Facility Self-Assessment (Mock Survey) Tool - Nursing Home Help

MOCK SURVEY ASSIGNMENTS
Prior to Mock:
Complete Survey History (OSCAR):
Ready upon entrance:
Complete and gather all survey preparation documentation:
Within 1 hour of entrance:
Complete CMS 802 form (Roster Sample Matrix)
Within 24 hours of entrance:
Complete CMS 672 form (Resident Census & Condition)
Upon arrival of Mock Team:
Print out QI/QM for last 6 months:
First 4 hours of survey:
Review the Quality Indicators and choose a sample group.
Team Leader:
Entrance Conference:
Exit Conference:
Activities:
Date & Time of Resident Council:
Administration:
Environment:
Nursing:
Med Pass:
Treatments:
Dietary:
Social Services;
Mock Summary Form Completion:
5.36