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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONPRINTED:7/18/2016 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY COMPLETED(X1)
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Step 1: Obtain a copy of the nursing home survey report form.
02
Step 2: Begin by providing the necessary information such as the facility name, address, and contact details.
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Step 3: Clearly indicate the date and time of the survey.
04
Step 4: Provide a detailed description of the survey process, including the number of staff members involved, areas covered, and methods used.
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Step 5: Document any observations and findings made during the survey.
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Step 6: Include any recommendations or suggestions for improvement based on the survey findings.
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Step 7: Sign and date the report to validate its authenticity.
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Step 8: Submit the completed report to the appropriate authorities or stakeholders as required.

Who needs nursing home survey report?

01
Nursing home survey reports are needed by various entities, including:
02
- Government health agencies to assess compliance with regulations and quality standards.
03
- Nursing home administrators and staff to identify areas of improvement and implement necessary changes.
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- Potential residents and their families to make informed decisions about choosing a nursing home.
05
- Insurance companies to evaluate the quality of care provided by nursing homes.
06
- Researchers and academics studying nursing home care and its impact on the elderly population.
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The nursing home survey report is a document that details the findings from inspections and evaluations conducted at a nursing home to ensure compliance with regulations and standards.
Nursing home administrators or owners are typically required to file the nursing home survey report.
The nursing home survey report can be filled out by providing detailed information about the facility's operations, residents, staff, and compliance with regulations.
The purpose of the nursing home survey report is to assess the quality of care provided to residents, identify areas for improvement, and ensure compliance with regulations.
Information such as resident care plans, staff qualifications, safety measures, and infection control protocols must be reported on the nursing home survey report.
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