Questions on State Visits

florianslove · May 13, 2009

thank you so much for your post. It is very informative and helpful. I will keep you updated. Wish us luck.

Roxann

achot chavi · May 14, 2009

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.

This is true, they feel like they have to justify their inspection, I have also seen the misquotes thing.

expltcrn · May 19, 2009

The other thing to remember is that the State Surveyors are people too. So, we are talking 1) Plenty of room for error/misrepresentation; 2) They have their own agenda (we don't always know what it is; 3) They will respond to your body language and demeanor, and may follow your lead with how your survey is going to go - meaning if you are hostile, and unfriendly, you may get the same response from them. Although watch out for the nicey-nice ones because they may be happily writing down all your little comments that you thought were harmless.

I have been through many surveys as my specialty is turning around troubled facilities so to speak. Part of running survey readiness, is readying the staff with a mind-set. This means aside from actual preparation, continuous audits, rounds rounds rounds, leadership will "mock interview" staff from all different levels and all difference departments. We made jeopardy games, pop quizzes, things like that.

Some staff/companies are opposed to this type of prep because they think the surveyors should see reality as it is. While there is truth to that, it would be akin to having your kids say you as a parent should see how they keep their room "all the time as it is without prep work" knowing you could withhold their allowance if it didn't pass your standards. If you are lucky enough to have a well-run facility, then the survey should only be once a year. And since this once a year snapshot is publicized, wouldn't you want to be ready for your "photo-shoot?"

Prepping staff includes: Quizzing them on their feet regarding fire/safety response - RACE - PASS, what to do if a patient elopes, how to slow down and ask the survey to clarify the question if they don't understand, where all the manuals are (once again), not to hand anything over to them without checking with your Supervisor first ("Let me check with my Supervisor just to make sure I am handing you the right thing,").

Okay, that's it for now. And by the way, it is a well-known legend that those who join the state surveyors were those who failed in management of a nursing unit of hospital elsewhere - don't get me wrong there are those who are brilliant and love what they do as a cause for improving senior care. And then when they don't do well as a front line surveyor, they don't get terminated, they get promoted!

debRN0417 · May 20, 2009

. And by the way, it is a well-known legend that those who join the state surveyors were those who failed in management of a nursing unit of hospital elsewhere - don't get me wrong there are those who are brilliant and love what they do as a cause for improving senior care. And then when they don't do well as a front line surveyor, they don't get terminated, they get promoted!

This statement bothers me....are you saying that state surveyors are surveyors because they failed in management?

expltcrn · May 20, 2009

Some of them yes, so they relish picking on the DON especially.

florianslove · May 27, 2009

Well. we passed our survey with very few tags. No med errors, no patient care issues, mostly housekeeping and dietary issues. I was disturbed to find that two of our surveyors were not nurses, one asked me why TSH wasn't on the MAR, I explained to him it was not a medication, but a lab. I asked him if he was a nurse and he said "no, but that doesn't mean I don't know what I'm doing". I beg to differ. Also one of our tags was because a straw was on the table of a patient that wasn't supposed to have a straw, even though there were three other people at the table who were allowed to have straws.

Anyway, good luck to all who will be facing sureys in the future. :up: :up::heartbeat:heartbeat

Good luck to all:yeah: :yeah:

achot chavi · May 27, 2009

Congrats, you deserve it and worked hard, you gotta reward your team- take em out for brunch or something!

and how ridiculous is that - surveyors not nurses!!!

I guess the tax auditors lack a background in accounting as well- explains everything.

CapeCodMermaid, RN · May 27, 2009

In Massachusetts not all surveyors are nurses. We usually get a nurse or two and a dietician or social worker. It's just the way it is. Congrats on your good survey.

morte, LPN, LVN · May 28, 2009

In Massachusetts not all surveyors are nurses. We usually get a nurse or two and a dietician or social worker. It's just the way it is. Congrats on your good survey.

yup....which is fine....but i would think they would stick to their specialty......had a SW be the only one to show up at a home, d/t a snow storm she demanded the doc be called about a patient and lab work run....the patient was terminally ill with advanced MS.....had very strange urine.....the doc wasnt impressed and asked the nurse, "so she thinks i dont know how to care for my patient?"that was after a rather long pause....everything turned ok,(lab work) but the additional cost to the home was unneeded.....

achot chavi · May 31, 2009

In Massachusetts not all surveyors are nurses. We usually get a nurse or two and a dietician or social worker. It's just the way it is. Congrats on your good survey.

Ok are you sitting down, we are a 180 bed SNF and 25 bed ALF ( soon to be 50 bed ALF) and the survey teams come separately- SNF and ALF, each a 13 member team -2 doctors, 2 nurses, 2 social workers, a dietitian, phys therapist, recreation therapist, occupational therapist, 2 for administration, 1 for bookkeeping (they check that the schedule is kept etc.)

If we are fighting for some equipment or changes to help the nurses, they usually help us- for example. on a newly built unit, the nsg station lacked a sink, we begged for one but was told it couldn't be done, the survey team wrote it up and presto - within a week we had our sink....its the small things....

Each discipline stays within the realm of their specialty. They can all ask questions of the nursing staff, but usually with the nurses from the survey team present.

The dietitian also checks the kitchen staff, getting under their skin by weighing and measuring portions (once found us short by a few ounces,...)

The doctors are the nicest and most understanding... the nurses are usually new each year, (lots of turn over) we usually get our license for 2 years but they get under our skin to achieve that

I have never had a dietitian ask me about the TSH, but I am sure she knows what that is, they are pretty knowledgeable.

lp_825 · Jun 9, 2009

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!

i can not thank you enough for all the above noted!!!!! this was a huge help for me and i have been searching for hours for this. although this is what i already do, i just need to be touched up on this before state comes!!! thank you again so so so much!!!!

expltcrn · Jun 9, 2009

You are most welcome. Glad to help! :mad: