What To Expect During State Survey

The new survey process has been in effect since November 28 of this year. I am waiting for my survey but I hear it's very different from the old survey process. There is less communication between the surveyors and the staff. They do 75% of the work before they walk in so they know which charts they're going to pull. No warm and friendly vibes any more...not that survey was fun or friendly, but I hear it's even worse now. We've been waiting since November for ours....I'll let you know what it's like when they arrive.

I have been through a few state surveys. They will ask you questions about certain residents such as,

"Does Jane Doe have any contractures? Any pressure ulcers? Does she use siderails? Do the siderails prevent her from freely exiting the bed? Is she on any nutritional supplements?"

Remember, you ARE allowed to use your MARs/TARs/charts, etc.

When they follow you on medpass, they want to see that you are observing your med rights, cleaning your hands and devices, administering with their right to privacy. ETC.

I believe there are YouTube videos to show you how to prep for state. I watch it every year LOL.

Good luck, it will go quick! The feel of the nursing home changes while state is there, haha. Mysteriously you have more staff around to help.

Lastly, remember, you can also tell them YOUR concerns also. Management wants you to fear the state surveyors. Don't buy into that.

If you have concerns you should share them with management and not the DPH.

I was present for last year's survey at my old facility. It was rough. I normally work 3-11pm but I was called in at 11am to help out. The surveyors went through all of our med rooms and med carts. They picked and pulled charts, asking nurses and CNAs very specific questions about recent falls, skin tears, etc. A few followed nurses around the floors and watched them give medications. Nursing supervisors (including myself) were there to assist nurses and CNAs with answering those questions, and act as resources. It lasted approximately one week. There was zero friendliness and it was by far one of the most stressful experiences in my nursing career.

Last state survey that I went through lasted 8 days. They make the CNA's perform peri care to make sure it's done properly, they pick a random pt with a wound and watch you perform wound care. They pick a random diabetic pt and watch you perform a fsbs, and then watch you draw up and administer insulin. They pick a random pt who is on breathing treatments and watch you administer a breathing treatment. They pick a random pt with a PEG tube and watch you administer PEG tube meds. They walk up and down the hall and monitor how long it takes for call lights and emergency lights to be answered. They interview residents who are alert and oriented, see how long it takes for incontinent residents to be toileted, look through charts. Make sure that the doors to your oxygen room and mEd room have functioning locks. Every time you leave your computer make sure you minimize your screen so that patient information isn't displayed. Whatever you do do not carry a portable oxygen tank up the hall, you have to use one those little etank dollies. Yeah it's a boatload of fun.

As a former surveyor (for about five minutes back in 2014), I was told I was "too friendly" with the staff; I know exactly how it feels to be on the receiving end of a survey, and I wanted to put them at their ease as much as possible. That's not OK, it really is an adversarial encounter and nobody is happy to be there. The job really *is* about finding evidence of poor care, and not in just nursing, but dietary, environmental services, even the laundry facilities. And yes, we knew exactly which charts we were going to pull before we entered, and they were always the residents with wounds, behaviors (gotta get rid of those pesky antipsychotics, you know), diabetes, weight loss etc. The deck is stacked against the NH, and deficiency-free surveys are unusual.

I'm sorry the process is so stressful, for all concerned. I'm actually glad I'm no longer a surveyor because I hated putting the screws to facilities that were doing their best to care for their residents. I did see one IJ tag that was richly deserved---the facility didn't have call lights on one whole hall because, according to the administrator, "the residents are too confused to use them"! So the annual inspections do have a purpose, but I totally get the stress involved. I've sat in on many an exit in my years as a nurse manager and DNS.

True story. And it's funny how all of a sudden all of the ADON's come out of the Woodworks, and people you've never even seen before report to work. AKA, you actually have adequate staff and no admits are accepted.

The surveyors arrived on Monday. They told me they were staying until next Monday. They left today. It was a different survey than I'm used to. They didn't ask about falls. They didn't watch any treatments. They did a med pass, checked the kitchen and the med rooms. Met with the Resident Council. Didn't look through any employee files. We had an entrance meeting which was a surprise because we were told that doesn't happen in the new survey process. One was rotten...the others were helpful during the exit interview. They answered our questions about a variety of things. The plan of correction will be put together tomorrow on the things we think we're going to get cited on.....

Sorry Viva, and some others. I have a different view.

As much as the survey teams are often viewed as PIAs, they have a function to perform. They are there to ensure that minimum standards of safe pt care are being observed.

We all know of some facilities that are h*llholes; places we wouldn't wish on our worst enemies. In 1985 ish, I saw a training video of some LTC facilities from the late 1970's that was horrendous beyond belief. To think that that video was less than 10 yo at the time, was very sobering. It was unexpected, unannounced survey visit teams that discovered the abuses noted. And it changed my perspective when I was present for future surveys.

So yes, while surveys are unwanted, they do provide some measure of QA/QP. I guess it all depends on the mentality/demeanor of individual survey team members. Like co-workers, like bosses, some are better than others. So I do recognize that when I remember surveys.