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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONPRINTED:9/20/2016 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY COMPLETED(X1)
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01
Start by gathering all necessary information, such as the name and address of the nursing home, the date of the survey, and any relevant background information.
02
Review the survey questions and familiarize yourself with the required information and documentation.
03
Begin filling out the report by providing basic information about the nursing home, including its name, address, and type of facility.
04
Answer each question on the survey form accurately and thoroughly. Provide any necessary explanations or additional information to support your answers.
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Use clear and concise language in your responses. Avoid using jargon or technical terms that may be unfamiliar to readers.
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Be organized and use bullet points or numbered lists to present your information in a clear and easy-to-follow manner.
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Include any relevant attachments or supporting documentation, such as photographs, records, or witness statements.
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Review your completed survey report for accuracy, consistency, and clarity. Make any necessary revisions or corrections before finalizing the report.
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Submit the completed nursing home survey report according to the specified guidelines and deadlines.
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Keep a copy of the report for your records.

Who needs nursing home survey report?

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Nursing home survey reports are needed by various individuals and organizations involved in the inspection and evaluation of nursing homes. This includes:
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- Government regulatory agencies responsible for monitoring and enforcing standards of care
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- Accrediting bodies or third-party organizations responsible for certifying nursing homes
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- Legal professionals involved in lawsuits or legal actions against nursing homes
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- Researchers and academics studying the quality of care in nursing homes
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- Advocacy groups and nonprofits working to improve conditions for nursing home residents
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- Insurance companies or healthcare providers assessing the reputation and quality of nursing homes
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Nursing home survey report is a comprehensive report that evaluates the quality of care and services provided by a nursing home facility.
Nursing home administrators or designated staff members are required to file the nursing home survey report.
The nursing home survey report can be filled out by providing accurate information about the care and services offered by the facility, as well as any deficiencies found during inspections.
The purpose of nursing home survey report is to ensure that nursing home facilities are providing quality care and services to their residents according to regulatory standards.
The nursing home survey report must include information about staffing levels, resident care plans, infection control practices, medication management, and overall quality of care.
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