Surviving a state inspection survey

CapeCodMermaid, RN · Aug 17, 2005

Crotch sniffing? And I thought I had heard it all!! We had one group of surveyors who were especially obnoxious. There were 4 of them. Each one at a different time would come up to me and in a demeaning, demanding tone ask "Who are you and what are you doing here?!?" At the time I was the supervisor. I explained that I was the supervisor and was in all parts of the building at different times. One yelled at me "What are you doing sitting there?" I told her I was working on care plans. Then she said, "And what are you going to do after that?" I told her I would be helping with tray pass as soon as the trays came up on the floor. She sneered at me and said, "OH, and I suppose you do that EVERY day." "Yes Ma'am" I said. "Every morning I am here handing out trays". She was mad that I had an answer for everything. I think you must have to have some sort of test and if you have on human, compassionate, polite bone in your body, they disqualify you from being a surveyor.

milky · Aug 17, 2005

I sometimes think state surveyors go to bed at night dreaming of new ways to terrorize LTC facilities. It makes me wonder.. have they ever worked the floor of a LTC facility??..To see what we nurses go through to give the utmost in good care to our residents??? A state surveyor once told me, they HAVE to find SOMETHING on each survey or else THEIR bosses the "FEDS" will come after THEM!!

MDSlady · Aug 17, 2005

Crotch sniffing? And I thought I had heard it all!! We had one group of surveyors who were especially obnoxious. There were 4 of them. Each one at a different time would come up to me and in a demeaning, demanding tone ask "Who are you and what are you doing here?!?" At the time I was the supervisor. I explained that I was the supervisor and was in all parts of the building at different times. One yelled at me "What are you doing sitting there?" I told her I was working on care plans. Then she said, "And what are you going to do after that?" I told her I would be helping with tray pass as soon as the trays came up on the floor. She sneered at me and said, "OH, and I suppose you do that EVERY day." "Yes Ma'am" I said. "Every morning I am here handing out trays". She was mad that I had an answer for everything. I think you must have to have some sort of test and if you have on human, compassionate, polite bone in your body, they disqualify you from being a surveyor.

I agree, I think they must have to take some kind of class or something on how to give people a hard time and treat them like dirt. This will be my 7th state survey and they still bother the heck out of me when they come. They can be very nasty people. Some people in my building can honestly say that the state survey doesn't bother them. They bother the crap out of me. :rotfl:

debRN0417 · Aug 20, 2005

I sometimes think state surveyors go to bed at night dreaming of new ways to terrorize LTC facilities. It makes me wonder.. have they ever worked the floor of a LTC facility??..To see what we nurses go through to give the utmost in good care to our residents??? A state surveyor once told me, they HAVE to find SOMETHING on each survey or else THEIR bosses the "FEDS" will come after THEM!!

Well, we don't go to bed at night dreaming of ways to terrorize LTC...all we want to do is make sure that the facilities are in compliance with the regulations and that the residents are receiving the care that they deserve. That is what we all are here for, right? I have been on both sides of the table. I know the challenges of LTC, but poor care is unacceptable either way. I do not badger, accuse, smell crotches or things like that. I cannot understand why anyone would. But, I do have to observe, assess, and question. It is a stressful time for you, but it is also stressful for us. We do not WANT to find anything. We would prefer that all LTC have 0 deficiencies. We DO have to make sure we are thorough because, yes, the Feds do sometimes follow us or sometimes come with us, but that is no reason to "dig". Just do what you do everyday to take care of the residents the best that you can and it will all be okay.

CapeCodMermaid, RN · Aug 21, 2005

Sorry but I don't believe you. I've been doing LTC for more than 20 years and every surveyor has tried to find things wrong...really dug to find I's not dotted and T's not crossed. It seems the outcome isn't good enough....all the surveyors must have a personality disorder...megalomaniacs each and every one.

Blackcat99 · Aug 21, 2005

Heck, if the dump I use to work at can pass inspection than anyone can. The trick it seems is having all of your paperwork in perfect condition. It's too bad the state didn't stay over for evening shift. I was told by eve. shift that residents usually have to wait at least 30 minutes before their call bells are answered due to staff shortage. :scrying:

Nurse Ratched, RN · Aug 21, 2005

Folks, let's take people at their words. No personal attacks, please.

Bird2 · Aug 21, 2005

Well, we don't go to bed at night dreaming of ways to terrorize LTC...all we want to do is make sure that the facilities are in compliance with the regulations and that the residents are receiving the care that they deserve. That is what we all are here for, right? I have been on both sides of the table. I know the challenges of LTC, but poor care is unacceptable either way. I do not badger, accuse, smell crotches or things like that. I cannot understand why anyone would. But, I do have to observe, assess, and question. It is a stressful time for you, but it is also stressful for us. We do not WANT to find anything. We would prefer that all LTC have 0 deficiencies. We DO have to make sure we are thorough because, yes, the Feds do sometimes follow us or sometimes come with us, but that is no reason to "dig". Just do what you do everyday to take care of the residents the best that you can and it will all be okay.

Good morning DebRN. I see that you are the one that fairly recently crossed over. I'm sure you have experienced state surveys in the past and I would imagine that this will make you a better and more fair surveyor. I have noticed over the years that the surveyors that we have had in the past seem burnt out and at times appear angry. So, please do not take any comments personally. We have all experienced some very negative happenings. I do recognize that all surveyors are not like this. My worst experience can not even be put in writing because I would not want to pin point my location or facility. But at that time I knew deep down it was aboout money not the care. I am not bitter any more but have just accepted the fact. I am fearful of speaking to some inspectors without a witness because I have seen them twist employee comments. We try to always have at least one witness. Surveys are always nerve wracking but we all do want the same end result of good pt care. Hopefully we will be seeing a culture change on both sides for the good of all pts. Also, I do empathize because this is like the treads r/t to nurses and nurse management until you cross over one does not fully understand what the other person is going through. Have a great day.

MDSlady · Aug 22, 2005

Hello all.... I never intended to offend anyone when I started this thread.....I must say however, that SOME state surveyors can be intimidating and I think we all must admit that. I actually have had a good experience with a state surveyor when I was working the floor as a staff nurse and it was opening day of survey. After reviewing all residents with the state surveyor that would be on my floor, I provided everything that she asked for. I personally feel that myself doing my job and the best that I can at it, I have nothing to fear or hide. As a matter of fact, my father is a patient in the long term unit where I work and I feel that I treat all my patients as if they were my own family and for that reason, I feel I have nothing to hide. However, there is that occassional state surveyor that will question everything that you do and for that I don't like it. I would like to think that we are all in for the best of the facility and patient care, however it does happen occassionally. Some can be intimidating, I prefer to work with a state surveyor that will work with me and not make me feel that they are working against me in trying to find something I do or say wrong. Again, I did not mean to make this thread a state surveyor bashing....again, I apologize for anyone that is offended by this. :wink2:

debRN0417 · Aug 22, 2005

I am not offended by anyones comments. I feel that everyone has a right to their own opinions and that all surveyors are different and yes, some often have agendas. Having been on both sides of the table and having gone through some rather rough surveys myself, I can understand why the feelings are out there. I too have felt as though I was being picked on. I have set the standard for myself that I will not treat anyone in a way that I would not want to be treated myself. I ask my questions, and do not badger. There is no reason for that. All I want is for the residents to be treated with respect and dignity and receive the best care they can be given. I understand that no place or no person is perfect. We all make mistakes. I am sorry for those of you who have had "mean" or intimidating surveyors. I feel there is no call for that. We are on the same team, for the same purpose. We are taught in training that we are to be professional, courteous and considerate. I am sorry that there are those who either forgot this part of their training, or chose not to follow this guidance for whatever reason. I feel bad that there are those who are "burnt" out and who do some things that I have seen posted here. I feel it is a shame. I have met wonderful people who really care about their residents and the jobs that they are doing. It does bother me sometimes when I have to write a tag for some things that are necessary, but I have a job to do too, and that is to see that the facility is in compliance with the regulations and the residents cared for. My job would be a lot easier if I had no tags to write. I don't like to come home and sit for hours writing. I cannot change the way that others act, but I can set an example by my behavior....who knows, maybe attitudes will change...on both sides.

Good luck to all of you on future surveys, Who knows, maybe one of you will be in a facility that I will have the opportunity to visit!

debRN0417 · Aug 22, 2005

Sorry but I don't believe you. I've been doing LTC for more than 20 years and every surveyor has tried to find things wrong...really dug to find I's not dotted and T's not crossed. It seems the outcome isn't good enough....all the surveyors must have a personality disorder...megalomaniacs each and every one.

I am sorry you have had bad experiences...I looked and looked, but I could not find a regulation that stated that you had to dot ALL your I's and cross ALL your T's. (Please don't take offense, just trying to be funny, here, and lighten things up a little) My husband is a therapist, maybe I should ask him if I have this disorder? I hope future experiences are better for you.

dogwalker · Aug 23, 2005

Hi all....
Does anybody else crinch at the thought of an upcoming state inspection? It seems that is all I think about lately.
I recently have been promoted to MDS Coordinator in my facility and am feeling that they are going to attack my MDS's and care plans.
I am trying my best, and I know they WILL find something, but does anybody else dwell on this??
Anybody have any suggestions on how to survive a state survey without having a nervous breakdown?

As a state surveyor, I would urge you to relax. You know more about MDS and RAPS than we do, actually. Most surveyors realize what a huge job MDS coordinator is and yes we do write deficiencies on miscoding and mistransmitting, but if you know your job, I doubt you'll have much of a problem. I hope that helps. Also, survey teams don't look at each and every resident. They look at a sample based on QI's and QM's that are accessible to you as well. The more you learn about the CMS regs and the survey process via CMS websites, etc., the better you will fare. Dogwalker