SURVEY TIPS#1

These items are always asked for when the surveyor arrives at your building. If you
know you are due for a survey, this is a great checklist to start from:

1. Administrative appointment form

2. Copy of Home Health Agency (state) license
3. Liability Insurance Certificates
4. Copy of CLIA license (for us and those places the agency takes labs)
5. Copy of Occupational License (RN/ PT/ OT/ ST/ MSW, etc) & personnel files for selected
employees.
6. Limited English Proficient document (identifying your translator)
7. P&P approval form
8. P&P Transmittals
9. Documentation of fire drill
10. Documentation of Emergency Prep Drill and Review
11. Hazard Vulnerability Assessment (HVA)
12. Minutes of Professional Advisory Board Meeting (at minimum yearly)
13. Copy of last State Survey Report
14. Copy of last Joint Commission or CAHPS survey
15. Measure of Success (MOS) from Evidence of Standards Compliance (ESC) and Periodic
Performance Review (PPR)
16. Copy of your PI quarterly reports
17. Copy of your utilization review chart audit findings with improvement plan (action plan)
18. Copy of your utilization review minutes with appropriate disciplines
19. Copy of Casper (OBQM/ OBQI) reports with findings
20. List of all employees with employment status
21. Copy of budget
22. Copy of unduplicated census
23. Number of discharges and discharge reason in the last 12 months
24. Will request full charts on any patients that they will selectively go out to visit with a
clinician to evaluate the care provided. Usually must print this copy or provide computer
access. They will also pull additional charts based on a percentage of total census
25. Copy of organizational chart structure hanging in the office.
26. Copy of administrative policy and procedures.
27. Copy of clinical policy and procedures.
 SURVEY TIPS#2

3-6 months prior to your survey, I would begin working these items.

● Focus audits on all wound care patients (especially those in close proximity to your
office)- make sure interventions and notes mirror actual md orders, check wound vac
orders, make sure nurse is using correct supplies, cg/ patient education is noted and
understanding verbalized and cg/ patient are doing wound care on days SN not
scheduled.
● Look for Pressure Ulcer teaching on patients with potential skin breakdown. Make sure
OASIS questions are answered correctly for wounds and that teaching in place for
intervention.
● Look at Diabetic foot ulcer teaching – if this is a therapy only patient, then it should also
be taught on all oasis points by that Physical Therapist.
● Focus audit all IV and TPN Patients – make sure the orders are correct, medications are
listed correctly, flushes are on the med profile, PICC and Groshong measurements in
place, arm circumference measured for PICC patients, CG and patient education in in
place with understanding verbalized and possibly return demo if patient or cg doing care.
● Review all patient charts that have foley or superpubic catheter, and especially if they
are bedbound with Aide in home. Typically a surveyor would pick one of these patients
for an onsite visit. Make sure the orders are correct, aide care plan reviewed, teach all
foley patients / CG irrigation of foley with orders from physician and make sure CG
verbalized understanding. With superpubic cath patients make sure that CG or Patient is
aware to call on call personnel immediately and that this documented in the chart.
● Review your previous survey and address all the issues that you previously had and
make sure you are now in compliance.
● Make sure all filing is up to date.
● Proactively pick out a few patients that are close to the office that might be appropriate
for IV or wound visits and get those charts ready for survey review.
● Make sure all of your admission paperwork is correct and in place.
● Make sure that your staff is utilizing the HHABN’s, BIPPA, etc and that they are on the
charts.
● Check your refrigerators in the office, make sure they are clean and defrosted, and
thermometer setting is logged daily.
● Do a bimonthly fire drill and document it.
● Have your Professional advisory meeting and sign in sheets ready for review.
● Have any performance improvement and QA efforts ready for review. Create a QA
project for wounds or IV’s, and use your “clean up” to get ready for survey as part of this
QA effort.
● Clean the supply room and make sure the MSDS books are updated.
● Update all personnel records.
● Make sure your business license, clia, delegation of authority, and PT therapy license on
the wall and in clear sight.
 ● Make a fun game and prep the staff with questions so that they know how to answer
surveyor questions and teach the patients about appropriate hotline numbers, how to
contact on call clinician, etc.

SURVEY TIPS#3

There are several G tags / deficiencies that surveyors always start out the survey process
looking for. Once they find a few of these items they will move on to other deficiency tags
and extend the survey. I wanted to make sure to list the most common G tag deficiency
items that you should be aware of:

G107 – Investigate & document complaints & resolutions (under patient rights)
G109 – Participate in the planning of care & treatment (under patient rights)
G123 – Identifiable line of authority (under organization, services, and administration)
G133 – Organizes & directs the agency’s functions (administrator- under the organization,
Services, and administration)
G143 – Maintain liaison & support plan of care objectives (under coordination of patient care)
G144 – Documentation shows effective care coordination (under coordination of patient care)
G157 – All patient’s needs adequately met in residence (acceptance of patients, plan of care,
And medical supervision)
G158 – Care follows written plan/ reviewed by physician (medical supervision)
G159 – Plan of care covers all pertinent diagnosis (plan of care)
G164 – Alert physician of changes in condition (plan of care)
G165 – Administer drugs/ treatments ordered by physician (conformance with MD orders)
G166 – Verbal orders put in writing / signed/ dated
G170 – In accordance with the plan of care (skilled nursing service)
G172 – Regularly re-evaluates the patient’s nursing needs (skilled nursing service)
G173 – Initiates the plan of care and necessary revisions (skilled nursing service)
G174 – Services requiring specialized nursing skills (skilled nursing service)
G185 – Services that are performed by qualified therapist (therapy services)
G186 – Assists physicians in evaluation/ developing plan of care (therapy services)
G187 – Prepares clinical and progress notes (therapy services)
G188 – Advises / consults with family and personnel (therapy services)
G224 – Written instructions by the RN or Therapist (home health aide services)
G236 – Maintain in accordance with professional standards (clinical records)
G331 – RN nurse must conduct an initial assessment visit (initial assessment visit)
G332 – Initial assessment within 48 hours or upon start of care date (initial assessment visit)
G337 – Comprehensive assessment must include review of all meds the patient is currently
Taking (drug regimen review)
G338 – Comprehensive assessment must be updated and revised
G340 – Within 48 hrs of the patient return home after 24 hrs or more hospital stay other than
Diagnostic tests (update of comprehensive assessment)