Long-Term Care Survey Alert

The right self-inspection fights more than F tags.

Catch problems before they topple your survey record by rolling out a topnotch mock survey program that boosts your bottom line and takes quality improvement to a new level.

Case in point: Presbyterian Homes and Services of New Jersey (PHS) conducts mock surveys using internal interdisciplinary teams from its care communities. The effort leads to excellent state survey results and identifies key drivers for quality improvement goals, according to Linda Rose, a nurse and VP of health services for the organization, in a presentation at the fall 2008 American Association of Homes & Services for the Aging annual meeting. PHS has also used its state survey results and quality improvement data to save the organization on insurance premiums to the tune of $100,000, Rose noted.

Inside secret: "We often do try to tie some of our [mock survey] findings to F tags," Rose reported."But we always emphasize that it's not just about the F tags -- it's about the standards of care and our policies and procedures and what we expect ..."

To make a mock survey process work for your facility, consider these lessons learned from PHS:

1. Provide adequate training. To prepare the mock surveyors, PHS holds an annual training session that provides CE credits for nurses and administrators. The daylong session kicks off with a review of the previous Department of Health survey results. The trainers then present any new state and federal tags and investigative protocols. They also try to get a speaker from the survey agency to provide a clear view of the other side of the fence. For example, one year, a state surveyor walked the mock surveyors through how the state surveyors prepare for the survey, not only offsite, but onsite, as well, said Judith Porter, a nurse and director of health services for PHS, who copresented with Rose.

When the interdisciplinary mock survey teams asked the care communities for charts of patients with certain clinical issues, they got nearly "perfect charts," Porter cautioned. When the state surveyors came in, they found problems with charts that the mock surveyors hadn't reviewed. So now PHS follows what the state does. They use the QI/QM reports in skilled nursing to choose the mock survey samples. The mock surveyors review residents and charts involved in a reported abuse situation or those who had weight loss, pressure ulcers, falls, recent onset of incontinence, psychotropic medication use, pain management, behavioral  symptoms, or restraints.

The sample selection process isn't written in stone, however. "Lots of times our samples will change based on the regulatory environment" in terms of what the Department of Health is homing in on, said Rose.

3. See the facility with surveyors' eyes. The mock survey team looks for problems that state surveyors will likely cite during the real deal. For example, in one mock survey, a surveyor approaching the building was able to look in the window of a room and see a nurse aide providing care to a resident. The team also checks for safety hazards, such as how easily residents can access chemicals in the beauty shop, if it's unattended.

Smart: One mock surveyor heads to the dining room to do a meal observation. She looks at the ratio of residents in the dining area and the staff assisting them. The surveyor observes the interactions between residents at the table and between residents and staff. "We recently got a deficiency because one resident was very annoying to another resident at the table," said Rose. "That should have been care planned, and we should have moved that resident a long time ago."

Members of the mock survey team also observe a resident's overall condition. They approach the resident, speak to the person, take his hands and look for clean, rounded nails that won't cause skin tears. They ask the person to smile and observe the condition of his teeth and mouth.

4. Make the most of the findings. If a community has what the mock surveyors believe to be a deficiency, the community has to compile a plan of correction similar to what the states requires. "We often identify many opportunities for improvement above and beyond the minimum requirements," Rose reported. "We have also used the mock survey process to increase both resident and staff satisfaction."

Not only that: Staff members who participate in the mock survey process have gained a lot of knowledge about the regulations and their community's policies and procedures, Porter noted. "We have seen a huge increase in cooperation between communities," which used to be very competitive.