How to Prepare for Long-Term Care Facility Annual State Surveys

• Annual surveys help determine whether or not a long-term care facility is in compliance with state and federal regulations. 
• As a vital part of a long-term care facility, nurses are responsible for addressing many of the questions asked during the survey. 
• Learn how to prepare yourself for questions from state surveyors. 

To maintain appropriate licensing and Medicare or Medicaid requirements, long-term care facilities need to comply with state and federal regulations regarding staff and patient safety. Annual surveys are typically unannounced to assess compliance with these regulations.  

When standards aren’t met, long-term care facilities receive citations, which can “lead to fines, costly corrective action, and lost business due to damaged reputation,” according to Janet Mackenzie, MD, ABPS, CWSP, AAGP, chief medical officer at Vohra Wound Physicians. 

Let’s discuss what long-term care/skilled nursing care is, how the surveys are conducted, and the nurse’s role in the survey. 

What Type of Care Do Long Term Care Facilities Provide? 

Long–term care facilities provide around–the–clock, onsite medical support. They offer short–term rehabilitation services for those recovering from illness or injury and care for those with ongoing and chronic medical conditions. Long–term care facilities employ medical professionals including RNs, LPNs, and CNAs.

What Do State Surveyors Include for a Long-Term Care Facility? 

Surveyors, who are sent by the state, review policies, patient records, and procedures of the facility. They also review prior survey results, investigate incidents of policy violations, and ensure everything is accurately documented and that proper protocols have been created. Surveys can last anywhere from a few days to a week or more. It all depends on how long it takes to observe and gather what they need to complete the survey. 

How Do Surveyors Grade a Long-Term Care Facility?

A five-star rating system is used to grade a facility. Each facility, according to VOHRA Wound Physicians, receives an overall score and a separate score based on the following components: 

• Health Inspections: Based on the three most recent health inspections and health complaint investigations. 
• Staffing: Based on the average hours of care provided per resident compared to their level of need. 
• Quality Measures: Based on the facility’s score across 15 criteria for patient care. 

How Are Nurses Involved in State Surveys?

Nurses are a vital part of these facilities, so they are responsible for addressing many of the questions asked during the survey. Nurses administer medicine, complete patient vitals, perform wound care, monitor mealtimes, and document all care that is provided. During the survey, nurses might be asked about resident care protocols, patient abuse or injury, and emergency responses, according to VOHRA Wound Physicians.  

How Can Nurses Prepare for State Surveys?

It can be anxiety-provoking to participate in the state survey, but there are a few ways to decrease anxiety and increase your confidence when they arise: 

• Become familiar with all policies, especially those pertaining to safety. From my experience, surveyors like to ask questions that affect both staff and patient safety to ensure staff knows what to do in the case of an emergency.  
• One of the most common survey violations is related to infection prevention and control. Since the COVID-19 pandemic, it is especially important to ensure facilities are operating under strict infection control practices to ensure compliance. Nursing staff should review their facility’s infection control practices prior to the survey. 
• If the surveyor asks you about something you don’t have the answer for, don’t be afraid to tell them you don’t know. However, make sure you go to another coworker or manager to get them the information they need.  
• Be friendly and confident in your abilities. Keep your nerves in check and keep a positive, confident attitude. Being able to exude a certain level of confidence will help the surveyor’s confidence and trust in you as a nurse. 
• Remember the surveyor was probably in your shoes at one time. In many cases, surveyors were, or still are, licensed nurses themselves. It is likely they have had to answer the same questions they are asking you. Surveyors are usually friendly and approachable, which can help as well. 
• Make sure you have a professional and clean appearance and that your name badge and position title is always visible. 

What Happens After a Survey is Completed?

The surveyor will meet with the staff to explain the outcome. If the facility receives violations, staff have 10 days to respond with a plan of correction. A follow-up survey will evaluate whether steps were taken to improve.

The Bottom Line

State surveys can be stressful for nursing facilities and their staff, but are necessary to highlight the facility’s strengths and weaknesses in providing nursing care. The more prepared the nursing care staff is to undergo the survey, the easier and the faster the survey will go. It’s most that the surveyors receive all the information and observe all the care they need to accurately grade the facility. If you are a nurse working in long-term care, I hope this article helps you during your next survey. 

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