Questions on State Visits

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As a new RN grad that recently started at a SNF, I am hearing horror stories from the other nurses related to the State coming for a visit: that they come and follow you around, ask you why certain patients are taking certain drugs, ask why I am giving my 8am meds at 10:30am (because there's too many patients and not enough time!)What exactly does the State searching for when they are looking at an RN and her job? How can I stay "out of trouble?"

Specializes in ICU, CM, Geriatrics, Management.
... I don't know how a deficiency could be written just based on a surveyors observation. It is not what you or I want, it is what the resident wants...

Agree.

Likely this occurred from an interview with a family member. As previously posted, if a responsible party went on the record that the SNF had been advised of the importance to the resident of the care not furnished, then a tag for dignity or QOL may be justifiable.

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The thing that would make me nervous is when they have their meeting with residents and solicit complaints or comments. There are residents who wait for the moment to complain, and others who are coerced to complain. These are the things you can't really prevent completely. I would want to strangle the nursing assistants who would purposefully go around egging on residents to complain and laugh about their ability to do so.

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Specializes in LTC, ER, ICU, Psych, Med-surg...etc....
The thing that would make me nervous is when they have their meeting with residents and solicit complaints or comments. There are residents who wait for the moment to complain, and others who are coerced to complain. These are the things you can't really prevent completely. I would want to strangle the nursing assistants who would purposefully go around egging on residents to complain and laugh about their ability to do so.

I agree, but disagree. Complaints are not solicited- there is a list of questions that are standard that are asked at all group interviews. Yes, there are some folks who wait until the state gets there to tell everything and complain about everything- but the next question from the surveyor should be "Have you discussed this with the facility staff or administrator?" "Are they aware that this happened to you or that you are concerned about this?" If the facility doesn't know that it's broken- how can they fix it? Same goes for any complaints received during private interviews- does the facility know? When did you tell them? What did they say? The facility needs to be permitted to respond to the allegation if the resident states that they told the facility- Allegations of abuse or neglect are the same, although reported immediately-- does the facility know? Again- you can't fix it if you don't know it's broken. If the same problem/complaint has been present AFTER the person has told the facility and maybe there is evidence of that in the resident counsel minutes then that is a problem....

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Specializes in Gerontology, Med surg, Home Health.

The State assumes we as managers are supposed to know everything. "Have you told anyone" is not one of the things I've ever heard a surveyor ask. I HAVE heard them ask leading and misleading questions and I have seen them set a nurse up to fail. I've also read their reports with outrageous misquotes. Surveyors are there for one thing...to find fault. Some are reasonable, most are zealots.

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I have worked in LTC for years and never once saw anyone shave a resident's legs. What tag could it be under? I would definitely IDR this. We are due for our survey any day now. It is what it is. We take excellent care of the residents.

i dont know a thing about the technicalities of survey......but i would hazard a guess the resident who didnt get their legs shaved might have been a younger, rehab patient? and might have to do with "dignity" issues? just a guess

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Specializes in Gerontology, Med surg, Home Health.

If it were a rehab resident, they should be shaving their own legs. Who's going to do it when they get home???

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Specializes in LTC, ER, ICU, Psych, Med-surg...etc....
The State assumes we as managers are supposed to know everything. "Have you told anyone" is not one of the things I've ever heard a surveyor ask. I HAVE heard them ask leading and misleading questions and I have seen them set a nurse up to fail. I've also read their reports with outrageous misquotes. Surveyors are there for one thing...to find fault. Some are reasonable, most are zealots.

Obviously you have had some rough surveys. Not all are like that, but I have known a few myself- I have had several discussions with some about attitudes and such. My experience is not to find fault but ensure regulations are being followed, but most important, that the residents are receiving the care that they deserve and the best that we can provide them.

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If it were a rehab resident, they should be shaving their own legs. Who's going to do it when they get home???

not if they are an incomplete quad.....or low back surgery....etc......there are a few things that might make it not possible to do....complex abd surgery......etc

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Specializes in Gerontology, Med surg, Home Health.

In the same vein...I guess you all think I should have wiped the lard a** of the fat woman who was too lazy to do it herself? When I asked her who was going to do it when she got home she said her friends!!

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In the same vein...I guess you all think I should have wiped the lard a** of the fat woman who was too lazy to do it herself? When I asked her who was going to do it when she got home she said her friends!!
not I! but you might actually get dinged for that to, if she actually couldnt do it......i have long said that NO ONE is goin to wipe my orifice as long as i can reach! lol.....you know, i have done some shifts it LTAC and maybe this experience is blurring with true rehab for me?....there, there really are persons who cant do these things for themselves, as of yet, but hopefully will progress to it.......
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Specializes in Home Health, SNF.

I'm a unit manager in a LTC facility in South Florida. We are anxiously awaiting our survey :angryfire:angryfire The problem in our facility is we have a very agressive DON who picks apart charts, nurses, CNA's, etc.. Also, at the end of March we started Optimus computer charting, which some of the nurses and CNA's are having a really hard time with. In essence, we are half in half out of paper charting. I am terrified. Has anyone in Florida had a state visit under optimus?

Roxann:redbeathe

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Specializes in Sub-Acute, SNF,ICU,AL,Triage, Cardiac.

regarding pending state visits:

if you are relatively new and actually had a little time to burn(so to speak). go to this link:

http://www.cms.hhs.gov/manuals/downloads/som107_appendicestoc.pdf

and on page 2, download these:

p

survey protocol for long-term care facilities

929 kb

pp

interpretive guidelines for long-term care facilities

1,440 kb

you will be able to obtain insight on how surveyors are taught to interpret the regulations, and what questions to ask, how to probe, etc. if you understand where they are coming from, and the purpose behind their line of questioning (whatever it may be), it is easier to provide a straight answer. if your facility has provided limited training on fed and state regulations, it will be a huge eye opener for you.

survey prep should be a reoccurring activity with any facility. if your leaders have not spent any time going over basic standards and expectation (the state regulations, the federal guidelines - key areas) ask them for a series of inservices.

good luck! there isn't enough time and space for me at present to give you the many things i have learned and taught over time, but here is a few:

always, make it obvious that you are following good hand hygiene habits before and after patient contact - they will be watching! sometimes they ask the patients if they saw you washing your hands!

always knock on the door and ask for permission before you enter a resident's room (if it is a non-verbal patient - knocking and announcing your entry would suffice).

during any interview, do not add words which are unnecessary (small talk) - they write everything down - date/time, your name and what you said. if you are nervous or flustered, take a deep breath and admit you are nervous-it is okay. ask them to clarify any questions you don't understand, or you are unsure of.

for life safety information and policies, you do not necessarily have to memorize everything - but you have to know where to find the answer - i.e. where the manual is, who you can ask, etc. but you must know your codes for fire and disasters, the acronyms race and pass - many facilities have them laminated and attached to the back of their badges, along with other tips.

know that if you are interviewed about abuse - your first action upon witnessing any situation which could be abuse, is to remove the patient from the unsafe situation, then immediately report to the supervisor or your abuse prevention coordinator (usually it is the administrator, don or social worker), fill out the required form, and the facility must follow the reporting guidelines to the regulatory bodies.

if you happen to be the med pass pick - anticipate this.

during survey, all carts must remain stocked with non-expired house supply - your supply person should assist with this. have your cups, spoons, syringes, whatevers - stocked - it is not the time to be running around for supplies. your pill crusher should be clean - pressure washing works or soaking in hot water and bleach or soap (whatever your approved method is). your insulins and other vials should all be dated when opened and the date of expiry also placed - dated/initialed accordingly - usually night shift nurses help with this prep.

your juices/apple sauce, etc. should be dated. refrigerate again after your med pass if you will be using again.

best tip? pick your easiest patients - avoid the ones who are usually problematic because once the surveyor reaches the quota, they will stop observation for a while, but may ask to specifically watch someone with a tube feeding. brush up on your policy for med administration for a tube feeder.

make sure you follow your patient identification procedure before you give any medications.

explain to the patient what you are giving them and what the meds are for - yes it is required. if a bp or pulse is needed before you give a med, do not pour those meds until you have taken the measurements so you can follow the parameters.

sign immediately after administering - never before - and never until after the entire med pass for all the patients!

cover your med sheets or med book (can use a folder, a paper, etc.) when you leave the cart to administer the meds to a patient.

do not give injectables, eye gtts, etc. in a public area (or dining room) - it's a newer dignity issue. unless a medication is ordered with food, do not interrupt a patient's meal by administering meds.

more to follow later

good luck!

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