Domain I. Environment assessment

For each "Item" below:
  1. Determine if the item is applicable to your agency. If it is not applicable, write NA in the "Item Score" column.
  2. If applicable: Determine if the item is present or not. If not present, the item scores "0".
  3. If it is present: Determine the quality of the item. This will result in a score of 1, 2, or 3. Half points (.5) may also be applicable. (See scoring guide for more information).
  4. At the end of this Domain, an average score will be determined.
  5. There will also be a policy score, which will be added to the average score for a Total Domain Score.

Assessment
Note : If you are a 24-hr facility, score N/A for item A, and score item E instead.

Question:

A. The physical environment is clean, functional, and secure.
Questions to consider in scoring Item A:
Is the physical space (including bathrooms, eating areas and general use areas) always clean?
  • Do they appear clean?
  • Do they smell clean?
Do the various spaces used by the women offer appropriate functionality (nothing broken, damaged, defaced, or in need of repair)?

Are there multiple spaces that are adequately sized for the activities/functions they are used for?
  • Is the kitchen adequate (if applicable)?
  • Are classrooms and/or group rooms spacious (not cramped or crowded)?
Are the furnishings of the space comfortable and conducive to the activities for which they are used (i.e., group work can be set up in a circle, assessment space is private, etc.)?

Are the entrances, exits and secluded spaces appropriately secured and monitored?

Answer:

Item Score
As Evidenced By: You may insert your agency's examples below.