Long-Term Care Survey Alert

When it comes to survey preparation, remember to keep indirect care staff in the loop, or your facility may find itself in the larger bureaucratic loop of battling survey sanctions.

"Keep in mind that surveyors today are talking to dietary aides, laundry aides and housekeeping," says Kathy Hurst, principal of Hurst Consulting Group in Chino Hills, CA. Surveyors today are quite likely, for example, to ask these staff what theyd do if a resident told them that they were being abused. "These workers need to be able to tell surveyors how they would handle such a situation," Hurst advises.

In Hursts experience, its a good idea to teach staff the terminology that surveyors are likely to use in querying about abuse policies and procedures. She recalls one facility that got an abuse citation recently because a Spanish-speaking nursing assistant didnt understand the word "misappropriation" when used by the surveyor. "She would have understood stealing or taking something from the resident," says Hurst. Even so, the deficiency was upheld on appeal. "And you dont want a deficiency for abuse at any level," Hurst adds.

Dietary aides may require some extra attention in preparing for the survey, considering they dont get the more extensive training that CNAs do. This is important, because the dietary section encompasses survey hot spots ranging from nutrition and hydration to quality of life issues.

"Its a good idea to prepare dietary aides for the survey by giving them some practice learning to interact with elderly people" so they dont just drop off food trays in silence, suggests Mary Knapp, senior director of ZA Consulting in Jenkintown, PA. If dietary staff dispense the meal trays, they should interact with the residents and check to see they have all of their utensils and the correct food choices. "If the surveyor sees the resident sitting there unattended, without a fork and spoon, while the food gets cold, the facility could end up with an F365 deficiency," Knapp says.

As a quality control measure, dietary aides should also ask residents if they like the food and for any suggested changes, advises Annette Kobriger, a long-term care nutritional consultant in Chilton, WI. "Otherwise, the dietary staff is making the same mistakes over and over again," a point not likely to escape surveyors attention if residents dont show much interest in the food or worse complain about it.