SURVEY INTERVIEW AND OBSERVATION QUESTIONS & PROBES
- State Survey RESIDENT OBSERVATION Care Areas and Probes
- State Survey RESIDENT INTERVIEW Care Areas and Probes
- State Survey FAMILY (Resident Representative) INTERVIEW Care Areas and Probes
- State Survey RECORD REVIEW Care Areas and Probes
- State Survey LTCSP Mapping Document
- State Survey List-of-Revised-FTags
OTHER TOOLS AND RESOURCES
- Survey Preparation Tool for Therapy Staff
- LTC Survey Process Procedure Guide (Oct 2023)
- Timeline of Updates to Survey Process
- State Survey Entrance Conference Form
- State Survey – CMS Form 672 – Data Collection and Instructions (Discontinued 10/1/23)
- State Survey – CMS Form 802 – Data Collection and Instructions
Survey Resources – 2/17/2023 (ZIP) Revision History for LTC Survey Process Documents and Files Updated 10/26/2022 (PDF) - Scope and Severity Grid
- State Operations Manual – Main Page
- SOM Chapter 7 – SNF Survey Rules and Process
- Appendix PP State Operations Manual
CRITICAL ELEMENT PATHWAYS: FORMS SURVEYORS USE TO AUDIT EACH AREA
PRINT / SAVE INDIVIDUAL PATHWAYS FROM LIST BELOW: (All Updated 10/2023)
- SNF Beneficiary Protection Notifications NOMNC ABN
- Dining Observation
- Infection Prevention, Control & Immunizations
- Kitchen Observation
- Medication Administration Observation
- Resident Council Interview
- Quality Assessment and Assurance (QAA) and Quality Assurance and Performance Improvement
- Abuse
- Environmental Observations
- Sufficient and Competent Nurse Staffing Review
- Personal Funds Review
- Activities
- Activities of Daily Living (ADL)
- Behavioral and Emotional Status
- Urinary Catheter or Urinary Tract Infection
- Communication and Sensory Problems (Includes Hearing and Vision)
- Dental Status and Services
- Dialysis
- General Care
- Hospice and End of Life Care and Services
- Death
- Nutrition
- Pain Recognition and Management
- Physical Restraints
- Pressure Ulcer/Injury
- Specialized Rehabilitative or Restorative Services
- Respiratory Care
- Unnecessary Medications, Psychotropic Medications, and Medication Regimen Review
- Medication Storage and Labeling
- Preadmission Screening and Resident Review
- Extended Survey
- Hydration
- Tube Feeding Status
- Positioning, Mobility & Range of Motion
- Hospitalization
- Bladder or Bowel Incontinence
- Accidents
- Neglect
- Resident Assessment MDS
- Discharge Planning
- Dementia Care
- Arbitration