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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION PRINTED:12 14/2015 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY
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How to fill out a nursing home survey report:

01
Start by familiarizing yourself with the purpose and format of the survey report. Understand the specific criteria and guidelines provided by the surveying agency or organization.
02
Collect all the necessary information and data required to complete the report. This may include resident records, staff information, facility policies, and any relevant documents or records.
03
Begin filling out the report systematically, following the provided sections or categories. Provide accurate and detailed responses while adhering to the survey requirements.
04
Pay close attention to the questions asked and provide complete and concise answers. Avoid vague or ambiguous responses and provide supporting evidence or examples whenever possible.
05
Make sure to include any additional supporting documents or records as required by the surveying agency. This may include incident reports, quality improvement initiatives, or resident satisfaction surveys.
06
Review and proofread the completed survey report for any errors or omissions. Make sure all sections and questions are answered properly and the information provided is accurate.
07
If necessary, seek clarification or guidance from supervisors or experts in the field to ensure accuracy and completeness of the survey report.
08
Submit the completed survey report to the designated surveying agency or organization within the specified timeframe.

Who needs a nursing home survey report?

01
Nursing home administrators: They require the survey report to assess the quality of care provided by their facility and identify areas for improvement.
02
Regulatory agencies: Survey reports are used by state or federal agencies to evaluate compliance with regulations and standards of care in nursing homes.
03
Insurance providers: Survey reports are often requested by insurance companies to determine eligibility for coverage or to assess risk.
04
Potential residents and their families: Survey reports can provide valuable insight into the quality and safety of a nursing home, helping them make informed decisions about placement.
05
Advocacy organizations: Survey reports are utilized by advocacy groups to monitor and advocate for quality care in nursing homes.
By following these steps and understanding the importance of a nursing home survey report, you can effectively fill out the report and contribute to maintaining high standards of care in nursing homes.
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The nursing home survey report is a detailed document that evaluates the quality of care provided by a nursing home facility.
Nursing home administrators are required to file the nursing home survey report.
To fill out the nursing home survey report, administrators must provide accurate and detailed information about the facility's operations and patient care.
The purpose of the nursing home survey report is to ensure that nursing home facilities are providing quality care to residents.
Information such as patient treatment plans, staff qualifications, and facility maintenance must be reported on the nursing home survey report.
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