following is a listing of what should be included in a survey entrance manual.
this is the information the surveyors will request upon entering into your facility.this will make the entrance go very well. this also will give the don more time to be with the nursing staff instead of rushing to get the nursing information. this will save the surveyors time also which keeps them happy.surveyors have been very impressed when this information is readily available.
1. resident roster with room numbers
2. blank 24 hour report sheet with residents names (one for each surveyor)
3. list of key personnel, including the pharmacy consultant and qa person
4. copy of facility layout-(one for each surveyor)
5. resident's advocate committee names
6. hcfa form 672
7. work schedule for rn/lpn (day of entrance)
8. hcfa 802-up to date
" indicate with an arrow if weight is up or down
under "uti/ inf control/antibiotic"-note utis
under "interview able: indiv/fam
" ,note with an "i"
if the resident is
interview able. a list would be also be acceptable.
under "psychoactive meds"
for psychoactive, "a"
anti-anxiety, and "h"
9. policy /procedure for monitoring accidents/incidents and system to
10. immunization practices (flu and pneumococcal)
11. list of employees since last survey (list position and hire date)
12. admissions (past 30 days)
13. list of discharges (during last three months)
14. medicare residents requesting demand billing (during past 6 months)
15. resident age 55 and younger
16. meal times (of all dining rooms)
17. dining room seating chart- (one for each surveyor)
18. copy of menus (including therapeutic menus for duration of the survey)
19. list of residents on therapeutic and mechanically altered diets
20. work schedule for lpn/rn (day of entrance)
21. medication pass times for inhalers, eye drops, injections, g-tube
medications, and nembulizers.
22. emergency water supply policy and procedure (5 gallons per resident per day)
23. clia wavier certificate
24. copy of surety bond
25. resident rights
26. admission agreement
27. policies /procedures to prohibit /investigate abuse
28. activity calendar (last three months)
29. resident advocate members
30. resident council meeting minutes-(last three months)