Nursing Home Survey Preparation Files

Nursing Home Survey FilesEvery nursing home is required to have at least an annual survey in the range of every 9 – 12 months.  Of course, if you have complaints or are a focus facility, your survey will have a shortened span between them, every 6 months or so.

The goal of every nursing home administrator and facility should be to be survey ready everyday.  It does no good to not think about survey all year until the State survey team shows up.

So, to help prepare for the nursing home survey, here is a list of items that you should have ready.  I usually put these in a plastic file box, organized by number in hanging files.  You may organize them any way you wish.  Do NOT hand this box to the survey team.  Only give them what they ask for.  If you just hand over your information, it may lengthen your survey as it might trigger them to look in areas they had not planned on.

Also, do not hand them your originals.  Make them a copy, because there is a good chance you will not get it back.

Nursing Home Survey Preparation Files

  1. Copy of Facility license
  2. Current census – alphabetical with room numbers  (This is how it’s asked for)
  3. Key facility personnel and their locations
  4. Copy of Administrator’s license
  5. Facility layout / floor plan
  6. Surveys / Resident Identifiers for last 3 years
  7. QI / QM – period of last 6 months
  8. 802 – Roster Sample Matrix
  9. 671 – LTC app for MCR/MCD
  10. 672 – Census & Condition
  11. 1513 – Disclosure of Ownership
  12. Information on Resident Rights provided to residents
  13. Meal times and dining locations
  14. Copies of the menu, including therapeutic diets
  15. Medication Pass times by unit
  16. List of admissions in the past 30 days
  17. List of residents transferred or discharged during past 3 months with destinations
  18. Residents with planned discharges in the next 30 days
  19. Current working schedule for nursing staff
  20. Facility admission contract
  21. Facility policies and procedures to prohibit abuse and investigate allegations of abuse
  22. Designated person to answer questions regarding abuse and abuse prevention
  23. Copy of a blank grievance form
  24. Evidence the facility routinely monitors accidents and incidents – blank Accident/Incident Report, Monthly Tracking log and Monthly Accident/Incident Analysis
  25. Current activity schedule calendar
  26. Residents age 55 and under
  27. Residents who communicate with non-oral communication, sign language, or who speak a language other than the dominant language
  28. Medicare residents requesting a demand bill in the last 6 months
  29. Administrator questions
  30. Waivers or variances
  31. QA Committee Members
  32. Resident Council president and minutes – last 3 months
  33. List of interviewable residents
  34. Residents receiving hospice services
  35. Hospice agreement
  36. Residents receiving dialysis
  37. Dialysis agreement
  38. List of residents receiving TPN
  39. TPN policy
  40. TPN agreement
  41. List of residents with negative pressure therapy
  42. Wound vac / negative pressure policy
  43. List of residents who self-administer medications
  44. List of all employees hired within the last 4 months
  45. List of CNAs
  46. CLIA waiver
  47. Medical Director contact information
  48. Ombudsman contact information
  49. TB tests
  50. License verifications
  51. Abuse registry checks
  52. Inservice education
  53. CNA annual required inservice hours
  54. Infection Control team members
  55. Copy of surety bond
  56. Nurse Aide Training class information
  57. Emergency water agreement
  58. Emergency transfer / relocation agreement
  59. Emergency transportation agreement
  60. Influenza / Pneumococcal Immunization policy
  61. Report of Resident Trust fund balances
    1. For any accounts within $200 of the SSI limit, we need evidence of notification.
    2. Discharged residents’ funds dispersed within 30 days
  62. Emergency Supplies Inventory and Needs Calculation
  63. Infectious waste disposal policy, contract, and last shipping record
  64. Standing Orders

Obviously, if you have special programs (ie- a secure unit, mist therapy, etc.) then, have your policies and procedures related to these programs ready as well.  Add those to the list above.

I suggest going ahead and gathering these items now and updating them at least monthly until you are in your survey window.  Once in the nursing home survey window, some items will need to be updated more frequently.

You’ll notice that I put your old surveys and your old resident identifiers on the list.  You should absolutely review these and see if any certain issues keep popping up on each survey or any particular residents seemed to be selected every year.  This will help you focus on those areas and hopefully avoid repeat deficiencies.

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