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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONPRINTED:4/16/2015 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY COMPLETED(X1)
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Begin by carefully reviewing the instructions provided for completing the nursing home survey report.
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Collect all necessary information and documentation related to the survey.
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Start by filling out the basic information section, such as the name and address of the nursing home.
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Follow the prompts and answer each question thoroughly and accurately. Use additional pages if necessary.
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Provide specific details and examples to support your responses wherever possible.
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Ensure that all information is entered correctly and legibly, as illegible or incomplete reports may be rejected.
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Double-check your responses and review the report for any errors or missing information.
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Submit the completed survey report to the designated authority within the specified timeframe.
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Keep a copy of the report for your records.
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If you have any questions or need assistance, reach out to the relevant authorities or support staff.

Who needs nursing home survey report?

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Various stakeholders require nursing home survey reports, including but not limited to:
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- Regulatory authorities responsible for monitoring and ensuring the quality of care in nursing homes.
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- Accreditation agencies that assess and accredit nursing homes based on their compliance with specific standards.
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- Government agencies that provide oversight and funding to nursing homes.
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- Researchers and academics studying the quality of care in nursing homes.
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- Families and individuals considering placement in a nursing home, who may use the report to make informed decisions.
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- Advocacy groups and organizations working to improve the quality of care in nursing homes.
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- Legal professionals involved in cases related to nursing home negligence or abuse.
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A nursing home survey report is an evaluation document that assesses the quality of care and compliance of a nursing facility with state and federal regulations.
Nursing homes that receive Medicare and Medicaid funding are required to file nursing home survey reports.
To fill out the nursing home survey report, facilities must provide detailed information about their operations, care practices, resident safety measures, and compliance with regulations.
The purpose of the nursing home survey report is to ensure that nursing facilities meet quality standards and provide safe, effective care to residents.
Information that must be reported includes staffing levels, resident care practices, incident reports, facility maintenance, and adherence to health and safety regulations.
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