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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

Review the nursing home survey form to understand the information required.

02

Observe and document the conditions of the facility, including cleanliness, safety measures, and overall quality of care.

03

Interview residents, staff, and family members to gather feedback and insights.

04

Document any deficiencies or areas that need improvement.

05

Ensure accuracy and thoroughness in filling out the survey report.

06

Submit the completed survey report to the appropriate regulatory agency.

Who needs nursing home survey report?

01

Regulatory agencies responsible for monitoring nursing homes.

02

Nursing home administrators and staff.

03

Residents and their families who rely on quality care in nursing homes.

04

Advocacy organizations working to improve standards of care in nursing homes.

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What is nursing home survey report?

Nursing home survey report is a document that provides information on the quality of care and services provided by nursing homes.

Who is required to file nursing home survey report?

Nursing homes are required to file the nursing home survey report.

How to fill out nursing home survey report?

Nursing home survey report can be filled out by providing detailed information on the care and services offered, as well as compliance with regulations.

What is the purpose of nursing home survey report?

The purpose of nursing home survey report is to ensure transparency, accountability, and quality improvement in nursing home facilities.

What information must be reported on nursing home survey report?

Information such as staffing levels, resident satisfaction, safety measures, and compliance with regulations must be reported on the nursing home survey report.

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