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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONPRINTED:3/7/2018 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:
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Start by gathering all the necessary information, such as the name and address of the nursing home, and the date of the survey.
03
Review the survey questions and understand what information is required for each section.
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Begin filling out the report by accurately documenting your observations and findings. Use clear and concise language, and provide as much detail as possible.
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Include any supporting documentation or evidence, such as photographs or witness statements, if applicable.
06
Ensure that the report is organized and easy to understand. Use headings, subheadings, and bullet points to structure your responses.
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Double-check your work for any errors or missing information.
08
Sign and date the completed survey report.
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Submit the report to the appropriate authority or agency as instructed.
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Remember to follow any specific guidelines or instructions provided by the relevant governing body when filling out the nursing home survey report.

Who needs nursing home survey report?

01
Various individuals and entities may need a nursing home survey report, including:
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- Regulatory authorities: Government agencies responsible for overseeing nursing homes and ensuring compliance with regulations often require survey reports as part of their assessment and monitoring processes.
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- Nursing home administrators: The administrators of the nursing home may use survey reports to identify areas for improvement and develop action plans to address deficiencies.
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- Insurance companies: Insurance companies may request survey reports to assess the quality of care provided by a nursing home before approving coverage.
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- Legal professionals: Lawyers representing residents or families of residents may need survey reports as evidence in cases of abuse, negligence, or other legal disputes.
06
- Researchers and academics: Researchers and academics studying the quality of care in nursing homes may use survey reports for data analysis and research purposes.
07
Ultimately, anyone involved in assessing, monitoring, or evaluating the quality of care in nursing homes may need a nursing home survey report.
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Nursing home survey report is a detailed report that evaluates the quality of care and services provided by a nursing home.
Nursing homes are required to file nursing home survey report.
Nursing home survey report should be filled out accurately, providing information about the facility's compliance with regulations and standards.
The purpose of nursing home survey report is to ensure that residents in nursing homes receive high-quality care and services.
Information such as staffing levels, resident care plans, infection control practices, and quality of life indicators must be reported on nursing home survey report.
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