i was just wondering about state inspections.... i went through one recently and it sucked!!... well.. we did fine and i was even offered a job by them... which was flattering.. but i was new there and the only RN that worked the floor... they were watching me like a hawk!! they were nice and all...but intimidating to the extreme.. i only work @ that LTC part time nights... and i just happened to be there when they showed up..
i was just wondering.... is it always total chaos and havoc when state shows up??
They start with 40 charts and then go on from there. They also pull anyone on Hospice, or dialysis. When the QIS started, they generated more tags , but now are less tags then before. The state average for MN is 5.4
Yes, there are facilities that can still generate over 20 tags. my facility closed in Dec and I entered a different one as a consultant before taking the position permanently. They were on the SFF list for almost 2 years. I am proud to say that our survey in May had 5 D-tags and is now off the SFF list.
They start with 40 charts and then go on from there. They also pull anyone on Hospice, or dialysis. When the QIS started, they generated more tags , but now are less tags then before. The state average for MN is 5.4
Yep, they cited our medical director for "inappropriate hospice referrals" he/she filed a complaint, lots of ruffled feathers in this state.
They start with 40 charts and then go on from there. They also pull anyone on Hospice, or dialysis. When the QIS started, they generated more tags , but now are less tags then before. The state average for MN is 5.4
Average tags for QIS 20 first year in this state, only 6 buildings surveyed so far, 3 put in stop placement.
Love the terms Barbecue....and blood bath, holy mother of all that is good, truer words were never spoken.I lost 15 pounds in 3 weeks, had unrelenting chest pain and was completely unable to eat or sleep for the entire 3 weeks,and for my efforts,.....on the chopping block! Life is good!
Specializes in Management, Emergency, Psych, Med Surg.
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.
It would be very unprofessional and unethical to offer a job on a survey. I have had staff inquire as to how to apply. I have given them the website. I would not solicit anyone while on site.
I think people freak out on survey because they so want to do the right thing. It is so hard to have someone standing over you watching every move. When you watch someone, you can tell if they are consistently doing the right thing and not just what they think you want to see...I try to reassure them to just do what they do every day, and that it will be fine, and 99% of the time it is. One little mistake does not mean the end of the world, I mean if a mistake is made and the person says right then and there, "Oh I didn't mean to do that, or I should have done this first" I can live with that because I know they know the right thing to do and nerves just took over. I will often have them just tell me what they should have done, or give me a step by step, and take their time. I try to talk to them a little beforehand and at least try to make them feel a little more at ease. It is often helpful if the resident joins in the conversation because you sometimes never know what they're going to say and it usually really breaks alot of the tension. I also try to tell them beforehand that I want to watch something so they have time to review their policy, or smoke a cigarette, or take a valium (hehe).... so they have time to mentally prepare...it is hard to be watched. We all know that it is very intimidating no matter who is watching.
Thanks! I'll have to remember "oh I didn't mean to do that or I should've done this" in case I do something wrong in front of a surveyor.
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.
If only you worked in my state. You are quite professional. OUr surveyors take it all very personally, and they interrupt our work for hours at a time, and this year, no less than 3 surveyors were ordering the nurses around, asking for this, and for that, knowing full well the RCM was assisting the OTHER surveyor and literally snapping their fingers to get her attention. My facility was disrupted for the weeks and at the end, I was insulted no less than twice, once a surveyor interfered with MY investigation and initiated a full investigation against our facility, prior to us being able to do OUR investigation (and interferred with each of the witnesses and with my specific investigation) (we did call his field manager, but it did not do a thing to stop this surveyor)and then, on the next last day, same surveyor, walked into my office and demanded to know what I had done with his missing documentation, then he demanded the same of the regional nurse and then...he found the papers HE lost in with HER stuff, and gave an apology to the other nurse (regional) but not to me.
Most unprofessional group of surveyors I have ever had the displeasure to work with. They got mad if we stopped answeirng their questions to turn around and address/assist a needy resident, and they seemed obivious to the phone ringing, families needing assistance and they were intrusive with family decisions/care conferencing and wanted to know why a hospice referral was being made, on "their" patient, really? Well, if you stay in a buildiing almost a full month, funny thing is, life goes on, and that might include dying, change of condition and a whole bunch of other "unacceptable things" in the fabricated world of survey. (They came in first week, mid week, next week only in 4 of 5 days, and next week one day holiday-perhaps if the one surveyor would have been on time, they could have exited as early as the 2nd week? They complained that their computers gave them fits, they seemed very unsure of their own QIS process and they were VERY punitive and insulting in their assessments of our failures.
One followed one of my nurses for an entire day, then told that nurse "Are you working on end of life issues with mrs smith? Did you know that mrs smith is a full code?"Nurse went to the chart (agast, as Mrs Smith was hospice and actively dying during survey) surveyor then said "Oh, my mistake, I meant Mrs Jones, isn't that who you have been working on all day?". DId not even have the right patient, followed that nurse into the Mrs Smith's (said her name right on the room)room 6 seperate times to interfere in private conversations with the out of town families that were finally being allowed to talk to MRs. Smith cuz she finally said the nurse could call her family. WHEN she DID die, another surveyor literally RAN into the room, looked at the dead patient, and then came out and said "Well, I guess it is ok for her to die, it was expected". Seriously? And yes, all of this was careplanned, but somehow it wasn't suppose to happen? Can anyone say "Pretty damn far from the bedside?" or "refresher course needed before ever gives direct care?"
Not the first time have witnessed this "too far from the bedside to know" attitude. About 3 years ago, another surveyor didn't "see" any green oxygen tubes in the patient's rooms and said this "I think we might have an I/J situation here." I just happened to be in the conference room, overheard the conversation the surveyor was having with the Admin and DNS, spoke up and said "Would you like to see the oxygen overflow room that we store the emergency tanks in and the room concentrators?". I had to literally SHOW her what we use for oxygen, cuz she COULD NOT PUT IT TOGETHER. Can anyone say "too far from the bedside? for too long?". Prior to this last QIS survey, I had a lot of respect for most of the surveyors but I cannot say that any longer. It has been hell here in this state, DSHS acting out, lots of "territorial" behaviors and lots of politics, all with the taxpayor money, and honey, I AM a taxpayor as well. Don't get me wrong, I have a ton of respect for the surveyors that come in, act professional, do their job and let ME do mine, and we both focus onthe resident, not their chart. Sometimes it seems the surveyors forget its a real patient represented in those charts and careplans.
I will step off my soap box, and this isnot directed at anyone, just venting. Thanks for listening.
noc4senuf
683 Posts
They start with 40 charts and then go on from there. They also pull anyone on Hospice, or dialysis. When the QIS started, they generated more tags , but now are less tags then before. The state average for MN is 5.4