The QIS Mock Survey Guide
Frosini Rubertino, RN, CRNA C, C-NE, CDONA /LTC, CPRA
What could be better than knowing what s wrong BEFORE a survey?
"The QIS Mock Survey Guide" helps you develop a survey team, conduct a mock survey, and ultimately test your facility s survey-readiness.
The best way to be prepared for a Quality Indicator Survey (QIS) is to know what you should expect. The only true way to gain that knowledge is to conduct mock surveys using the actual materials used by surveyors in the field.
The new HCPro resource "The QIS Mock Survey Guide" is a book and CD-ROM that provides you with a step-by-step outline of what happens during a survey under the revised process. It simplifies the differences between the traditional survey and the QIS and provides educational tools to complete the survey process.
This solution-based guide:

• Includes an overview of the QIS and how to transition into the QIS from the traditional survey process
• Offers instructions on how to perform both Stage I and Stage II of the QIS at your organization
• Provides a detailed outline of everything you need to do to prepare before the arrival of surveyors
• Includes case studies that look at five separate instances where facilities were found deficient under F-tags 329, 309, 314, 323, and 505
• Outlines the best way to develop a survey team, conduct a mock survey, and troubleshoot any potential problems
• Contains the actual forms and worksheets used by surveyors in the field today

Each tool below is included in the book and on the companion CD-ROM:
APPENDIX A: Entrance conference forms

• Task 1 Worksheets
  • CMS-20044 Offsite Survey Preparation Worksheet
  Task 2 Worksheets
  • CMS-20045 Entrance Conference (team copy)
  • CMS-20046 Entrance Conference (facility copy)
  • CMS-672 Resident Census and Condition Report
  • CMS Quality Indicator Survey Demonstration Project brochure
  APPENDIX B: Stage I Forms and Worksheets
  
  • Task 3 Initial Tour Worksheet
    • CMS-807 Surveyor Notes Worksheet
    Task 4 Worksheets
    • CMS-20047 Admission Sample Record Review
    • CMS-20048 Census Sample Record Review
    • CMS-20049 Family Interview
    • CMS-20050 Resident Interview and Resident Observation
    • CMS-20051 Staff Interview
    Task 5 Facility Level Worksheets
    • CMS-20052 Liability Notice and Beneficiary Appeal Rights (Demand Billing)
    • CMS-20053 Dining Observation
    • CMS-20054 Infection Control and Immunizations
    • CMS-20055 Kitchen and Food Service Observation
    • CMS-20056 Medication Administration Observation and Drug Storage
    • CMS-20057 Resident Council President/Representative Interview
    • CMS-20058 Quality Assurance & Assessment Review
    Task 5 Triggered Task Worksheets
    • CMS-20059 Abuse Prohibition Review
    • CMS-20060 Admit, Transfer, Discharge Review
    • CMS-20061 Environmental Observation
    • CMS-20062 Sufficient Nursing Staff Review
    • CMS-20063 Personal Funds Review
    • CMS-20084 Cognitive Performance Scale Calculator
    APPENDIX C: Stage II Worksheets: Critical Element Pathways (CEs) and Unnecessary Drug Review Worksheet
    
    • Task 6 and 7 Worksheets
      • CMS-20065 Activities
      • CMS-20066 ADL-ROM
      • CMS-20067 Behavioral/Emotional
      • CMS-20068 Bowel/Bladder/Catheter
      • CMS-20069 Communication/Sensory problems
      • CMS-20070 Dental
      • CMS-20071 Dialysis
      • CMS-20072 General
      • CMS-20073 Hospice
      • CMS-20074 Hospital death
      • CMS-20075 Nutrition/Hydration/Tube Feeding
      • CMS-20076 Pain Management
      • CMS-20077 Physical Restraints
      • CMS-20078 Pressure Ulcers
      • CMS-20079 Psych meds
      • CMS-20080 Rehabilitation
      • CMS-20081 Ventilator
      • CMS-20082 Unnecessary Drugs
      Stage II care area investigation keyAPPENDIX D: Quality of Care Indicators (QCI) and mappings
      
      • Quality of Care Indicators and Facility Level Tasks by Care Areas
      • Quality of Care Indicators Mapped to Care Areas
      • Quality of Care Indicators mapping to F tags
      • Quality of Care Indicators by data source
      • F tags to Care Areas to Critical Element Pathways
      Table of Contents:
      Introduction: The Long Term Care Survey: The Big Picture
      Types of Surveys
      Scope and Severity of Findings
      Transitioning to QIS Survey Process
      Overview of the QIS Process
      Goal and Benefit of a Quality Indicator Mock Survey
      Review of the Quality Measures/Quality Indicators (QM/QI)
      Review of the Oscar 3 Report
      Let s Get Started: Begin With First Things First
      Using Your Regulation Manual as a Resource
      Glossary of Terms
      Task 1: Off Site Survey Preparation and Initial Sampling
      Task 2: On Site Survey Activities and Entrance Conference
      Task 3: Initial Tour
      Task 4: Stage I Survey Tasks
      Task 5: Facility Level Survey Tasks
      Task 6: Transition from Stage I to Stage II
      Task 7: Stage II Survey Tasks
      Task 8: Analysis and Decision Making
      Task 9: Exit Conference
      Case Studies
      Regulatory Groupings
      This resource is organized by task so you can find what you need FAST
      "