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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION PRINTED:7 30/2014 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY
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How to fill out nursing home survey report:

01
Start by carefully reviewing the instructions provided with the survey report. Familiarize yourself with the sections and questions that need to be addressed.
02
Collect all the necessary data and information required to complete the survey accurately. This may include resident records, documentation from staff members, and any relevant policies or procedures.
03
Begin the survey report by providing basic details about the nursing home, such as its name, address, and contact information.
04
Follow the structure of the survey report, addressing each section and question in a clear and concise manner. Provide specific examples, observations, and documentation to support your responses.
05
Offer objective and unbiased answers, reflecting the true conditions and practices of the nursing home. Avoid making assumptions or providing subjective opinions.
06
If a question requires multiple parts or sub-questions, ensure that each component is addressed separately. Use headings or numbering to clearly indicate your responses.
07
If there are sections or questions that are not applicable to the nursing home, explain the reason for the omission or provide a brief statement indicating its inapplicability.
08
Double-check your survey report for any errors, omissions, or inconsistencies before finalizing it. Ensure that all sections and questions have been addressed appropriately.
09
Seek clarification or guidance from the relevant authorities or experts if you encounter any challenges or uncertainties during the completion of the survey report.

Who needs nursing home survey report:

01
Regulatory authorities: Nursing home survey reports are required by regulatory bodies responsible for overseeing the quality and safety of nursing homes. These reports help regulators assess compliance with regulations and identify areas for improvement.
02
Nursing home administrators: Nursing home administrators need survey reports to evaluate the facility's performance, identify areas of concern, and implement necessary changes to enhance resident care and satisfaction.
03
Public and potential residents: Survey reports can be accessed by the public and potential residents to make informed decisions about choosing a nursing home. These reports provide insights into the quality of care, safety measures, and overall reputation of the facility.
04
Healthcare professionals: Physicians, social workers, and other healthcare professionals may request survey reports to assess the quality of a nursing home before referring patients or clients to that facility.
05
Insurance companies: Insurance companies may utilize survey reports to determine coverage options and payment rates for nursing home services. The reports help them assess risk levels associated with each facility.
06
Research institutions: Survey reports can be valuable resources for research institutions studying nursing home care and quality. These reports contribute to the understanding of trends, challenges, and best practices in the industry.
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Nursing home survey report is a document that provides information about the quality of care and services provided by a nursing home, based on the findings of a survey conducted by state or federal agencies.
Nursing home administrators are required to file the nursing home survey report.
The nursing home survey report can be filled out by providing accurate and detailed information about the care and services provided by the nursing home, as well as any deficiencies found during the survey.
The purpose of the nursing home survey report is to ensure that nursing homes are providing quality care to their residents and to identify any areas that need improvement.
The nursing home survey report must include information about staffing levels, resident care plans, medication management, infection control practices, and any deficiencies found during the survey.
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