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Provides a structured approach for nursing home leadership and staff to stay survey-ready every day, using an organized, up-to-date Survey Book. Guides weekly review routines, staff awareness of where survey materials are kept, and readiness planning for entrance conferences and different timeframes for required items. Includes section tools such as the Entrance Conference Worksheet (January 2022) and facility information checklists covering census, resident conditions, infection control, vaccination effort, and posted survey signage.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":20,"@type":76,"position":81},"https://docshare.wps.com/document/exam/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/survey-preparedness-long-term-care-survey/434327/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/survey-preparedness-long-term-care-survey/434327.png","ImageObject",300,407,{"name":92,"@type":93},"Fans","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-17","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the purpose of the Survey Book in long-term care survey readiness?","Question",{"text":112,"@type":113},"The Survey Book helps staff be survey ready every day. It contains the information surveyors ask for when they enter the building, and it must be organized and kept current at least weekly.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How often should the Survey Book be reviewed to prepare for annual visits?",{"text":117,"@type":113},"The Survey Book should be reviewed weekly so it remains up to date and ready for the survey team.",{"name":119,"@type":110,"acceptedAnswer":120},"What key information must be provided to the facility upon entrance for the entrance conference worksheet (January 2022)?",{"text":121,"@type":113},"The worksheet lists requirements such as the census number, a complete matrix for new admissions in the last 30 days, an alphabetical resident list, smoking residents and times/locations, confirmed or suspected COVID-19 cases, and staff names responsible for infection prevention and control and for COVID-19 vaccination efforts.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},434327,1792233045,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":19,"category_name":20,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},5909892330395,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Survey Preparedness  \nLONG-TERM CARE SURVEY  \nMANUAL PREPARED BY MU NHA  \nCONSULTANT  \nSECTION 1-SURVEY  \nPREPAREDNESS  \nSurvey Preparedness-TheMULong Term Care Leadership Coaches recommend that your home maintain a SURVEY BOOK. The purpose of the book is to help your staff be survey ready every day. To be ready for the annual visit, the SURVEY BOOK should be reviewed weekly so that it is kept up to date. Make sure that all your management staff knows where the book is located as surveyors might show up when the NHA and/or DONare not in the facility. This section provides you with several tools offered for you to consider. The key to a SURVEY BOOK is that it is organized, up-to-date, and designed to meet the needs of your nursing home.  \nSECTION PAGE \\#  \n\n| Survey Readiness | 3 |\n| --- | --- |\n| The Survey Book | 4 |\n| Entrance Conference Worksheet | 5-9 |\n| COVID-19 Focused Infection Control (FIC) Survey with Staff Vaccination Mandate Entrance Conference Worksheet | 10-12 |\n| COVID-19 Staff Vaccination Matrix Instructions for Providers | 13-16 |\n| QIPMO Entrance Conference Supplement | 17 |\n| MO DHSS Long-Term Care Regions | 18 |\n| Matrix | 19-21 |\n| Long-Term Care Facility Application for Medicare and Medicaid (CMS 671) | 22-24 |\n| Resident Census and Conditions of Residents (CMS 672) | 25-31 |\n| Pre-Survey Checklist | 32 |\n| Think Survey Preparedness | 33-34 |\n| Common Questions State Surveyors Ask CNAs | 35 |\n| Survey Preparedness Quiz | 36-43 |\n| Scavenger Hunt for Survey Preparedness | 44 |\n\nQIPMO Culture Change Resources 45  \nSURVEY READINESS  \nBe Prepared:  \n1. BE SURVEY READY EVERY DAY OF THE YEAR!!  \na. Continuous training with staff  \nb. An effective QA/QAPI program  \nc. Active Resident Council  \nd. An effective Customer Service Program  \ne. An effective Grievance Program  \nf. Daily and weekly rounds  \n2. Make sure you maintain a SURVEY BOOK and it is complete and updated weekly. See “ITEMS NEEDED FOR YOUR SURVEY BOOK” Pages 1.4 thru 1.11  \n3. Make sure that all staff knows their job functions before surveyors enter the facility.  \n4. Make an announcement on the intercom welcoming the survey team.  \n5. Have a plan for weekend, holiday, and after hour surveys.  \n6. Train staff on what to expect during the survey.  \n7. Train staff on how to respond to surveyors when questions are asked.  \na. Review the list of questions surveyors could ask.  \nThe Survey Book  \nThe goal of every nursing home administrator and facility should be to be survey ready every day. You should think about your survey all year and not wait until the State survey team shows up at your door. Best practice is to be prepared for the nursing home survey with a Survey Book—this book should contain everything that the surveyors will ask for when they enter your building. Please refer to the Entrance Conference Form on the next few pages. The Entrance Conference Form is also available at [https://www.cms.gov/Medicare/Provider](https://www.cms.gov/Medicare/Provider)Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html. This Survey Book should be available, organized, and kept current at least weekly. Make sure that other management people know where you keep this notebook—surveyors might show up when you are not available.  \nSome of these items are required within one hour, some within four hours, some by the end of the first day and some within 24 hours of entrance. If you have these items available and current, you and your team will not be wasting time gathering this information. Each region should utilize the same Entrance Conference Form (referenced above); however, each region may have a different LSC Entrance Form. Be sure you keep current on what your region is asking for so you will be ready for the next survey.  \nYou can organize these items in any way you wish—we would suggest you keep them all in one notebook. Do NOT hand this entire notebook to the survey team. Only give them what they ask for. If you just hand over ","cbCaihF3qh8dWVpG","https://ap.wps.com/l/cbCaihF3qh8dWVpG","pdf",1368688,46,"English","# Survey Readiness\n## The Survey Book\n## Entrance Conference Worksheet\n## COVID-19 Focused Infection Control Survey (FIC)\n## COVID-19 Staff Vaccination Matrix Instructions\n## QIPMO Culture Change Resources\n## Survey Readiness Checklist","[{\"question\":\"What is the purpose of the Survey Book in long-term care survey readiness?\",\"answer\":\"The Survey Book helps staff be survey ready every day. It contains the information surveyors ask for when they enter the building, and it must be organized and kept current at least weekly.\"},{\"question\":\"How often should the Survey Book be reviewed to prepare for annual visits?\",\"answer\":\"The Survey Book should be reviewed weekly so it remains up to date and ready for the survey team.\"},{\"question\":\"What key information must be provided to the facility upon entrance for the entrance conference worksheet (January 2022)?\",\"answer\":\"The worksheet lists requirements such as the census number, a complete matrix for new admissions in the last 30 days, an alphabetical resident list, smoking residents and times/locations, confirmed or suspected COVID-19 cases, and staff names responsible for infection prevention and control and for COVID-19 vaccination efforts.\"}]","Survey Preparedness - LONG-TERM CARE SURVEY | PDF",1790668596,116]