What does State look for?

We've just been through a state survey, they want to know about any resident's who've had a weight loss or gain and what you've done about it. They inspected the rooms, make sure all supplies such as toothbrushes are in holders and labeled, cups, pitchers, etc, all labeled. They wanted to know which residents are on psychotropic drugs. They checked a lot with MDS. If a resident was coded as a DNR they wanted to see the actual DNR in the chart. They will follow a cart nurse to see how she does a med pass, make sure you do everything right, check medications, check wrist bands, etc. WASH YOUR HANDS, before and after. Don't wear gloves in the hallway.

They may want to see a CNA perform peri care on a resident. If you can, go over this with your CNA's now to make sure they do it right. Privacy and dignity are big. Every person in the facility from nursing to housekeeping must knock and announce before entering a resident's room.

There is a lot to a survey, every department has it's own headaches. Just make sure there are no holes in your MARS or TARS. Take your time and realize as much as a pain in the butt surveys are you're all there for the same reason, the resident's health and safety.

Good Luck

Roxann:nurse:

I'm a new grad and working my first nursing job at a Rehabilitation/LTC facility. Everyone is stressed because the state is due to come in. I've never been through this before, and I'm not exactly sure of all the rules. I've asked over and over for paperwork to study, so I can be ready, but no one has anything they can give me. They all just tell me different things they look for. I'm so nervous and just want to be prepared. Is there a website anyone knows of that will give me the information I'm looking for? Thank you in advance for your help. It's greatly appreciated.

I am an RN for almost a year now, but prior to I was a CNA for a long time, many years of which was in rehab/LTC. So I remember all to well the pre-state frenzy. State looks at everything, from the kitchens to the nursing staff. They sometimes will follow you in a room with a patient and observe that you're basically doing things right and by the book. You need to know your facility's policies/procedures for many issues, especially safety issues, etc. You have to know for example, where the fire extinguishers on your floor are, your role in an emergency, etc. Anything you don't know, you should know where to find the info or direct the surveyor to your superior. For specifics for your role and facility, you should really go to your manager, or your HR person, or if you have a quality or even education nurse. Most supervisors will happily explain what is expected of you when state is in the building.

They might follow you on a medication pass, remember your 6 rights! And best of luck.

if they cant find something then they start nit-picking...we just got wrote on falls..even though they say the patient has the right to fall..no broken bones or injuries with these falls either...we got wrote for staffing..no mandatory staffing ratios in texas ( however, we do need more staff) ...we even got wrote for some of the tiles cracked in the floor despite the fact our new floor went in this week.... if it was wrong it was corrected on the spot but we still got tagged for it....

they will want to know that YOU know your own facility's policies and are abiding by them. Look over the ones pertaining to patient safety - like restraints, med errors, fall, etc. Don't forget the basic things, like handwashing.

In Texas you go to www.dshs.state.tx

Thank you everyone for your input. I sure wish there was a website I could go to and study, but all the tips you gave are very helpful. I'll be sure to read up on the facility's policies. Thank you!

Here's a big one that was pounded in my head in school: If they ask a question you don't know the answer to, the best response is: "I'm not sure, let me find someone who can answer that for you." Then, immediately proceed to finding the appropriate person to address their concern. That way, allegedly, it proves you know how to find the answer to a problem you may run into. We just had state leave this past Thursday for a re-visit after some tags, and I was getting hammered by a surveyor with questions that I had no idea about. (I've only been at this facility for 3 months, and have only been a nurse for 18 months, mostly nights). I used this response TO DEATH. They followed me on a med pass as well. (EEEKKK!!!) I just gave her a bit of background info on the res, their likes/dislikes, how they took their meds, (crushed, whole in applesause, etc), remembered the 6 rights, knocked on the door and announced myself, washed my hands or used hand sanitizer between each res, etc. Also, pay very close attention to meds that are to be given "before meals", "after meals" or "with food". We were tagged for that during our annual survey. I also tried to remember that they aren't ogre's, they are there to make sure the residents are being taken care of properly. They also offer a wealth of info, and most don't mind questions. (So long as you're not questioning facility policies of course!). We came away deficiency free this time. Whew! Only 363 days until the next one...

Thank you so much for the info. It's very helpful!

"STATE" will look for "text book". You already know how to do that. Just do everything by the book. That sounds hard, but it is not. Do what you have been taught. One thing to remember. If you do not know the ans. to the question.....just say so. but say.....give me a moment and I will find that ans. Then go back to the person and give them the ans. Best wishes

You're right, it's in my head. There's just so much to remember. A coworker gave me a bunch of handouts that lists the do's and don'ts to med passes, etc. I'm feeling a bit more confident now. Thank you :)

Infection control and isolation technique!!!!!

Hi there,

If you are really interested in reading about how the survey process is conducted and what the Federal requirements are then I can point you to two documents published by the Centers for Medicare and Medicaid Services (CMS). CMS contracts with State Agencies to conduct surveys for recertification. States also conduct state licensing surveys. State rules are different in each state. Federal requirements are the same in every state.

The two Federal documents are:

State Operations Manual (SOM) Appendix P: SOM-P This is the survey protocol for long term care facilities.

State Operations Manual (SOM) Appendix PP: SOM-PP This is the Guidance to Surveyors for Long Term Care Facilities. In here you will find all the "F-Tags" that are cited when deficiencies are identified.

If you want to know what surveyors look for and how they go about the survey process, then this is what you may become familiar with. Appendix P and Double PP are the specific instructions given to surveyors to guide them in their survey process. So much information is contained in these two documents and the files are big. Don't print Appendix Double P unless you have over 500 sheets of paper!

take care~