State survey

Specialties Geriatric

Published

Hello all!

This isn't really a question, but mainly a vent. We recently had our state survey and got a cite for skin integ. The state is saying that a resident developed a pressure ulcer. We are saying its a stasis ulcer from poor circulation. (this resident is in poor health, DM Dialysis, has already lost one leg dt this) We have documentation, and The would doctor that comes in and his own doctor have both documented well on this residents wounds being stasis ulcer.

Now the sate surveyers win. We get the cite. How can they do that?? They are basically lying in my opinion just to give us the cite. They surverys also stated that someone in management made a statement that was never said. I just don't understand how they can do this. How can they sleep at night?

I have been in LTC for about 15 years, I have never seen surveyers do this.

thanks!!

Kathy

pennyaline

348 Posts

How long ago was this survey done? Has your facility received the final report from the State? Survey teams do make mistakes and misinterpret information. In their report they must specify where the information they used to make their determinations comes from. It ain't over 'til the fat lady sings. Until the facility receives the final findings, it's all speculation.

If your facility disagrees with the final survey findings and wants it reexamined, the administrator can request an IDR (informal dispute resolution) at which time the facility can assemble and present all of its documentation relevant to the tag in question. If all of the medical record agrees that this is a stasis ulcer and there is no basis to consider it anything else, it is likely that the tag will be dropped in IDR.

Orca, ADN, ASN, RN

2,066 Posts

Specializes in Hospice, corrections, psychiatry, rehab, LTC.

I am a nursing administrator in a correctional facility. We had state auditors in about a year and a half ago. Some of their citations were laughable. They claimed that we had "clerks going in and out of the medication room". These "clerks" were our outpatient psychiatric nurses, who wear street clothes. The auditors never bothered to ask who they were and drew their own conclusions. We don't even have clerks. They also cited us for not having proof of a nurse's license when we did have documentation of the renewal, just not a copy of the card itself (it was late in being issued by the Board of Nursing due to a technical problem with their printing equipment). They also claimed that our dental technician never called them back to answer questions about our dental operation (she was absent on survey day), even though a week before the report came out one of the auditors told me "She has called me several times, but I have always been out of the office."

Anyone who is smart takes these reports with a grain of salt.

eriksoln, BSN, RN

2,636 Posts

Specializes in M/S, Travel Nursing, Pulmonary.
I am a nursing administrator in a correctional facility. We had state auditors in about a year and a half ago. Some of their citations were laughable. They claimed that we had "clerks going in and out of the medication room". These "clerks" were our outpatient psychiatric nurses, who wear street clothes. The auditors never bothered to ask who they were and drew their own conclusions. We don't even have clerks. They also cited us for not having proof of a nurse's license when we did have documentation of the renewal, just not a copy of the card itself (it was late in being issued by the Board of Nursing due to a technical problem with their printing equipment). They also claimed that our dental technician never called them back to answer questions about our dental operation (she was absent on survey day), even though a week before the report came out one of the auditors told me "She has called me several times, but I have always been out of the office."

Anyone who is smart takes these reports with a grain of salt.

Hospital auditors are like Home Inspectors. They are paid to find X amt. of issues. If they dont find real ones, they will paint imaginary ones to fill the quota. A good many of them are college drop outs who are in their position simply because their uncle knows someone. Not the brightest bunch around to say the least.

Thats why the only people who take them seriously are the administration who have to humor them. Those of us on ground level who know better and dont have to be bothered with them.................we find them easy to ignore. Me, I had one walk up to me a few times while working and start the "interigation" stuff. I cut them off med sentence and tell them I'm busy, that a patient needs me, and I dont do it nicely. Only once did I hear anything about it afterwards.

They dont deserve my time, and I dont give it to them. If they want to shut down a hospital because I wont be bothered humoring them.........go ahead and try.

State surveyors definitely have their place in maintaining patient safety. However, having said that, I have seen many instances in which their interpretation of events was questionable or just plain wrong.

The surveyors are not omniscient and they, too, can make mistakes. The most frustrating aspect of these situations is that the surveyor’s interpretation goes on the report. If you want to dispute it, there is an entire bureaucracy with which you have to contend.

eriksoln, BSN, RN

2,636 Posts

Specializes in M/S, Travel Nursing, Pulmonary.

With these people, its an issue of "Mind Over Matter".

I dont mind, cause they dont matter.

pennyaline

348 Posts

With these people, its an issue of "Mind Over Matter".

I dont mind, cause they dont matter.

Don't kid yourself. "They" and the survey process matter very much and can cause a great deal of grief for facilities burdened with persistently negative findings.

pennyaline

348 Posts

State surveyors definitely have their place in maintaining patient safety. However, having said that, I have seen many instances in which their interpretation of events was questionable or just plain wrong.

The surveyors are not omniscient and they, too, can make mistakes. The most frustrating aspect of these situations is that the surveyor's interpretation goes on the report. If you want to dispute it, there is an entire bureaucracy with which you have to contend.

But even with that bureaucracy to face down, if the facility's got its paperwork right and its ducks in a row, winning an IDR is a simple matter. It's all in the details... and using the survey team's own words against it :coollook:

debRN0417

511 Posts

Specializes in LTC, ER, ICU, Psych, Med-surg...etc....

I sleep very well at night, however as it has already been said, the report is not final until the facility receives the formal 2567. After that, the Administrator can request an IDR. The burden of proof at that time is upon the facility to present evidence contrary to the report on the 2567. Surveyors are people. They make mistakes. They are not omnipotent, and are not always right, but neither are the facilities. The administrator can also contact the supervisor and discuss the facts after the receipt of the 2567- supervisors in my state have been known to contact the surveyor with the new evidence and delete the citation. I don't know how it works in your state...but from where I stand I cannot see how a surveyor can lie on a report when there is not evidence to back up what is written. All reports and paperwork are reviewed for accuracy not only by the state office but by CMS as well. I am not saying that what you say cannot happen-I am saying that if it is not factual, then when reviewed or in IDR, the truth will come out.

CapeCodMermaid, RN

6,090 Posts

Specializes in Gerontology, Med surg, Home Health.

If you have documentation that the wound is a stasis ulcer, don't accept a tag. That's why the IDR process was developed. And to all those people who said survey doesn't matter, apparently they haven't been working in the business long enough. Of course it matters.

But even with that bureaucracy to face down, if the facility's got its paperwork right and its ducks in a row, winning an IDR is a simple matter. It's all in the details... and using the survey team's own words against it :coollook:

I guess I just do not like the mindset of guilty until proven innocent.

Common sense is the missing link here. It is just a shame, in my opinion, that so much time and energy must be expended on disputing a facetious citation. How much time and energy could be saved if the surveyor would simply use some common sense to determine what is really happening prior to initiating this complex chain of events?

The use of common sense by a governmental agency: I guess that is too much to ask.

debRN0417

511 Posts

Specializes in LTC, ER, ICU, Psych, Med-surg...etc....

We cannot know exactly what evidence was presented- we only have one side of the story. Again, I don't want to offend anyone, but until you yourself have sat down and reviewed the evidence, how can you know? Common sense? I can tell you some horror stories about common sense....or lack thereof...I know that I am a disliked minority- I truly wish it were not that way.

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