State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Reporting of Findings from TA Visits to the Survey Agency


Study states fell into two groups here. In more than half of them (Florida, Maryland, Missouri, Texas) TA findings are not formally reported to long-term care survey staff. Hardly surprisingly, the states that have steered clear of regulatory-based TA fall into this group.

No Formal Reporting to the Survey Agency

Maryland TA staff do not share findings with the State Survey Agency unless very serious violations (i.e., situations where conditions in the facility are causing residents actual harm or placing them in immediate jeopardy.) At the time of our visit, TA staff reported this has only happened once. The regular process when violations are identified during a TA visit is to have the Quality Assurance team bring these to the attention of the nursing home staff and require a plan of correction.

In Missouri, TA visits are also confidential (except in the rare cases of immediate jeopardy or actual harm to residents). No details are reported to the survey agency (not even which facilities were visited). State law mandates that the TA nurses report any situations where there is actual harm or immediate jeopardy. They must inform the facility about the issue of concern; and then must contact the LTC survey agency to discuss it. TA staff report that such a situation has never come up.

In Florida, TA staff do not share information gathered during the TA visit with surveyors, but they will bring concerns about facilities that are performing poorly to their supervisors within the state survey office, as well as report on non-compliance related to staffing and risk management. TA staff are advised to call the state hotline to report instances of immediate jeopardy.

Formal Reporting to the LTC Survey

In Maine, copies of the TA reports go to the TA supervisor (who works in the survey office) and are available to surveyors. In Washington, TA staff report all serious violations to, and share all findings with survey staff. In Texas, Quality Monitor reports are available over the IntraNet to surveyors and are reviewed as part of preparation for surveys.

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