Nursing home state surveyor general tips please!

[Snowchild]

Hi, I don't see this anywhere on the community wide site, so I am posing a question to those of you like me who have "gone to the dark side." 

As a (not so new but still have a great deal to learn) nursing home state surveyor, do any of you experienced surveyors have tips you've learned along the way that can help me in my journey? I am trying to feel confident each time and put on my brave face each time I go out to a survey, but to be honest I'm still pretty terrified. 

[Emergent, RN]

Be sure to find something wrong, even if it has zero actual impact on patient wellbeing. Concentrate on the yearly target problem so you can make the geniuses in regulatory feel good about their worthless careers. 

[Davey Do]

2 hours ago, Emergent said:

Be sure to find something wrong, even if it has zero actual impact on patient wellbeing. Concentrate on the yearly target problem so you can make the geniuses in regulatory feel good about their worthless careers. 

Translation: Do what the others have who have gone on before you have done.

And I'm quite sure Emergent, bless her heart, is typing with her tongue in her cheek.

In reality, Emergent is saying, of which I agree, is to assess & survey that which directly affects patient care & well being. Areas of focus could include, but is not limited to, staffing ratios, assessment types and interventions. With LTC, skin breakdown, nutrition, and hydration are important.

Increased confusion & agitation, as well as reported cases of UTIs, could indicate subpar monitoring and institution of fluid and dietary intake.

In a perfect world, a surveyor would start at the top, discussing services with administration, and work their way to professional & ancillary staff, obtaining bottom line feedback from the served population.

In my experience, surveyors have requested to review documentation on specific patients before their visit. Of course those charts and computer entries are going to shine, because management makes sure this is so!

To be able to randomly review a high acuity patient's documentation for assessments, interventions, evaluations, and plans would be beneficial and give a good indication of the quality of service and care.

Godspeed and good luck, Snowchild!

[CharleeFoxtrot, BSN, RN]

I would say be flexible during circumstances that warrant it. For example, when I was working in a SNF I was at my computer on wheels charting and talking with a state inspector. In the room across the hall, a CNA shouts for help as a patient is falling. Of course I run in and help out. Of course I left my laptop open and unsecured. The inspector stood by my computer (she had closed it which locked the screen) and gave me a lecture afterwards.

We could have been cited, and honestly the corporate office probably would have fired me. 

Best of luck!