Survey & Licensing Readiness Kit

Eight editable Word templates for a USA non-medical home care agency, in one instant download. Get ready for a state licensing survey, renewal or complaint visit with one matching set of self-review tools: run a mock survey, audit personnel and client files, organize your survey binder, and track deficiencies through a plan of correction.

Every file is an editable Microsoft Word (.docx) document. This is a Word-only download: no PDF, Excel, or Canva files are included. You can also open the files in Google Docs or LibreOffice; some layout may shift slightly.

What’s included (8 templates, 9 Word files)

1. Mock Survey Master Checklist (6 pages)
2. Personnel File Audit Tool (6 pages)
3. Client Record Audit Tool (6 pages)
4. Survey Binder Index and Document Request Log (4 pages)
5. Plan of Correction Template (3 pages)
6. Deficiency and Corrective Action Tracker (4 pages)
7. Annual Program Evaluation and Quarterly Record Review (4 pages)
8. Survey-Day Staff Prep and Entrance/Exit Conference Checklist (3 pages)

Plus an Agency Instructions guide for the whole set. Remove it before use.

Who it’s for

• Agency owners and administrators preparing for a state licensing survey
• Agencies preparing for license renewal or a complaint visit
• Quality and compliance leads running mock surveys and record audits
• New agencies setting up their first survey binder

How it works

1. Purchase and instantly download one ZIP file with all the Word documents.
2. Open each file in Microsoft Word.
3. Use Replace All (Ctrl+H) to change [Agency Name] and [State] to your own details.
4. Fill in the blank lines with your own policies, contacts and choices, then save, print or share as needed.

Please note

• This is a digital download. No physical item will be shipped.
• These are customizable templates, not legal advice, and are not a license to operate or state-approved. They do not guarantee that your agency meets any law, licensing survey or standard.
• State rules vary. Check every state-specific item against your state requirements and have a qualified professional review the templates before use.
• Some lines cross-reference policy numbers from a companion Policy & Procedure Manual (sold separately); edit them to match your own policies.