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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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How to fill out nursing home survey report

01
Read the instructions: Before filling out the nursing home survey report, carefully read the provided instructions to understand the requirements and the format.
02
Gather necessary information: Collect all relevant information required to complete the survey report, such as patient details, specific incidents or observations, and any supporting documents.
03
Use proper headings: Begin each section of the survey report with appropriate headings, making it easier for readers to navigate and understand the content.
04
Provide accurate information: Ensure that all information provided in the survey report is accurate and based on facts. Avoid assumptions or personal opinions.
05
Use clear and concise language: Write the report using clear and concise language, avoiding technical jargon or unnecessary details. Be specific and to the point.
06
Use objective language: Be objective in your observations and avoid emotional or biased language. Stick to the facts and present them objectively.
07
Include supporting evidence: Whenever possible, include supporting evidence such as photographs, medical records, or witness statements to strengthen your findings.
08
Be thorough: Conduct a comprehensive review of the survey report before submitting it, checking for any errors or missing information. Ensure that all relevant sections are completed.
09
Follow submission guidelines: Follow the specified guidelines for submitting the survey report, including deadlines and required formats.
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Seek guidance if needed: If you encounter any difficulties or have questions while filling out the survey report, reach out to the appropriate authorities or supervisors for guidance.

Who needs nursing home survey report?

01
Government agencies: Nursing home survey reports are often needed by government agencies responsible for monitoring and regulating nursing home facilities. These reports help in assessing compliance with regulations and quality of care.
02
Healthcare professionals: Doctors, nurses, and other healthcare professionals may require nursing home survey reports to evaluate the quality of care provided by a particular facility. This information can help them make informed decisions about patient referrals or care considerations.
03
Families and caregivers: Individuals seeking nursing home placements for their loved ones often rely on survey reports to assess the quality and safety of different facilities. This information aids in making well-informed decisions regarding long-term care options.
04
Legal entities: Attorneys or legal entities involved in cases related to nursing home negligence, abuse, or malpractice may need nursing home survey reports as evidence to support their claims or to establish the standard of care.
05
Advocacy groups: Organizations or advocacy groups dedicated to promoting the rights and welfare of nursing home residents may require nursing home survey reports to identify areas of concern, lobby for policy changes, or advocate for improved quality of care.
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