An Administrator’s Best Friend
The Long Term Care Survey book, F-tag book, or any other name you might call it is commonly referred to as the “Watermelon Book” in our circles. It’s called the watermelon book because of the color scheme being red and black on the outside with a section of green pages on the inside. It gives you a complete list of all the federal regulations by F tag number, major changes that took place, the survey protocol, survey procedures, including how to determine immediate jeopardy and scope & severity, a copy of the guidance to the surveyors, and exhibits of commonly used survey forms. It is, in fact, your cheat sheet to a great survey.
There is one thing that you must do. Read the book. Cover to cover. And, then read it again. Everytime you read the watermelon book, you will come across something new, something you had forgotten, or something that maybe you just skimmed over the first time.
To have successful surveys, you must maintain compliance with the regulations within this book – year round. And, you must know your regs better than your surveyors. Many administrators and DONs alike get very stressed out during their survey. The mere mention of the word STATE sends chills through them. And, why wouldn’t it? Our entire survey process is flawed. I regularly encounter surveyors who have never had the responsibility of running a facility or even managing a group of people in healthcare in any shape or form. In fact, they usually have never worked in a nursing home. The ones who have, well, many of them didn’t make it in our world, so they left to be surveyors. So, some of them do, but as a whole, they don’t understand long term care or any aspect of the actual operations of a facility. Their training generally sucks! (Hey, what can I say? Our training isn’t anything to brag about, either. Most of my training in the AIT consisted of actually running a large building without much guidance – trial by fire!) I could preach a sermon on the qualifications I believe one needs in order to be an effective surveyor, but that’s another post. You still must know the regs better than the surveyors. To keep down the stress, think of survey as if it were a game. What’s the best way to win a game? To know the rules. The watermelon book is your rule book.
Learn your regs, study one a day. Make your team learn them, too. Your department heads and key personnel need access to this information even more than you do. How can you hold a Dietary Manager responsible for F-371, kitchen sanitation, when she has never had the opportunity to read the regulation and has never had access to the watermelon book? How can you expect a Social Services Director to ensure proper discharge planning is done when she has never been shown what is required by CMS? Even your Wound Treatment Nurse will be more confident and more effective after reading F-314.
I actually make a copy of tags relevant to each department and distribute to the department heads. I then ensure that I have enough watermelon books inhouse to have one in my office, one in the DON’s office, and two or three accessible to department heads and staff. We regularly inservice our frontline staff on the regs, but I also have my department heads and key personnel take the watermelon book and research an F-tag so they can explain it in the next day’s morning meeting. One F-tag per day and the next department heads brings a different tag the next day. It works great and many of my department heads say they have learned something they did not know before hearing it explained in the morning meeting F-tag review.
Give it a try and let me know how it works for you.