Survey begins

Specialties Geriatric

Published

argh! Last Saturday morning at 8:30.........These people well know that most of us are better staffed during the week-I guess they decided to shake things up a bit this year.Saturday I worked with an agency LPN-she had not been on the unit for months but she was great...I'm a float and I had not been up there in a week but we worked together and things worked out very well....A few staff nurses had signed up for OT for Sunday but did not show and the supervisor had cancelled the agency...It was awful-we had 2 less cna's and I worked with a pool RN who is less then ambitious-she chatted and smoked while I ran around like a nutcase-with the surveyor up my butt all day....I came home exhausted and with a screaming headache.I took 2 tylenol PM and went to bed-did not wake up until this morning.......I will never ever work like that again.....It was entirely my own fault but I did not want to get into any kind of confrontation while the surveyor was lurking about......I volunteered myself to become a victim-I hate myself!!!!!:trout:

Specializes in med/surg, telemetry, IV therapy, mgmt.
what is the first thing they usually want to do, especially when they come in on an off-shift?

in my experience, they are there to see what is going on with the night shift. how many people are actually there and working, what the place looks and smells like and what kind of routine is being followed for the morning get up and breakfast. they might even want to question some of the staff about policy and protocols.

i heard at the last facility, and again at this facility, that when state comes, we'll have all kinds of staff that we don't usually have - this seems dishonest to me.

mostly, what you are hearing is gossip and rumor. it is true that many facilities put on extra staff on survey days. but, the true reason for this is so that the facility can attend to the survey team. that is acceptable. in actuality, the surveyors have access to and often look at the back months of the staffing schedules. they can also review the payroll records if they want to verify or confirm any questions they have. the surveyors are also aware of complaints that might have been made against a facility and they can follow up or investigate further into those complaints if they desire.

many of the survey teams have an agenda that they work from. so, there are certain areas they are looking into at every facility just as a team goal they are working on that the state health department or medicare is monitoring trends in. they also are checking to make sure that basic standards are being followed. believe me, they know all the tricks places try to pull off to show they are in compliance.

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:confused:

Our facility never really knows when they will come in. They have three months before and three months after your last survey to come in. So there is a window there where we know at anytime they could come in but we do not know for sure when it will be. How do the facilities know when they will be coming in? We are in OH. Are they in a different state?

I think maybe the state surveyors call a day or two ahead of time, at least that's what happened at the LTC I worked at.

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Specializes in Too many to list.
The surveyors in Massachusetts seem to be zooming in on emergency plans and supplies. They wanted to know at one facility how much emergency water the facility had...

I would be very interested in knowing if any other facilities undergoing surveys are asked about emergency plans and supplies. I am trying to track how states are implementing their panflu plans on a level that impacts nursing. It is unclear if these surveyors in this post are interested in panflu planning specifically, but checking emergency plans and supplies is a step in the right direction.

Do your states have specific panflu plans for LTC? The state that I work in does. It will be in the infection control manual or possibly in another manual for emergency/disaster situations.

Thanks for your assistance.

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Specializes in Gerontology, Med surg, Home Health.

I think that the emergency plans we have must cover every emergency...not just the panflu. We have a general plan and then specific ones for the kinds of things we might actually have to work through. We are a mile away from the ocean, so things like flooding and hurricanes are a very real possibility. We are not really at any threat from earthquakes so we don't really spend much time on that. The push for all this started with Katrina. We've been told by the state that we are supposed to keep a 30 day supply of medication for all residents at all times. Trouble is, at least 1/2 the residents are on Medicaid and we can't get any more than one 30 day supply. We're also told to have one gallon of water for each patient and staff member for a 3 day period....don't know where we are supposed to keep 500 +/- gallons of bottled water....we don't even have enough room to keep medical records!

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Specializes in Too many to list.

Thank you for that information, and I can certainly understand the lack of space for storage. Water is bulky and heavy!

The Dept of Health is meeting with the Nursing Home Assoc today in the state where I am working. One of the main topics will be on panflu preparedness plans though not specifically avian flu, as we do not know what virus may be responsible. I am hoping that in the light of the recent release of the SARS committee data, that they will recommend an emphasis on PPE for the nursing staff, and educating the educators (infection control nurses) on the very real health risks. Gauze face masks and a pair of goggles per nurses station if not adequate! They really have to start looking at this issue, and now the state is going to be insisting that they have to. We are very unprepared for ANY catastrophic event, particularly this one.

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Specializes in LTC,Hospice/palliative care,acute care.

I'd like to see this thread keep going.We can really use it to our advantage,I think.I'm still trying to get my head above water and fix the mess the unit had fallen into over the past 6 months with no charge nurse on staff...it's tough to get caught up and stay current along with the rest of the crap.Heaven forbid if a resident has an actual acute NEED...I'm too busy with therapeutic exchange recs,prior authorizations for meds-etc.....

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Has anyone working in Ohio had the new computer generated survey? If so how did it go with your facility? We had one last year et it was not as bad. But they did look through a whole lot more charts. And we were not able to debate them like you could when they just watched et observed. Based on the questions et answers given et put into the computer, it will cite you. And if the computer says it is a cite, then you get it. Another question for anyone out there is have you ever been through a survey where the facility was not given a cite? Just currious. The best one we had, they still picked a couple of silly things to give a citation on.

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Specializes in Gerontology, Med surg, Home Health.

For me the thing scarier than a computer(which the surveyors don't use in Massachusetts) is the digital camera which they are starting to use. From what I understand it's to cut down on the number of 'rebuttals' facilities have for certain tags. If the surveyor took a picture of a moldy wall, the facility can hardly say it wasn't as bad as the surveyor said. BUT, and not that I'm paranoid, anyone with Photoshop can make any picture look any way they want.

As a PS. I think the days of 'perfect' surveys are over. Most DNSs I know are happy if they get a few Ds or Fs. It gets harder every year to satisfy the requirements.

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Specializes in LTC, Sub-Acute, Hopsice.
Why the escort? Facilities most of the time are warned they are coming and clean up the problems long enough to get a better rating but not really solve anything. Personally, I'd like to see them show up with no warning once in a while, maybe even work a facility undercover, and really clean up these bad facilities.

Boy, I wish I had worked at those facilities...We always had a bit of an idea when the survey was due, but since there is a 3 month window before and after the date they came last year, we never knew. And when they come late it is worse then when they come early. When they come early you panic, desparatly try to think of ANYTHING that they might find in the first day thay you could possibily fix in the next 10 minutes and start praying to every god you ever heard of that no one did or said anyting stupid (...like an RN who talked about a resident who was having falls and a pretty fast decline at the outer nurses station [Hippa, hippa hippa] in a loud voice, in front of a surveyor, and when I was making faces at her to get her to stop, just said "What is wrong, wasn't I supposed to say that?" She no longer works there.) When they are late, you have been in "survey mode" for so long that you think that maybe the State forgot that your facility was there and were going to give you a reprieve this year. So when they come in everything is usually WORSE then when they come early. As for working "undercover", if that would work it might be good, but in South Jersey, anyone who has worked in LTC for any period of time knows the surveyors from 2 or 3 different teams and after a while, with job changes, conventions, DON meetings etc., a lot of us know each other anyway. They would stick out like a sore thumb.

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I also live in Ohio and we do not get any type of advanced warning for survey. Just the 3 months before and 3 months after last years survey window. We just had ours in December and did well. I work at a really great facility and we have had deficient free surverys in the past. I havent heard of the computer generated survey before. Is that something new?

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I also live in Ohio and we do not get any type of advanced warning for survey. Just the 3 months before and 3 months after last years survey window. We just had ours in December and did well. I work at a really great facility and we have had deficient free surverys in the past. I havent heard of the computer generated survey before. Is that something new?

It is something new that they tested on part of the facilities around the state last year. And it is going to be what they do in the future when all the kinks are out. It is basically where they review charts, nurses notes, MARS, TARS, and there are questions that the computer asks. They are strictly yes/no questions and based on what is entered, you either pass or you get a cite. There is also more patient and family interveiw questions that the answers are put into the computer as part of the survey. The computer will prompt them based on whether they imput a "yes" or "no." And depending on what the answer should be, it will prompt the next question. You are not able to "argue" your point of view and maybe save yourself from being cited like you can when it is strictly observation from the surveyors. If the computer says it is a citation, then it is. I will have to try to find my papers on it and see if I can get more detailed information for you on it. But they all carry around lap tops. We have a 150 bed facility and they went through 100-120 charts last summer (our survey was in June I think.) They never go through that many but it is required by the new standards. And a percentage of them have be people that have been discharged or passed away.

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Thanks for that info.. I definatly will not be looking forward to a survey like that. They usually do go through some Dc'd charts at our facility but nowhere near 100 charts!

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