Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX XXV: Verification Script

11/01/2011

VERIFICATION SCRIPT
November 5, 2009

INSTRUCTIONS: Refer to this hardcopy script to administer all verification cases. Type answers in Verif_WeekX_RegionX.xls. Refer to Project FAQs if necessary to answer questions from facility.

READ IF NECESSARY

NOTICE—Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920–0780).

Assurance of Confidentiality—All information which would permit identification of an individual, a practice, or an establishment will be held confidential, will be used for statistical purposes only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL–107–347).

INTRODUCTION: Hello, my name is ______________________. I’m a supervisor with RTI International. May I speak with (DIRECTOR’S NAME/NAME OF RESPONDENT TO FACILITY QUESTIONNAIRE, SOMEONE ELSE)?

I am calling to verify the work of one of our interviewers, FI NAME, who conducted a recent interview at this facility for the National Survey of Residential Care Facilities.

IF DOING VERIFICATION WITH DIRECTOR (OR RESPONDENT TO FACILITY INTERVIEW) USE THIS COLUMN

1. Did you complete an in-person interview with FI NAME on DATE?
   a. YES, I COMPLETED IT.
   b. NO, I DID NOT COMPLETE AN INTERVIEW
   c. I DON’T REMEMBER IF I COMPLETED AN INTERVIEW

IF DOING VERIFICATION WITH SOMEONE ELSE USE THIS COLUMN

NOTE THE PERSON’S NAME AND POSITION:

1. Did someone at FACILITY complete an in-person interview with FI NAME on DATE?
   a. YES, FACILITY COMPLETED IT.
   b. NO, FACILITY DID NOT COMPLETE AN INTERVIEW.
   c. I DON’T KNOW IF FACILITY COMPLETED AN INTERVIEW

2. Were you [IF Q1=DON'T REMEMBER OR NO: You would have been] asked questions about NAME OF FACILITY, such as the number of residents and rooms, the services you offer, and general information on staffing?
   a. YES, I WAS ASKED THESE QUESTIONS
   b. NO, I WAS NOT ASKED THESE QUESTIONS
      -- PROBLEM.
      -- IF Q1 = YES, PROCEED TO Q3
      -- IF Q1 = NO OR DON¡¯T REMEMBER, SKIP TO Q7.

   c. DON¡¯T REMEMBER IF I WAS ASKED THESE QUESTIONS.
      -- PROBLEM.
      -- IF Q1 = YES, PROCEED TO Q3.
      -- IF Q1 = NO OR DON'T REMEMBER, SKIP TO Q7.

2. Was someone at FACILITY [IF Q1 = NO OR DON'T KNOW: Someone at FACILITY would have been] asked questions about the facility, such as the number of residents and rooms, the services you offer, and general information on staffing?
   a. YES, FACILITY WAS ASKED THESE QUESTIONS
   b. NO, FACILITY WAS NOT ASKED THESE QUESTIONS
      -- PROBLEM.
      -- IF Q1 = YES, PROCEED TO Q3
      -- IF Q1 = NO OR DON¡¯T KNOW, SKIP TO Q7.

   c. DON¡¯T KNOW IF FACILITY WAS ASKED THESE QUESTIONS.
      -- PROBLEM.
      -- IF Q1 = YES, PROCEED TO Q3.
      -- IF Q1 = NO OR DON'T KNOW, SKIP TO Q7.

3. Did the interviewer ask you to provide a list of residents?
   a. YES
   b. NO
      -- PROBLEM.
      -- SKIP TO Q5.

   c. DON'T REMEMBER

3. Did the interviewer ask for a list of residents?
   a. YES
   b. NO
      -- PROBLEM
      -- SKIP TO Q5.

   c. DON'T KNOW

4. And did the interviewer ask a series of questions about (3,3,4,6) residents?
   a. YES
   b. NO
      -- PROBLEM
   c. DON'T REMEMBER.

4. And did the interviewer ask a series of questions about (3,3,4,6) residents?
   a. YES
   b. NO
      -- PROBLEM
   c. DON'T KNOW.

5. How long was the interviewer at your facility?
   __________Hours
   __________Minutes

***FIGURES ASSUME ALL RESIDENT INTERVIEWS WERE COMPLETED***

5. How long was the interviewer at your facility?
   __________Hours
   __________Minutes

***FIGURES ASSUME ALL RESIDENT INTERVIEWS WERE COMPLETED***

Small and Medium Facilities

0-45 MINUTES --> PROBLEM
45 MINUTES - 3 HOURS --> OK
3 OR MORE HOURS --> PROBLEM

Small and Medium Facilities

0-45 MINUTES --> PROBLEM
45 MINUTES - 3 HOURS --> OK
3 OR MORE HOURS --> PROBLEM

Large Facilities

0-1 HOUR --> PROBLEM
1 HOUR - 3 ½ HOURS --> OK
3 ½ OR MORE HOURS --> PROBLEM

Large Facilities

0-1 HOUR --> PROBLEM
1 HOUR - 3 ½ HOURS --> OK
3 ½ OR MORE HOURS --> PROBLEM

Very Large Facilities

0-1 HOURS --> PROBLEM
1 ½ - 4 HOURS --> OK
4+ HOURS --> PROBLEM

Very Large Facilities

0-1 HOURS --> PROBLEM
1 ½ - 4 HOURS --> OK
4+ HOURS --> PROBLEM

Respondent is unsure of time

EXPLAIN

Respondent is unsure of time

EXPLAIN

6. We would like you to assess the overall performance of the interviewer FI NAME. Would you say (his/her) performance was excellent, very good, good, fair or poor?
   a. EXCELLENT
   b. VERY GOOD
   c. GOOD
   d. FAIR. PROBLEM
   e. POOR. PROBLEM
   f. DON'T REMEMBER.

5. N/A

7. Did you have any concerns about the interview or data collection procedures?
   a. YES (DESCRIBE)
   b. NO
   c. DON'T REMEMBER.

7. Did you have any concerns about the interview or data collection procedures?
   a. YES (DESCRIBE)
   b. NO
   c. DON'T REMEMBER.

CONCLUSION: Thank you very much for your time. Goodbye!

DESCRIBE ANY PROBLEMS NOTED ABOVE:

ADDITIONAL COMMENTS:

CONCLUSION: Thank you very much for your time. Goodbye!

DESCRIBE ANY PROBLEMS NOTED ABOVE:

ADDITIONAL COMMENTS:

 

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