A Disturbing New Surveyor Trend

There is a trend I’m noticing in surveys recently when the surveyors are conducting staff interviews.  It seems some survey teams are having facility staff members write and sign statements outlining what they’ve done wrong as discovered in the surveyor’s interview of them.  The statements are then used as evidence to support the tag you are about to be cited for a deficient practice.  Why are administrators allowing this to happen in their buildings?  There is nothing I’ve read in our provider agreement that says we have to sign written statements for the surveyors in our facility survey.  Guys, this practice will only allow more tags to be cited in your building and is extremely intimidating to your staff.  It makes the whole survey process feel like a police detective’s interrogation.

But won’t it make the surveyors angry if we refuse to sign a statement?  Well, probably.  Won’t that mean more tags?  Not necessarily.  Make them dig for their own evidence to support the tag.  Better yet, take note and ensure your state’s health care association or nursing home association is aware of this practice.  Rally their support in frowning upon this surveyor  tactic.  It does nothing but make our survey an even more hostile and negative process than it already is.  And, none of us need that!

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5 Responses to “A Disturbing New Surveyor Trend”

  • Christina on

    We recently got through a State Survey in which 3 of the 5 surveyors were, what I call, “crooked”. They were trying to cite and “IJ” after only being in our building for 1 hour. We immediately started our rebuttal and our investigation to disprove their accusations. We started seeing how “crooked” they were by trying to cite things when they had no facts or justifications. They were literally out to get us. They interrogated staff into tears and were not fair in their duties. We had suspicions of at least 2 of the 5 surveyors being incompetent with 1 of those 2 needing to retire because of displaying “dementia-like traits”. What is our defense to the surveyors when they try to be “the bad guys”? Is there a rule book of some sort that facilities are allowed to look at in regards to what guidelines these services have to follow in their practice??

  • Mark on

    Hi, Christina. The watermelon book will give you the basic procedures the surveyors should follow. The CMS website also has much info on the newest guidelines for LTC and even has a surveyor training section here. Obviously, you did the right thing by immediately jumping on the IJs. Your defense is to read the watermelon book and show how the issue they are citing does NOT meet the requirements of an Immediate Jeoprdy level…. even if that means accepting a lower level tag. A “G” is better than an “IJ”. Sometimes, it’s best to speak with the team leader by themselves without the rest of the team. The team leader, unless they are simply an idiot, should realize that effective staff interviews should not lead to tears. I might also arrange for a meeting with their survey agency director to express your concerns with the surveyor with dementia-like traits. It needs to be non-threatening. I hope this helps!

    P.S. If after meeting with the survey agency director, you feel they are still out to get you, I would suggest for your administrator to meet with the president of the nursing home association in your state. They typically know what’s going on politically with the State and can help guide you back off the radar.

  • nlomeli on

    good article above.I have a question about a recent incident report I filled out on a patient who fell repeteadly. I was his therapist. I was transferring him unto a wheelchair from his bed. he proceeded to fall and was lowered to the floor. an incident report followed. a few month later my manager notified me to sign an inservice report as state as tagged the fall. im not sure what this means altogether. she also said that the nursing home was trying to clear the tag since reports had indicated that he had progressed from an assist of 2 to 1. ive never seen not heard anything like this before. do all incident reports get sent to the state and looked at? or is this something they reviewed when they came for their annual survey?

  • Mark on

    Hi, Nanditta. Although I would need a bit more information, it sounds like this particular resident was selected to be reviewed by the State. Not all incident reports are sent to the State and (depending on which state) usually, only those with a serious outcome, that had injury and were not witnessed, and/or had suspicious circumstances surrounding them would need to be reported. It could have been a facility’s self-report, a complaint survey, or just someone they reviewed on the annual survey.

    So, the facility got a deficiency cited on this resident related to his falls. The deficiency puts the facility out of compliance with their Medicaid and Medicare agreement. The deficiency has to be lifted in a maximum of 180 days or your facility faces losing their Medicare/Medicaid provider agreement, in which case, you will not be able to accept or provide care for these residents at the facility and those living there would be transported elsewhere. There are fines and other remedies that are imposed along the way before 180 days is reached. That’s why it’s important the facility clear the citation as soon as possible.

    It is irrelevant if he progressed from 2 to 1, that alone would not clear a deficiency. However, it would need to be reflected on his care plan, MDS, and ADL sheets. The important thing to remember is that an incident report itself is pretty much useless other than to communicate what happened. There should be a reasonable care plan falls intervention put into place immediately after each fall. This should have made it less likely for the resident to fall repeatedly. This is most likely where the citation is aimed. Many times if a resident is a repeat faller, it’s difficult for a facility to ensure appropriate interventions are put in place immediately; so, the resident has another fall without a new intervention – which in the State’s eyes – could have potentially been prevented.

    It is common to inservice both direct care and therapy staff when trying to clear a care tag such as this. That doesn’t necessarily mean that you did anything wrong. The facility simply needs to prove that they have made reasonable effort to communicate this to the staff.

    I hope this helps.

  • nlomeli on

    thank you so much for the clarification. this definitely helps!


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