Surviving a state inspection survey

CapeCodMermaid, RN · Aug 16, 2005

Join the club! We are always worried about survey...all of us especially in management. There's really no way around it....just know that you've done your job and remember to have 15 months of MDS's in the charts. We got tagged last year on 4 "inaccurate" MDS's, but when we looked at them, we found that WE were right in 3 cases and the surveyors had misinterpreted them....good luck. Our survey window has been open and we've heard that the surveyors are handing out citations for the stupidest things. One facility got tagged because one little piece of wall paper was coming off the wall. Surely they have better things to do. I always tell my nurses to do the easy things...sign off all their meds and treatments, do the weights, skin checks etc...make those darned surveyors look for things to tag us on. Don't make it easy for them!

MDSlady · Aug 16, 2005

Hi

Thanks for the reply. You're right, they never will come in an say good job see you next year.

They also tried to get us last year for claiming that I didn't do a change of condition MDS on someone when in fact he didn't meet the criteria for a change. Thank god my DNS is supportive and helped me fight them

Just have to wait and see....Wish me luck!!! :crying2:

Antikigirl, ASN, RN · Aug 16, 2005

Good luck with your audit from state!

I don't get too nervous at my facility because I complain about the same things a State Nurse Inspector will have issue with and it takes that scare and direction for change more times out of any to get things to be correct! Not to mention I suggest these ideas I have and keep them on file so I am not found as part of the probelm but the solution...

Many things in my assisted living die at the administration level (not nursing admin, but you have to clear ALL nursing things through upper management!), so State Audits normally get things actually passed that roadblock and point out potential probelms we need to address! I could certainly use that feedback to improve things for residents and staff!

I see them as intimidating sure, but helpful as well...at least when I looked at it as mentioned...it doesn't seem to panic me so much...LOL!

fluffwad · Aug 16, 2005

I'm right in the middle of survey :chair: ! I stay in my office and hammer away at those MDSs unless someone comes looking for me. They'll always find something ( I've often thought they'll invent stuff if they want), but the thing is to keep the care plans current ( updated ) and cover the chronic and acute issues ( falls, decubs, etc).

Aside from that, accuracy is your best friend. Check out www.aanac.org which is the best resource for MDS nurses. Take the education modules.

And don't take survey personally. Thats the DONs job. :rotfl:

southern_rn_brat · Aug 16, 2005

Our survey was just a few weeks ago. They walked in on me at 8am on a Sunday morning :crying2: . It was my first survey as a nursing supervisor and I was the only management in the building when they got there. About 2 hours into it... I wanted to throw up!! lol

The team leader of the survey was great though. She told me exactly what she needed and she told me what to do, lol. I paged the administrator and every darned dept head 911:D .

Good luck!!!

Nascar nurse, ASN, RN · Aug 17, 2005

Just completed our re-survey today. We eventually cleared our prior 7 tags, but pulled teeth to get here. This surveyor was absolutely nuts. Cornered me an asked my why I didn't do a significant change on a resident with a new stage II pressure wound, her attitude implied I had done something wrong. I responded.. "didn't do it b/c this was only one change and otherwise she is stable, interventions are in place, etc, etc... only need to complete sign. change if she had had 2 changes." She let me go thru the whole thing, smiled and said "I know that, I wanted to see if you knew that". She asked the ADON to sniff a crotch area and tell her about the odor. ADON, (with no other choice), leaned down, sniffed and smelled nothing - but in fear of the surveyor stated she smelled a faint odor. The surveyor smiled and said, "Really, I didn't smell anything at all" - smiled and walked away. Seems absolutely ridiculous to me. I'm sure there are some really bad LTC facilities out there, but seems surveyors make a game out of the whole thing, an attitude of "Can't wait to catch you screwing up". For crying out loud - go pick on someone that really deserves it! After today, I wonder why I even work LTC and why would anyone want to.

Bird2 · Aug 17, 2005

Just completed our re-survey today. We eventually cleared our prior 7 tags, but pulled teeth to get here. This surveyor was absolutely nuts. Cornered me an asked my why I didn't do a significant change on a resident with a new stage II pressure wound, her attitude implied I had done something wrong. I responded.. "didn't do it b/c this was only one change and otherwise she is stable, interventions are in place, etc, etc... only need to complete sign. change if she had had 2 changes." She let me go thru the whole thing, smiled and said "I know that, I wanted to see if you knew that". She asked the ADON to sniff a crotch area and tell her about the odor. ADON, (with no other choice), leaned down, sniffed and smelled nothing - but in fear of the surveyor stated she smelled a faint odor. The surveyor smiled and said, "Really, I didn't smell anything at all" - smiled and walked away. Seems absolutely ridiculous to me. I'm sure there are some really bad LTC facilities out there, but seems surveyors make a game out of the whole thing, an attitude of "Can't wait to catch you screwing up". For crying out loud - go pick on someone that really deserves it! After today, I wonder why I even work LTC and why would anyone want to.

That Surveyor was out of line! I spoke with another LTC nurse that said her facility got tagged for having an isolation cart in the hallway and it was not moved for over 30 minutes. Who in the world would move the isolation cart. They said that if it was not moved every 30 minutes then it was considered a storage area. Money must be tight because they are going after ridiculous things. Our survey window is about to open and it is always the most stressful, obnoxious weeks. We actually had a Surveyor dump water on the floor and wait to see if someone would wipe it up. They were not expecting the act to be witnessed by an employee. What is someone had fallen in it???

Editorial Team / Admin · Aug 17, 2005

Hi all....
Does anybody else crinch at the thought of an upcoming state inspection? It seems that is all I think about lately.
I recently have been promoted to MDS Coordinator in my facility and am feeling that they are going to attack my MDS's and care plans.
I am trying my best, and I know they WILL find something, but does anybody else dwell on this??
Anybody have any suggestions on how to survive a state survey without having a nervous breakdown?

You should be the one that, when you walk through the door, everyone cringes to see you. :crying2:

I WAS THE most unloved person around.

nrsjo · Aug 17, 2005

I just went through an acute care survey with the state. That was bad enough. But not nearly as bad as all the tail chasing, and confusing new paperwork and insane policies that upper division management comes up with to keep the ship from sinking. I do not know how some of those folks get their jobs.

MDSlady · Aug 17, 2005

:smackingf

Just completed our re-survey today. We eventually cleared our prior 7 tags, but pulled teeth to get here. This surveyor was absolutely nuts. Cornered me an asked my why I didn't do a significant change on a resident with a new stage II pressure wound, her attitude implied I had done something wrong. I responded.. "didn't do it b/c this was only one change and otherwise she is stable, interventions are in place, etc, etc... only need to complete sign. change if she had had 2 changes." She let me go thru the whole thing, smiled and said "I know that, I wanted to see if you knew that". She asked the ADON to sniff a crotch area and tell her about the odor. ADON, (with no other choice), leaned down, sniffed and smelled nothing - but in fear of the surveyor stated she smelled a faint odor. The surveyor smiled and said, "Really, I didn't smell anything at all" - smiled and walked away. Seems absolutely ridiculous to me. I'm sure there are some really bad LTC facilities out there, but seems surveyors make a game out of the whole thing, an attitude of "Can't wait to catch you screwing up". For crying out loud - go pick on someone that really deserves it! After today, I wonder why I even work LTC and why would anyone want to.

OH MY GOD!!!! Just had to respond to this!!! I CANNOT believe that a state surveyor got away with that....that was totally out of line. You're right, they can't wait to catch you screwing up, but NEVER tell you you did a good job. I hate this survey stuff!!! They really should find better things to do.

Nascar nurse, ASN, RN · Aug 17, 2005

I guess in the end, I don't even care if they tell us we've done a good job - not really their responsibility to tell us that. BUT, they are there to determine if we are providing adequate standards of care - if we are.. Great - have a nice day/see ya next year. If were not, then follow the protocols, BUT do not play games with me. This profession is hard enough. I am in Indiana. Next on my plate is "EDS inspection" - which is our Indiana medicaid inspection with focus on all MDS's in RUG group clinically complex and above and 45% (i think) of all RUG groups below CC. If we can not validate our RUG score w/ documentation, they actually change the RUG score and take away money already paid by M/A. Anyone else have a process like this? Good news is these inspectors are much more repectful and give us every opportunity to validate our records. Bad news, this is total spot light on the MDS team. The rest of the building doesn't even get nervous, or for the matter even understand how important this is.