Are some states really laxed on their surveys?

debRN0417 · Dec 14, 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.

They're telling us that the computer system will pick the sample and that there will be certain information that is put into it by the survey team. It is supposed to then "tell you" what areas need further investigation. To be honest, they haven't really told us much of anything, although when I was with a Federal person recently I was told that most states do not like the process because it drags the survey out longer. I think it will prevent a lot of "digging" and unnecessaty citations because as I understand it, you can only go wherever the information leads you and can't get into alot of nonsense. I think it will certainly prevent those tags that come from the nasty people, and the "just because I can" people. Those are the ones they should get rid of. I do not feel there is any place in this process for that kind of attitude. I always thought that we were on the same side, trying to help each other make things better....not to be punative. When we start getting information or training, I will pass on what I can. Hopefully, like the MDS 3.0, they will give all of us the same information and train us all the same. I will let you know!

Nascar nurse, ASN, RN · Dec 14, 2010

They're telling us that the computer system will pick the sample and that there will be certain information that is put into it by the survey team. It is supposed to then "tell you" what areas need further investigation. To be honest, they haven't really told us much of anything, although when I was with a Federal person recently I was told that most states do not like the process because it drags the survey out longer. I think it will prevent a lot of "digging" and unnecessaty citations because as I understand it, you can only go wherever the information leads you and can't get into alot of nonsense. I think it will certainly prevent those tags that come from the nasty people, and the "just because I can" people. Those are the ones they should get rid of. I do not feel there is any place in this process for that kind of attitude. I always thought that we were on the same side, trying to help each other make things better....not to be punative. When we start getting information or training, I will pass on what I can. Hopefully, like the MDS 3.0, they will give all of us the same information and train us all the same. I will let you know!

DebRN, I am glad you are on allnurses. Your posts are always informative and fair. I agree with CCM...if only they were all like you! Thank You

Nascar nurse, ASN, RN · Dec 14, 2010

Got the same problem in our part of Indiana
Personally I think the "State Surveyors" are a Major reason for many Nurses leaving LTC!

I agree with you more than words can say. What nurse in their right mind went into this profession for the amount of stress involved. God forbid you miss an initial in one little paper out of the thousands upon thousands of papers signed in a 6 month period.

End result, I play MAR/TAR/MDS/Assessment police all day every day. No idea what is actually going on with the residents because I am to busy auditing every little thing. Of course the line staff doesn't get it & think I'm just nit-picking them and aren't to fond of me for it. I don't think this is how the system was intended to be.

Bella'sMyBaby · Dec 14, 2010

I agree with you more than words can say. What nurse in their right mind went into this profession for the amount of stress involved. God forbid you miss an initial in one little paper out of the thousands upon thousands of papers signed in a 6 month period.
End result, I play MAR/TAR/MDS/Assessment police all day every day. No idea what is actually going on with the residents because I am to busy auditing every little thing. Of course the line staff doesn't get it & think I'm just nit-picking them and aren't to fond of me for it. I don't think this is how the system was intended to be.

Yes, know exactly what you're saying.

Several Nurses in our building were recently turned in to the BON & Attorney General's Office ("Courtesy" of State Surveyors) for leaving holes in their MAR/TARS.....

Hope I never make a Mistake! :eek:

CapeCodMermaid, RN · Dec 14, 2010

Again the zealots are out there. I reported a nurse to the BON (and DPH) because she was 'acting peculiarly' and didn't sign off meds as given to 19 residents. When the woman from the BON came out she said. "I know the rule says if you didn't sign it off, it wasn't given, but....' Some regulatory types are reasonable and rational. Unfortunately, this is not true of all of them. The BON has far more serious problems than going after a nurse who forgets to initial an MAR on occasion.

debRN0417 · Dec 23, 2010

What was the outcome? Can it be proven that because the meds were "not signed out" that they were not given? The only way would be if the resident suffered some type of an outcome. As far as I am concerned, not signing out cannot mean not given unless you can prove it. It is a "paper tag" and unless there are many missed dates/times which would lead one to believe there is poor practice because nurses are not following through and signing out medications/treatments. So it all boils down to- sign as you go, then you don't have to worry about it because just what if you DID give the meds, but DIDN'T sign, and there was some type of reaction that the resident had, and you COULD NOT prove that you gave them, and YOU got in trouble for it...protect yourself!

CapeCodMermaid, RN · Dec 23, 2010

The BON is not obligated to tell anyone the result of their investigation. All the residents were fine and she told me that I had done everything necessary.

JacknSweetpea · Dec 27, 2010

I don't think so. Citations mean fines, but I will say I like the team of surveyors that come to our facility better than our management!

diane227, LPN, RN · Dec 28, 2010

I am currently in my training to become a state nursing home surveyor/ complaint investigator for the State of Washington. I can't speak to other states but I can tell you that complaints surrounding nursing homes, boarding homes, adult family homes etc are taken very seriously.

We rely on the federal rules and regs, known as "F-tags" and state regulations known as "WAC's" (Washington Administrative Code) each time we visit a facility. We visit facilities as a part of a routine survey at regular intervals but we also go out to investigate specific complaints. It is strictly against our policies to announce the visit in advance or to accept ANYTHING from the facility we are looking at.

Trust me, the investigators have had years of training and experience. We actually have a year of orientation before we can be on our own as an investigator. You will not find any investigator who does not have a strong background in their area of speciality. New or inexperienced nurses are not hired into these types of positions. You may also think that these nurses have not worked in years and don't understand the real issues that the staff and patients have to deal with. Believe me, they do. They/ we are trained to see things that others might not. More often than not, when a facility is not sited for an infraction it is not because the problem does not exist, it is just that at the time we investigate the complaint, we cannot find sufficient evidence to substantiate the complaint. I URGE all staff to continue to call in those complaints because all complaints are tracked. All are required to be investigated. Don't give up. If you have a problem at your facility, report it. If you suspect unprofessional conduct on the part of the surveyor, you should report that as well. I can tell you that from my training and experience with the staff I work with, they demonstrate a high level of professional conduct and are truly dedicated to the welfare of the residents in these nursing homes and do their jobs with the best interest of the patient in mind. I cannot imagine any of them taking a bribe or doing anything that would jeopardize the care of patients. The people I work with are some of the most mature, professional nurses that I have ever worked with and they take their jobs very seriously.

Pfiesty · Jan 2, 2011

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.

I was not aware that OSHA does routine surveys. I wish they did. I have found that the OSHA investigators that review injuries to HCWs are generalists and could not identify a safety sharp from a regular one or a safe procedure from a banned procedure.

Have you seen OSHA perform a survey?

debRN0417 · Jan 4, 2011

I've only heard of it...never actually been involved in one, though I "heard" they do them.

mytara777 · Jan 5, 2011

As a previous state surveyor I can say this...some I worked with let the so called "power" go to their heads! They loved to make nurses squirm, I hated that behavior. I think it's more personality, some women are just that way. Instead of going into a facility and do the job as a surveyor looking at the "systems" to ensure residents are safe and well cared for they "nit pick" because they know they can. I wasn't that way and tried to change it. Unfortunately management down state became this way also, so the process will continue until the state finds people that have integrity and compassion. I was saddened to see the management sink to a low level type of people.