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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION PRINTED:8 12/2015 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY
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How to fill out a nursing home survey report:

01
Read the instructions: Before you begin filling out the nursing home survey report, carefully read the instructions provided. This will help you understand the purpose of the report and what information needs to be included.
02
Gather relevant information: Collect all the necessary information before starting the report. This may include details about the nursing home's facilities, staff, resident care, and compliance with regulations. It is important to ensure that the information you provide is accurate and up-to-date.
03
Follow the report structure: The nursing home survey report typically has a specific structure. Make sure to follow it closely to ensure your responses are organized and easy to understand. This may involve sections such as facility overview, resident care, staff qualifications, and regulatory compliance.
04
Provide detailed responses: When filling out the report, provide detailed and specific responses to each question or section. Use clear language and provide examples or evidence to support your answers. The more information you provide, the more valuable the report will be in assessing the nursing home's quality of care.
05
Be objective and unbiased: It is crucial to approach the survey report objectively and without bias. Avoid making assumptions or personal judgments. Stick to factual information and avoid including any personal opinions or emotions in your responses.
06
Ensure accuracy and completeness: Double-check your responses to ensure accuracy and completeness. Review the report thoroughly to make sure you have addressed all the necessary sections and provided all the required information. Any omissions or errors could undermine the validity of the report.

Who needs a nursing home survey report?

01
Health authorities: Nursing home survey reports are often required by health authorities and regulatory bodies to assess the quality of care provided by nursing homes. These reports help identify any areas that may need improvement and ensure compliance with regulations.
02
Nursing home administrators: Administrators of nursing homes rely on survey reports to identify areas of strength and weakness within their facilities. These reports can guide them in making strategic decisions, allocating resources, and implementing changes to improve resident care.
03
Families and prospective residents: Survey reports are valuable resources for families and prospective residents looking for a nursing home. These reports provide insights into the quality of care, safety, and compliance of a nursing home, helping families make informed decisions about the best place for their loved ones.
04
Researchers and policymakers: Nursing home survey reports are also important for researchers and policymakers in the healthcare field. These reports contribute to the body of knowledge about nursing home care and can inform policy development and improvements in the industry.
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Nursing home survey report is a comprehensive document that evaluates the quality of care and services provided by a nursing home facility.
Nursing home administrators or facility owners are required to file the survey report.
Nursing home survey report must be filled out by providing accurate and detailed information about the facility's operations, staff, and resident care.
The purpose of nursing home survey report is to ensure that nursing home facilities are providing high-quality care and services to their residents.
Information about staff training, resident safety, infection control measures, and overall quality of care must be reported on the survey report.
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