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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER / SUPPLIER (X2) MULTIPLE CONSTRUCTION / CIA A. BUILDING
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Read the survey instructions carefully to understand the requirements.
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Review the nursing home survey report form to familiarize yourself with the sections and questions.
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Gather all necessary information and documentation before filling out the report.
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Start by providing general information about the nursing home, such as its name, location, and contact details.
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Answer each question accurately and thoroughly, providing detailed explanations when necessary.
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Who needs nursing home survey report?

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Healthcare regulatory authorities responsible for monitoring nursing homes.
02
Nursing home administrators and staff who need to evaluate their facility's compliance with regulations.
03
Government agencies and auditors involved in assessing the quality and safety of nursing homes.
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Individuals or organizations involved in legal cases or disputes related to nursing home care.
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Researchers and academics studying the effectiveness of nursing home regulations and policies.
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Nursing home survey report is a document that provides information on the quality of care and services provided by a nursing home, including findings from inspections and evaluations.
Nursing homes are required to file the nursing home survey report with the appropriate regulatory agency.
Nursing home survey reports are typically filled out by designated staff members at the nursing home who are familiar with the facility's policies, procedures, and care practices.
The purpose of nursing home survey report is to ensure that nursing homes are providing quality care and services to residents, and to identify any areas that may need improvement.
Information that must be reported on nursing home survey report includes details about residents' health and well-being, staff qualifications, facility maintenance, and compliance with regulations.
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