Deficiency Free Survey TIP #2: Prepare Your Survey Binder

When State walks into your facility for your annual survey, and requests standard documents, are you and your team scrambling around to find and provide said documents?

Scramble no more!

A Survey Binder is your tool/secret weapon/sidekick on your road to becoming deficiency-free. 

What is a Survey Binder? 

A Survey Binder is a binder that you and your team put together that includes the documents that Surveyors most frequently request during the entrance interview. 

So, instead of scrambling to find the documents that they have requested, you hand them a pre-prepared binder, that has the information that they are looking for. This saves time, relieves stress (for your and your team), and makes the Surveyors job much quicker and easier (thus making them happy). 

Having a Survey Binder sets the tone for the survey and indicates to the State Surveyors that you are prepared for the survey. 

Here is a list of recommended documents that you should include in your binder. 

(note: This is not a complete list. This is list of documents to help get you started. You will update your binder each year, and add to it additional documents that state may have requested).

SURVEY BINDER RECOMMENDED CONTENT LIST

⃞  Census number

⃞  List of new admissions in the last 30 days who are still residing in the facility.

⃞  An alphabetical list of all residents (note any resident out of the facility).

⃞  A list of residents who smoke, designated smoking times, and locations

⃞  Information about the facility’s emergency water source (verbal confirmation is acceptable).

⃞  A copy of an updated facility floor plan, if changes have been made.

⃞  Name of Resident Council President

⃞  A Schedule of meal times, locations of dining rooms, copies of all current menus including therapeutic menus that will be served for the duration of the survey and the policy for food brought in from visitors.

⃞  A Schedule of Medication Administration times.

⃞  Number and location of med storage rooms and med carts.

⃞  The actual working schedules for licensed and registered nursing staff for the survey time period.

⃞  List of key personnel, location, and phone numbers. Note contract staff (e.g., rehab services).

⃞  Admission packet.

⃞  Dialysis Contract(s), Agreement(s), Arrangement(s), and Policy and Procedures, if applicable.

⃞  List of qualified staff providing hemodialysis or assistance for peritoneal dialysis treatments, if applicable.

⃞  Agreement(s) or Policies and Procedures for transport to and from dialysis treatments, if applicable.

⃞  Does the facility have an onsite separately certified ESRD unit?

⃞  Hospice Agreement, and Policies and Procedures for each hospice used (name of facility designee(s) who coordinate(s) services with hospice providers).

⃞  Infection Prevention and Control Program Standards, Policies and Procedures, and Antibiotic Stewardship Program.

⃞  Influenza / Pneumococcal Immunization Policy & Procedures.

⃞  QAA committee information (name of contact, names of members and frequency of meetings).

⃞  QAPI Plan.

⃞  Abuse Prohibition Policy and Procedures.

⃞  Description of any experimental research occurring in the facility.

⃞  Facility assessment.

⃞  Nurse staffing waivers.

⃞  List of rooms meeting any one of the following conditions that require a variance:

• Less than the required square footage

• More than four residents

• Below ground level

• No window to the outside

• No direct access to an exit corridor

⃞  Provide each surveyor with access to all resident electronic health records – do not exclude any information that should be a part of the resident’s medical record. Provide specific information on how surveyors can access the EHRs outside of the conference room. 

⃞  Completed Medicare/Medicaid Application (CMS-671).

⃞  Completed Census and Condition Information (CMS-672).