Are some states really laxed on their surveys?

CoffeeRTC, BSN, RN · Dec 3, 2010

There is a big old book of the rule and the rules for the state surveyors and that is what they should be going by. Sometimes the Feds will come by and watch the state inspections.

Big joke where I worked a while ago..."Who paid off the inspectors?"

Leelee2 · Dec 3, 2010

Big joke where I worked a while ago..."Who paid off the inspectors?"

I've thought the same and heard the same comment many times in various facilities. Scary.

In my state one of our newspapers has watchdog reports for citizens to read about lax doctors and lax laws.

www.jsonline.com watchdog reports. Some of my favorite educational reading regarding the failures of the system.

classicdame, MSN, EdD · Dec 3, 2010

What type of facility are you referring to? Our hospital gets surveyed by OSHA, Joint Commission and the State. Since there are way more beds than inspectors state-wide, I assume they are not able to drop in frequently without a reason.

debRN0417 · Dec 3, 2010

We have "the great big book of everything" (as we call the State Operations Manual) and we have to go by that. When survey teams come in to facilities, things don't always go as they "usually do". Some facilities bring in more staff, the "carpet people" come out on the floor, and we don't always see what you all see everyday. And yes, the Federal Surveyors come with us to observe how we do our jobs, and so far I have been FOSSed (Federal Oversight Survey) four times in the past 6 months. They make sure we are seeing what we should, following the regulations, and coming to the correct "decision" about deficiency citations. They watch everything we do and review the records behind us to make sure we don't miss anything. So....ya'll get a survey once a year and we get a survey four or five times a year! FOSS survey's make it hard on facilities though, I think, because not only do they have us to deal with, but also Federal Inspectors poking around as well. But if you do what you do everyday and do the right thing, then there is nothing that should worry you. I am curious as to what you are referring to as lax? There have been many times that I have talked to facilities about an observation, because one observation in some cases, does not a deficiency make. There are some times, though that one observation could, in the case of an Immedicate Jeopardy situation, but that is a lot different. Can you elaborate on lax? I'm just curious. I do not take anything from this board to work with me. I am just a poster like the rest of you when I am here...trying to help a little if I can, and learn things...off the record.

CapeCodMermaid, RN · Dec 4, 2010

Anyone who thinks the surveyors are lax has never worked in Massachusetts.

indigonurse · Dec 9, 2010

I think it all comes down to the individual surveyor. I am amazed as well at some of the things that go unnoticed. It also depends on how much experience they had in long term care and what type of nursing they practiced. The most difficult part is correlating an F tag with the deficiency. I have seen them come in and find no deficiency one year, then put a place out of business the next.

Nascar nurse, ASN, RN · Dec 10, 2010

Anyone who thinks the surveyors are lax has never worked in Massachusetts.

And they have never worked in my part of Indiana. There are several facilities in my area that have petitioned the state to ban our surveyors as they are just so vindictive towards certain buildings...I know of 5 facilities in a 2 county area that want them kicked out. My facility is unwilling to petition the state for fear of retaliation by them if they are not banned.

There is no such thing as "substantial compliance" here...the expectation is 100% perfect. One missing lab = F tag... one missing bowel/bladder assessment = F tag.

I'm not kidding or exaggerating. Most of our entire plan of correction with 9 nursing tags were based off just 4 or 5 mistakes (because they also like to use multiple F tags for each area of "concern"). And trust me, they dug and dug and dug for 5 days to find these mistakes that ultimately had no consequences to the care of the resident. Now instead of being out and about with the residents, I spend my day being MAR and MDS police, ie: auditing.

debRN0417 · Dec 13, 2010

And they have never worked in my part of Indiana. There are several facilities in my area that have petitioned the state to ban our surveyors as they are just so vindictive towards certain buildings...I know of 5 facilities in a 2 county area that want them kicked out. My facility is unwilling to petition the state for fear of retaliation by them if they are not banned.
There is no such thing as "substantial compliance" here...the expectation is 100% perfect. One missing lab = F tag... one missing bowel/bladder assessment = F tag.
I'm not kidding or exaggerating. Most of our entire plan of correction with 9 nursing tags were based off just 4 or 5 mistakes (because they also like to use multiple F tags for each area of "concern"). And trust me, they dug and dug and dug for 5 days to find these mistakes that ultimately had no consequences to the care of the resident. Now instead of being out and about with the residents, I spend my day being MAR and MDS police, ie: auditing.

I despise "double dipping" (writing 4 or 5 tags from one issue) as I call it. but my supervisor loves it- so I just try to word my citation so that it can't go anywhere but where it is and when she says what about this and that? I say "I didn't have that information...."

I worked with a surveyor that was just plain old mean. I finally had enough of it and had a "come to Jesus" meeting with her in the conference room at a facility. I told her she was mean and I was not going to stand for it any longer, that I would not have my reputation associated with her craziness and meaness. I was a little more flavorful in my verbage, however. I then reported it to my supervisor, and had the facility Administrator report it as well. I also had other team members who validated my "issues" with this person as I told the supervisor to call them. That surveyor is no longer with us. Our Director does not tolerate such behavior or "vindictiveness".. I cannot understand why this happens. People are people and we all want to do the right thing. Every time I go into a facility, it is a "NEW" survey....whatever happened in the past is the past. I do not feel a facility whould have to drag around previous issues for years....nor the staff who work so hard to do a good job and care for the residents every day.

CapeCodMermaid, RN · Dec 13, 2010

Deb....if only all the DPH surveyors were like you. Do you think the QIS process will be better? We haven't had it yet in Massachusetts but we are all hoping the 'zealots' we sometimes have to deal with won't be able to tag us because they don't like the facility or the company that owns the facility.

Bella'sMyBaby · Dec 13, 2010

Anyone who thinks the surveyors are lax has never worked in Massachusetts.

Or Indiana..... :eek:

Bella'sMyBaby · Dec 13, 2010

And they have never worked in my part of Indiana. There are several facilities in my area that have petitioned the state to ban our surveyors as they are just so vindictive towards certain buildings...I know of 5 facilities in a 2 county area that want them kicked out. My facility is unwilling to petition the state for fear of retaliation by them if they are not banned.
There is no such thing as "substantial compliance" here...the expectation is 100% perfect. One missing lab = F tag... one missing bowel/bladder assessment = F tag.
I'm not kidding or exaggerating. Most of our entire plan of correction with 9 nursing tags were based off just 4 or 5 mistakes (because they also like to use multiple F tags for each area of "concern"). And trust me, they dug and dug and dug for 5 days to find these mistakes that ultimately had no consequences to the care of the resident. Now instead of being out and about with the residents, I spend my day being MAR and MDS police, ie: auditing.

Got the same problem in our part of Indiana

Personally I think the "State Surveyors" are a Major reason for many Nurses leaving LTC! :rolleyes: