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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONPRINTED:6/19/2014 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY COMPLETED(X1)
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Step 1: Start by gathering all necessary information and documentation needed for the survey report.
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Step 2: Begin the report by providing an introduction and background information about the nursing home being surveyed.
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Step 3: Clearly list and describe all areas that need to be assessed and evaluated, such as the quality of nursing care, cleanliness, safety measures, etc.
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Step 4: Use a structured format to organize the findings and observations for each area being assessed.
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Step 5: Include specific details, data, and examples to support your findings, including any violations or areas of concern.
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Step 6: Provide recommendations for improvement in each area of concern or violation identified in the report.
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Step 7: Conclude the report by summarizing the overall assessment and highlighting any commendable aspects.
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Step 8: Proofread and make any necessary revisions to ensure the report is clear, accurate, and well-organized.
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Step 9: Submit the completed nursing home survey report to the appropriate authorities or relevant stakeholders.

Who needs nursing home survey report?

01
Nursing home administrators and staff members who want to assess the quality and compliance of their facility.
02
Government agencies responsible for overseeing nursing homes and enforcing regulations.
03
Insurance providers who need to evaluate the safety and standards of a nursing home before providing coverage.
04
Potential residents and their families who want to make informed decisions about which nursing home to choose.
05
Researchers and academics studying nursing home facilities and looking for data and insights.
06
Legal entities involved in cases related to nursing home neglect, abuse, or violations.
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The nursing home survey report is a documentation of the findings and observations made during an inspection of 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 is typically filled out by documenting observations, findings, and compliance with regulations during an inspection of the facility.
The purpose of the nursing home survey report is to ensure that nursing home facilities are in compliance with regulations and providing quality care to residents.
Information reported on the nursing home survey report may include observations of cleanliness, staff interactions, resident care, and compliance with regulations.
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