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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION PRINTED:2/7/2017 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY COMPLETED
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Read the guidelines and instructions provided for the nursing home survey report.
02
Gather all necessary information and documentation before starting to fill out the report.
03
Begin by providing the basic details of the nursing home, such as its name, address, and contact information.
04
Follow the given format and structure of the report to ensure accuracy and consistency.
05
Include a detailed description of the nursing home's facilities, services, and staff.
06
Document any observations or findings related to the nursing home's compliance with regulations and standards.
07
Provide specific examples or incidents that support your assessments or ratings.
08
Ensure that all sections and questions in the survey report are completed thoroughly and accurately.
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Review and proofread the report before submitting it to ensure it is clear, concise, and free of errors.
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Submit the completed nursing home survey report to the appropriate authority or organization.

Who needs nursing home survey report?

01
Government regulatory bodies responsible for overseeing nursing homes and monitoring their compliance.
02
Healthcare organizations or agencies that provide accreditation or certification to nursing homes.
03
Insurance companies or reimbursement agencies that require the survey report for payment purposes.
04
Advocacy groups or associations working to improve nursing home standards and quality of care.
05
Legal professionals or law enforcement agencies involved in investigating nursing home violations or abuse cases.
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Nursing home survey report is a document that evaluates the quality of care provided by nursing homes and ensures they are in compliance with regulations.
Nursing home administrators or authorized representatives are required to file the nursing home survey report.
Nursing home survey report can be filled out by providing detailed information on the quality of care, resident satisfaction, staffing levels, and facility compliance.
The purpose of nursing home survey report is to ensure that nursing homes are providing high-quality care to their residents and are in compliance with regulations.
Information that must be reported on nursing home survey report includes quality of care measures, resident satisfaction surveys, staffing levels, and compliance with regulations.
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