Here’s what long term care surveyors are checking
By Deirdre Carlson, RD
The Centers for Medicare and Medicaid Services (CMS) conducts an annual survey to determine the eligibility of a long-term care facility to accept and care for Medicare and Medicaid patients. They look at multiple areas including privacy, dietary, pharmacy, nursing, and housekeeping. CMS then uses the survey results as part of the criteria to determine a facility’s rating under its five-star system. Real-time results of state surveys can be found on at Medicare.gov.
If you have worked in a long-term care facility, you have most likely heard about the state survey inspection that happens on a yearly basis.
During my time with Dietitians On Demand as a long term care consultant dietitian, I went through my fair share of state survey inspections. Following every survey, I made a list of things that went well, things that didn’t go well, etc. so that I could be better prepared for the next time I went through an inspection. Here is a summary of some of my tips and tricks to help prepare for a future state survey.
Paperwork is Important
I once had a facility administrator tell me “an ounce of prevention is worth a pound of paperwork” when discussing state survey readiness. Most long term care facilities require a designated team member to perform a preventative survey of their department. In most cases, this is done on a monthly or quarterly basis. Although sometimes these “mock surveys” take a significant amount of time, the goal is to determine what items may be getting overlooked, and identify ways to correct them.
Review Performance Metrics
During inspection, surveyors have a set of performance metrics called “F-Tags” that measure a facility’s ability to provide safe, high-quality care to residents. A best practice is regularly conducting a mock audit, finding the areas of improvement, and comparing those to the list of F-Tags that surveyors look for. Overall, this helps continuously monitor a facility’s performance against the F-Tags in efforts to make improvements prior to inspection.
These are a few of the most notable F-Tags I’ve noticed surveyors look for:
483.21 Comprehensive Resident Centered Care Plans
- F-656 Develop/Implement Comprehensive Care Plan (This was a HUGE focus of surveyors recently to document in the care plan any nutritional interventions that were being done, update them quarterly, etc. They wanted the care plan to “mirror the resident’s care from all interdisciplinary levels.”)
483.25 Quality of Care
- F-686 Treatment/Svcs to Prevent/Heal Pressure Ulcers (This can fall more to nursing, but for example, it would be an issue if a pressure ulcer was not properly documented and no one had notified the dietitian to perform a full-assessment, recommend appropriate wound healing supplements, etc.)
Under 483.60 Food and Nutrition Services
- F-803 Menus Meet Res Needs/Prep in Advance/Followed (We saw a few times during Survey that the menu wasn’t followed exactly to a T, and the substitutions weren’t approved by the dietitian or the dietary manager first.)
- F-812 Food Procurement, Store/Prepare/Serve – Sanitary (This is pretty self-explanatory — foods uncovered in the walk-in cooler, were not dated, etc.)
Keep Calm during Inspection
Going through a state survey can be extremely stressful. Remember to communicate with your department and interdisciplinary team on a regular basis throughout the process. Treat the surveyors with respect, and remember – they are humans too. If your department receives a citation, it is not the end of the world. Think of it as an area of opportunity for increased education and training for your department.
At the end of the day, most potential survey citations can be easily prevented and remedied. It all comes down to having the knowledge and awareness of how the process works, and taking the proactive steps for improvement prior to survey.
Preparation resources for state surveys are also available at www.cms.gov, and don’t forget to review how Phase 2 of the latest CMS Regulation revisions impact dietitians.
Deirdre Carlson, RD, is a Minnesota native who now lives in Northern California thanks to a travel position with Dietitians On Demand. Deirdre started out in a temporary position but was converted to a permanent employee at a long term care facility. She spent nearly two years working in long term care before recently transitioning to acute care.
Dietitians On Demand is the nationwide leader in staffing registered dietitians, specializing in short-term, temporary and permanent-hire positions in acute care, long term care and food service positions. Our dietitians cover a vacancy, maternity leave, vacations, FMLA or increases in census. Check out our job openings, or request your coverage today!
DePaul, Rhonda. The Long-Term Care Mock Survey Toolkit – A Step-by-Step Guide to Survey Readiness. http://hcmarketplace.com/media/supplemental/3329_browse.pdf Accessed April 8, 2018.
Handy, Linda. Mastering Title 22, CA Codes, and New Survey Procedures in Dietary Services