Survey Preparation

1. resident roster with room numbers

2. blank 24 hour report sheet with residents names (one for each surveyor)

3. list of key personnel, including the pharmacy consultant and qa person

4. copy of facility layout-(one for each surveyor)

5. resident's advocate committee names

6. hcfa form 672

7. work schedule for rn/lpn (day of entrance)

8. hcfa 802-up to date

under "wt." indicate with an arrow if weight is up or down

under "uti/ inf control/antibiotic"-note utis

under "interview able: indiv/fam" ,note with an "i" if the resident is

interview able. a list would be also be acceptable.

under "psychoactive meds" note :"p" for psychoactive, "a" for

anti-anxiety, and "h" for hypnotic.

9. policy /procedure for monitoring accidents/incidents and system to

prevent/minimize

10. immunization practices (flu and pneumococcal)

11. list of employees since last survey (list position and hire date)

12. admissions (past 30 days)

13. list of discharges (during last three months)

14. medicare residents requesting demand billing (during past 6 months)

15. resident age 55 and younger

16. meal times (of all dining rooms)

17. dining room seating chart- (one for each surveyor)

18. copy of menus (including therapeutic menus for duration of the survey)

19. list of residents on therapeutic and mechanically altered diets

20. work schedule for lpn/rn (day of entrance)

21. medication pass times for inhalers, eye drops, injections, g-tube

medications, and nembulizers.

22. emergency water supply policy and procedure (5 gallons per resident per day)

23. clia wavier certificate

24. copy of surety bond

25. resident rights

26. admission agreement

27. policies /procedures to prohibit /investigate abuse

28. activity calendar (last three months)

29. resident advocate members

30. resident council meeting minutes-(last three months)

• Here's some items that should be inserviced before your upcoming survey. These are alot of the areas the surveyors will be reviewing.
  
  
  
• All staff to wear name tags
  
• Greet and smile at surveyors as appropriate. They are guests in the facility and should be treated as guests. Offer water and coffee after breakfast is done.
  
• Call residents by their names only
  
• Nembulizers-include cleaning procedure
  
• Inhalers-include cleaning procedure. Remind staff to shake the inhaler in-between puffs and offer water for resident to rinse mouth out.
  
• Accucheck machine-clean after every use!!
  
• Eye Drops-if giving multiple eye drops, know how long to go in-between giving them
  
• Injections
  
• Peri-care--try to have two staff go together. They can coach each other. Keep residents appropriately covered during intimate procedures.
  
• Emptying of Foley bags
  
• Tube medications-Do each med separately and flush between each med
  
• Med pass- remind staff to use hand gel every time after giving a resident's meds. Wash hands with soap and water after every 5th resident.
  
• Policy and Procedure for Cleaning Razors
  
• Positioning of residents
  
• All residents to receive appropriate cueing and assistance during meals.
  
• Keep all hazardous items locked up
  
• All residents to be appropriate dressed
  
• Man shaved by 10am
  
• If wheeling a resident in a w/c their leg extensions must be on and feet appropriately placed.
  
• All O2 tubing should be in a plastic bag and not laying on the floor.
  
• Keep clean and dirty items separated by three feet minimum.
  
• All staff to know where the care plans are located.

We just finished with our survey. They came in at 7pm Monday evening. It was our annual + 6 complaints which were all unsubstatiated. This was my second survey as a LPN, I went through 6 surveys as a dietary manager prior. I noticed that they were focusing a lot on environmental and ensuring that the patient's privacy was maintained. This is great info to keep fo reference.

These lists would work for those in states that are being surveyed by the older format but, there is changes with the QIS.

We do not give TF meds individually but, combine them if applicable since the TF usually have a precise amount of free water they are administered in a 24 hour period.

These lists would work for those in states that are being surveyed by the older format but, there is changes with the QIS.

We do not give TF meds individually but, combine them if applicable since the TF usually have a precise amount of free water they are administered in a 24 hour period.

We would get cited for giving G tube meds all at once...stupid because they take them po all at once. The amount of water used for preflush,between med flush, and post flush should all be taken into account when calculating the amount of free water given.

Our policy on TF was scrutinized last fall when the state was in.... it passed with flying colors. Even the water used to mix the meds is taken into account for the amount of free water given.

We all need to go by our own STATE guidelines.

We have to follow the Federal Guidelines, those are universal. My preparation for survey besides the excellent list above. Provide excellent patient care.