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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONPRINTED:6/13/2017 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY COMPLETED(X1)
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How to fill out nursing home survey report

01
To fill out a nursing home survey report, follow these steps:
02
Gather all the necessary information about the nursing home, including its name, address, and contact details.
03
Review the survey questions carefully and understand what information is being asked for.
04
Visit the nursing home and observe the different areas and facilities. Take notes of any potential issues or concerns.
05
Talk to the residents and their families to gather their feedback and experiences with the nursing home.
06
Collect any relevant documents or records that can support your observations or findings.
07
Organize the information in a systematic manner and accurately document your observations.
08
Use the provided form or template to fill out the survey report, ensuring all sections are completed.
09
Double-check your answers for accuracy and completeness.
10
Submit the survey report to the appropriate department or organization responsible for collecting these reports.
11
Follow up if necessary and be prepared to provide additional information or clarification if requested.

Who needs nursing home survey report?

01
Several parties may need a nursing home survey report, including:
02
- Government agencies or regulatory bodies responsible for oversight and monitoring of nursing homes.
03
- Nursing home administrators and staff, as they can use the report to identify areas for improvement and take corrective actions.
04
- Prospective residents and their families, who can use the report to make informed decisions about choosing a suitable nursing home.
05
- Researchers and academicians studying the quality of care in nursing homes.
06
- Legal authorities investigating allegations of abuse or neglect in nursing homes.
07
- Insurance companies evaluating the risk associated with providing coverage to nursing homes.
08
- Non-profit organizations advocating for the rights and well-being of nursing home residents.
09
- Healthcare professionals involved in the care and treatment of nursing home residents.
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The nursing home survey report is a detailed inspection report on the conditions and quality of care provided at a nursing home facility.
Nursing home administrators or designated staff are required to file the nursing home survey report.
The nursing home survey report must be filled out according to the guidelines provided by the regulatory agency overseeing nursing homes.
The purpose of the nursing home survey report is to ensure that nursing homes are providing quality care to residents and meeting regulatory standards.
The nursing home survey report must include information on staffing levels, resident care, safety measures, and facility cleanliness.
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