or requests that residents may have. These observations provide critical insights into the quality of care and support offered to residents daily.

Step 3: Monitor Their Living Space

Possessions of Loved One: Verify the presence and condition of your loved one’s personal belongings. Check that items are in good repair and that nothing appears to be missing, as missing items could indicate theft or neglect. Take note of any changes in the arrangement or condition of their belongings, which might suggest that something is amiss.

Sanitation and Security: Take a thorough look at your loved one’s room to ensure it is clean and safe. Check if the bed is neatly made and look for any potential tripping hazards or areas in need of repair. Inspect the bathroom and common areas for cleanliness and safety. This guarantees that everything is free from clutter and hazards that could cause accidents.

Additionally, observe the overall environment for signs of neglect, such as insufficient lighting, broken furniture, or unclean surfaces. Pay attention to the temperature and ventilation in the room to ensure it is comfortable. Engage with your loved one to gauge their comfort level and emotional state, and ask them about any concerns they may have regarding their living conditions. This comprehensive review can help you identify any issues that need immediate attention or further investigation.

Step 4: Observe Your Loved One’s Overall Health

Recognizing signs of abuse and neglect in nursing homes is vital for safeguarding the health and safety of residents. These signs, such as unexplained injuries, changes in mobility, and neglect of basic needs like hygiene or medical care, highlight the importance of vigilant observation and prompt intervention to ensure residents receive proper care and protection from harm. More signs to look out for include:

  • Unexplained Injuries: Bruises, cuts, fractures, or welts that cannot be adequately explained or don’t match the explanations given.
  • Changes in Mobility: Sudden or unexplained changes in the resident’s ability to move around, such as difficulty walking or using limbs.
  • Malnutrition or Dehydration: Rapid weight loss, signs of dehydration (dry skin, cracked lips), or malnutrition-related issues (such as hair loss, or brittle nails).
  • Poor Hygiene: Noticeable changes in personal hygiene, including dirty clothing, strong body odor, or unkempt appearance.
  • Medication Issues: Overmedication or undermedication, can lead to various health problems or unusual sedation.
  • Fear or Withdrawal: Emotional or behavioral changes, such as increased fearfulness, withdrawal from activities, or reluctance to speak openly.
  • Bedsores or Pressure Ulcers: Development or worsening of bedsores, particularly in areas not easily seen during routine care.
  • Unexplained Death or Hospitalization: Instances where a resident unexpectedly dies or requires hospitalization without a clear medical reason.
  • Delayed Medical Care: Instances where necessary medical treatment is delayed or not provided promptly.

Step 5: Track Activities and Services the Nursing Home Offers

Review Meal Times: If possible, observe meal times to assess not only the nutritional value and appeal of the food but also the dining atmosphere. Are meals prepared to meet diverse dietary needs and preferences? Additionally, observe whether staff provide necessary assistance to residents who require help with eating, ensuring they receive adequate support. These observations are crucial for maintaining residents’ health and allows them to have a positive dining experience.

Activities for Residents: Review the activity schedule to confirm that scheduled activities are indeed taking place. Pay attention to how actively residents are encouraged to participate. Are staff members actively engaging with residents to motivate their involvement? Such interactions can significantly enhance residents’ overall experience and well-being during their stay.

Step 6: Check in With Other Resident’s and Their Families

Engage with Residents: Become familiar with residents to gather valuable perspectives on the care provided. It’s important to initiate conversations with residents to observe their satisfaction with the facility and the staff. Their insights can offer valuable feedback on various aspects of their experience. If they are not receiving the proper care needed, there is a chance your loved one may not be either.

Introduce Yourself to Residents Families: Interacting with families is crucial for gaining a deeper understanding of their experiences and concerns. By talking to families, you can gather firsthand information about any issues they may have noticed or any specific aspects of care that could be improved. This open conversation helps everyone see clearly what’s going on and allows the facility to quickly fix any problems, making sure all residents get the best care possible.

Step 7: Record Your Observations

In this step, it’s important to carefully document everything you notice. Keeping clear and detailed records helps make sure any problems are properly addressed. By taking thorough notes and, when appropriate, using photos to capture evidence, you can highlight issues that need attention and back up your observations with solid details.

Write Detailed Notes: Keep comprehensive notes of your observations, including the dates and times of your visits. Record any concerns, irregularities, or positive aspects you notice. This detailed documentation will be crucial for any follow-up actions or discussions.

Take Photos: When appropriate, take photographs of any concerning issues, such as unsanitary conditions or visible injuries. Ensure that you respect privacy and obtain necessary permissions if required. Photographic evidence can be invaluable in highlighting specific problems and supporting your concerns.

Step 8: Take Action Immediately

When a loved one is in a nursing home, suspicions of abuse can trigger intense emotions. However, it’s important to handle the situation calmly and strategically. By staying composed, collecting information, and seeking the right help, you can effectively address potential elder abuse. If you suspect abuse, follow our guide to approach the situation effectively.


Ensuring the well-being of a loved one in a nursing home is a critical responsibility that requires vigilance, thorough observation, and prompt action. By conducting unannounced visits, assessing the environment and care provided, and engaging with residents and their families, you can understand the quality of care your loved one receives. Staying calm, informed, and proactive allows you to effectively advocate for your loved one’s best interests, ensuring they receive the high-quality care they deserve. Through these steps, you can help create a supportive and secure environment in which your loved one can thrive.

Questions About a Potential Lawsuit Involving A Nursing Home or Assisted Living Facility?

Michael Hill is a nationally recognized attorney who handles exclusively cases against long term care facilities. Michael and his firm, Michael Hill Trial Law, are headquartered in Cleveland, Ohio but handle cases across the country.

Disclaimer: This information is provided for informational purposes only. Nothing in this article should be construed as providing legal advice or the creation of an attorney client relationship. Laws are updated frequently and change from state to state. If you desire legal advice, you can contact Michael Hill Trial Law at www.protectseniors.com, send an email to info@protectseniors.com, call (800) 659-2712 to begin an investigation, or contact another attorney.