CMS and the QIS process sets forth very structured numbers for review. Residents are pulled at random into the sample based on the MDS data and other things depending on our observations of the facility. It always disturbs me that surveyors are rude. I, fortunately, do not work with a team like that. We make a strict commitment to be nice and courteous to everyone. Because, like it or not, we are all here to make life the best that it can be for the residents who live in the facilities. There are a number of excellent systems out there and in every facility I have been in I learn excellent ways of doing things. It is a shame that the facilities don't talk to each other more and discuss what works and what doesn't.
When I go into a facility I make the assumption that the facility is in compliance unless I see otherwise. And yes we do follow staff around because we are observing direct care given to the residents. Observation is the most important part of what we do. For the most part I have seen committed, friendly people who like helping the residents they care for. Most people do not come to work with the idea that they are going to do a bad job.
When you have a negative experience with a surveyor, please call their field manager to discuss your concerns. These matters need to be brought to their attention.
And remember, if you don't know the answer to a question it is ok to say that. It is not a test and you can't know everything. But you should be able to know where to find the information.
And PLEASE use your care plan. Your care plans should be up to date, working documents that are used by all team members. This is not just needless paper work. The best facilities use their care plans, share the plan with all staff members and update them any time a change occurs. They are up to date and should be structured in a way that if you had a nurse who walked in off the street, he or she would be able to look at that care plan and know exactly what needs to be done for that resident.
If you have a question, ask the surveyor. Most will be glad to explain the QIS process. You can also find out a lot of information on the CMS web site. We are not out to get you. We just want to make sure that residents are getting good, safe care. Remember, they live there, and those of us who come in, staff included, are visitors to their home. When you remember that this is their home, it has an effect on how you approach your daily work.
Good luck to all of you in your next survey. Take a deep breath, answer questions the best that you can and ask questions if you need help.