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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONPRINTED:11/9/2020 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY COMPLETED(X1)

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How to fill out nursing home survey report

01

You can fill out the nursing home survey report by following these steps:

02

Start by reviewing the instructions and requirements for the survey report.

03

Gather all the necessary information and documents related to the nursing home being surveyed.

04

Begin with the introduction section, providing details about the nursing home such as its name, address, and contact information.

05

Proceed to the resident information section, where you will enter details about the residents being surveyed including their names, medical conditions, and care plans.

06

Move on to the facility assessment section, where you will assess and document the overall conditions of the nursing home including cleanliness, safety measures, and adherence to regulations.

07

Complete the resident rights and quality of life section, ensuring that you capture information on how well the nursing home is protecting residents' rights and promoting their quality of life.

08

Fill out the resident assessment and care information section, documenting the assessments and care plans for each individual resident.

09

Finish with the additional information section, including any additional observations or remarks that you feel are important to include.

10

Once you have filled out all the required sections, review the survey report for accuracy and completeness.

11

Finally, sign and submit the survey report according to the specified submission process.

Who needs nursing home survey report?

01

Nursing home survey reports are needed by various entities and individuals such as:

02

- Government regulatory agencies responsible for overseeing nursing homes and ensuring compliance with regulations.

03

- Nursing home administrators and staff who use the reports to identify areas of improvement and develop quality improvement plans.

04

- Families and loved ones of nursing home residents who seek transparency and information about the quality of care provided.

05

- Insurance companies and healthcare organizations that may require survey reports for evaluation and accreditation purposes.

06

- Researchers and academics studying the quality of nursing home care and identifying trends and patterns.

07

- Legal professionals involved in nursing home litigation cases who may use the reports as evidence.

08

- Interested members of the public who want to make informed decisions when choosing a nursing home for themselves or their loved ones.

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What is nursing home survey report?

Nursing home survey report is a document that provides detailed information about the quality of care and services provided at a nursing home.

Who is required to file nursing home survey report?

Nursing home administrators and operators are required to file the nursing home survey report.

How to fill out nursing home survey report?

The nursing home survey report can be filled out by providing accurate and detailed information about the care and services provided at the facility.

What is the purpose of nursing home survey report?

The purpose of the nursing home survey report is to ensure that nursing homes are providing quality care to their residents and meeting regulatory requirements.

What information must be reported on nursing home survey report?

Information such as staffing levels, resident care plans, infection control measures, and quality of life indicators must be reported on the nursing home survey report.

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