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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION PRINTED:5/27/2016 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY
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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 carefully reviewing the survey instructions provided. It is important to have a clear understanding of the specific requirements and guidelines for completing the report.
02
Gather all relevant information and documentation. This may include resident records, incident reports, staffing schedules, policies and procedures, and any other supporting materials that may be necessary to accurately complete the survey report.
03
Start by providing basic information about the nursing home, such as its name, address, and contact details. Ensure that all the required fields are filled accurately.
04
Proceed to answer each question or section of the survey report thoroughly. Take your time to provide detailed and concise responses, while ensuring all information is accurate and up-to-date.
05
Pay close attention to the specific criteria and standards outlined in the survey instructions. Use these criteria as a guide to assess the nursing home's compliance and performance in each area.
06
If a question requires a narrative response, ensure that your answers are clear, complete, and support your observations or findings. Provide specific examples or incidents that highlight any issues or areas of improvement.
07
Be objective and unbiased in your observations and evaluations. Avoid any personal opinions or assumptions when reporting on the nursing home's performance.
08
If you come across any concerns or deficiencies during the survey, document them accurately and provide recommendations for improvement if possible. Follow the appropriate procedure for reporting any immediate risks or hazards that may require immediate attention.
09
Take note of any safety or regulatory violations, potential abuse or neglect situations, or other critical issues that may impact the quality of care provided to residents.

Who needs a nursing home survey report:

01
Regulatory authorities and government agencies responsible for overseeing nursing home facilities often require survey reports to assess compliance with regulations and standards.
02
Nursing home administrators and staff use survey reports as a tool to identify areas for improvement and develop plans to enhance the quality of care provided to residents.
03
Residents and their families may benefit from survey reports as they provide insights into the nursing home's performance and the quality of care received.
04
Researchers and professionals in the field of geriatrics and long-term care may utilize survey reports to study trends, identify best practices, and work towards enhancing the overall quality of nursing home care.
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Nursing home survey report is a document that provides detailed information about the conditions and quality of care provided in a nursing home facility.
Nursing home administrators are typically responsible for filing the nursing home survey report.
Nursing home survey reports can be filled out by documenting observations and assessments made during facility inspections.
The purpose of nursing home survey report is to ensure that nursing home facilities are providing quality care and meeting regulatory standards.
Information such as resident demographics, staff qualifications, facility cleanliness, and quality of care provided must be reported on nursing home survey report.
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