Dot gov

Official websites use .gov
A .gov website belongs to an official government organization in the United States.


Secure .gov websites use HTTPS
A lock () or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Quality Assurance and Quality Improvement in Assisted Living

The Wisconsin Bureau of Assisted Living (BAL) encourages Assisted Living Facilities (ALFs) regulated by BAL to formalize an internal Quality Assurance (QA) and Quality Improvement (QI) program. ALFs include adult day care centers, 3-4 bed adult family homes, community-based residential facilities, and residential care apartment complexes.

BAL, in collaboration with the Division of Medicaid Services and University of Wisconsin Madison, invited employees of ALFs to participate in a QA and QI survey to identify commonly used practices of QA/QI in ALFs. The survey asked respondents to think about QA/QI efforts at their ALF and asked for their advice about assisted living QA/QI for the future. To learn more about the survey findings and recommendations developed, please review the Quality Assurance and Quality Improvement in Assisted Living, P-03075 (PDF).

It is recommended the provider implement an internal QA/QI program that contains all of the following:

  • What corrective action and system changes will be made to ensure insufficient services are corrected and regulatory compliance is maintained?
  • Who is responsible for monitoring for continued regulatory compliance?
  • Date of completion for each corrective action
  • Collect and analyze data (for example: consumer/legal representative satisfaction, mock surveys, tracking/trending of quality metrics such as admission processes, falls, staff retention, caregiver misconduct)
  • Detect and respond to violations of state licensing/certification surveys of assisted living regulations
  • Continuous evaluation of assisted living facility systems, processes, and policies

These definitions were constructed with influence from the Centers for Medicare & Medicaid Services (CMS) and the Quality Assurance publication authored by Klein TA, Seelbach CL, and Brannan GD.

  • Quality refers to the ability of a service to meet its consumer need
  • Quality Assurance (QA) is the process that ensures quality
  • Quality Improvement (QI) is the framework used to systematically improve care

Internal QA and QI involves continuous activities that promote the model of Plan, Do, Check, and Act (PDCA). This problem-solving model looks to answer these three questions:

  • What are you trying to accomplish?
  • What changes can you make that will result in an improvement?
  • How will you know that a change is an improvement?


Use the FOCUS method to establish an action plan:

  1. Find a problem to improve. Information collected that may identify areas for improvement may include the following:
    • Resident and family satisfaction evaluations
    • Complaints and grievances
    • BAL licensing/certification surveys
    • Employee meetings
    • Internal facility audits
  2. Organize a team of individuals who will be involved in the improvement plan. Involve staff at all levels of operations and identify team members' roles and responsibilities.
  3. Clarify current knowledge of the problem by reviewing background information and understand the current condition or process. Define the goal or what you want to accomplish.
  4. Understand the root cause of the problem.
  5. Select the improvement. Develop an action plan to accomplish the goal, include necessary staff, resources, and a timeline.


Implement the action plan.

  • What measures or outcomes will you monitor/collect during the action plan?
  • Consider documenting problems, unexpected occurrences, and general observations during the action plan.


Evaluate the results. Study the data before and after the change, as well as, compare the results to your initial goal.

  • Did the action plan result in an improvement?
  • Did you meet your goal?
  • What lessons did you learn?
  • Did you find any trends?


Determine the next steps.

  • If the plan was successful in improving the problem, incorporate the plan into common practice.
  • If the plan was not successful in improving the problem, return to the planning step and begin the PDCA cycle again.
  • Will you continue to implement the change or will you try a different alternative to improve the problem?
  • How will you sustain the improvement?
  • Consider sharing the results with staff.

The assisted living case examples and regulatory solutions feature content providers may use to facilitate discussion-based exercises to evaluate their facility’s current operations and identify opportunities for improvement.

When reviewing the case examples, providers may consider the following areas as it relates to their operations: consumers served, staff, training, equipment, policies and procedures.

Contact Us

Questions may be directed to BAL at

Last revised January 27, 2023