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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION PRINTED:4 7/2014 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY COMPLETED
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How to fill out nursing home survey report

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How to fill out a nursing home survey report:

01
Begin by reviewing the instructions provided for the survey report. Familiarize yourself with the different sections and requirements outlined in the document.
02
Collect all the necessary information before starting the report. This may include patient records, staff interviews, and observation notes. Ensure that you have accurate and sufficient data to provide a comprehensive assessment.
03
Start by identifying the demographics of the nursing home, including its name, location, and contact information. This basic information is essential for accurate reporting.
04
Proceed to the resident section of the survey report. Record the details of each resident, including their names, ages, medical conditions, and any specific concerns or complaints they may have expressed.
05
Document the observations made during your visit to the nursing home. This may involve examining the cleanliness of the facility, the quality of care provided, and the overall environment. Note any potential hazards or violations that you identify.
06
Conduct interviews with the staff members to gather additional information. Ask them about their roles, qualifications, and experiences. Also, inquire about the training programs and infection control protocols in place.
07
Once you have gathered all the necessary information, proceed to analyze and evaluate the nursing home's performance. Assess its compliance with regulatory standards and identify areas for improvement.
08
Include any recommendations or suggestions for enhancing the quality of care provided by the nursing home. This could involve proposing changes to policies, increasing staffing levels, or improving resident engagement activities.
09
Review your survey report thoroughly before submitting it. Make sure all information is accurate, clear, and well-organized. Proofread the document to correct any spelling or grammatical errors.

Who needs a nursing home survey report?

01
Government regulatory bodies: Nursing home survey reports help governmental agencies ensure that nursing homes are operating in compliance with established standards and regulations. These reports assist in evaluating the quality of care provided and enforcing necessary improvements.
02
Nursing home administrators: Survey reports provide administrators with valuable insights into the strengths and weaknesses of their facilities. This allows them to better understand areas that require improvement and implement appropriate changes.
03
Potential residents and their families: Nursing home survey reports can serve as a resource for individuals seeking a suitable nursing home for their loved ones. These reports offer transparency and help families make informed decisions regarding the care and well-being of their relatives.
Note: It is important to consult specific guidelines and regulations provided by your local nursing home authority when filling out a survey report, as requirements may vary by jurisdiction.
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Nursing home survey report is a document that evaluates the quality of care and services provided by a nursing home.
Nursing homes are required to file the nursing home survey report.
The nursing home survey report can be filled out by documenting the necessary information about the care and services provided.
The purpose of nursing home survey report is to ensure that nursing homes are meeting the required standards of care.
Information such as resident care, staffing levels, facility cleanliness, and quality of services must be reported.
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