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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION PRINTED:4/5/2017 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY COMPLETED
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01
Start by carefully reviewing the nursing home survey report form and familiarizing yourself with all the sections and questions.
02
Gather all the necessary information and relevant documents before you begin filling out the report.
03
Begin with providing general information about the nursing home, such as its name, address, and contact details.
04
Follow the instructions provided on the form to answer each question accurately and thoroughly.
05
If applicable, provide specific incidents or incidents that you want to highlight in the report, ensuring you include any relevant supporting evidence or documentation.
06
Use clear and concise language to describe any concerns, observations, or complaints regarding the nursing home facility.
07
Be honest and objective in your responses, providing factual information rather than personal opinions.
08
Organize your responses in a logical manner, addressing each section or question in a systematic order.
09
Make sure to double-check your answers for any errors or omissions before submitting the completed survey report.
10
Finally, sign and date the report to indicate your completion and ensure all necessary supporting documents are attached, if required.

Who needs nursing home survey report?

01
Regulatory authorities and government agencies responsible for overseeing nursing home facilities require survey reports to assess compliance with regulations and licensing requirements.
02
Nursing home administrators may need survey reports to identify areas of improvement and address any deficiencies or concerns raised.
03
Healthcare professionals, such as doctors or nurses, may need survey reports to understand the quality of care provided by a nursing home before referring patients or recommending placement.
04
Potential residents or their families may need access to survey reports to make informed decisions about choosing a nursing home.
05
Researchers or academics studying nursing home care may utilize survey reports for data analysis and identifying trends or areas in need of improvement.
06
Legal professionals involved in cases related to nursing home care may require survey reports as evidence or documentation.
07
Insurance companies may request survey reports when determining coverage or assessing risks associated with nursing home facilities.
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Nursing home survey report is a detailed evaluation of the quality of care provided by a nursing home facility.
Nursing home administrators are required to file the nursing home survey report.
The nursing home survey report can be filled out by documenting observations, assessments, and data related to the quality of care provided.
The purpose of nursing home survey report is to ensure compliance with regulations, monitor quality of care, and identify areas for improvement.
Information such as resident assessments, staffing levels, health and safety standards, and quality of life measures must be reported on the nursing home survey report.
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