Some time ago I bought a bunch of nursing home books on ebay and came into possession of a mini-manual from one of the state nursing home associations (which will remain anonymous) on how to effectively manage surveys. Some of it was quite good, such as making sure that staff did not acknowledge guilt. This would be evidenced by a surveyor's statement on the 2567 (Statement of Deficiencies) that stated "The DON admitted that the CNA should have never done that", for instance. Some of it was bad, such as the suggested method for doing mock surveys that I will not go into here. And some of was disturbing. One particular chapter of this manual was devoted to keeping tabs on the surveyors. It actually stated that "an unobtrusive surveillance system to keep tabs on the surveyors...is essential". If that is not possible, the manual states, a staff member should be placed outside the door with walkie-talkie access to the administrator. Now before I go any further, I want to make it clear that this manual was about 15 years old, and would probably no longer be applicable because the state this came from currently utilizes a different type of survey protocol. But is goes to perfectly illustrate the industry's ridiculously paranoid attitude toward regulatory compliance. Interestingly enough, a expose that came out in 1997 ("Patients, Pain, and Politics") described similar behavior going back to the 1960's, when nursing home regulation was nothing compared to what it is today. Even when I worked the floor just a few years back this same attitude was the rigor de norm. Everyone sneaked around, talked in hushed tones, and tried to predict which resident would be interviewed next. As a consultant, I still see this behavior.
Nursing home surveys are nothing to be paranoid about, unless you're trying to hide your substantial noncompliance. Survey protocol is clearly spelled out in the State Operations Manual. It should be no mystery who gets interviewed, because the manual tells you. "But the surveyor's don't do things by the book!", I can hear someone cry. If they don't, then appeal it. That's what IDR and the appeals process is for. The reason that deficiencies happen is primarily because nobody knows the rules of the game called survey. As I cannot emphasize enough, TEACH YOUR STAFF THE STATE OPERATIONS MANUAL!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Of course this is a problem if you don't know it yourself. When a week long DON orientation attempts to cover everything about survey in 45 minutes, and the required text for virtually every AIT program in the country doesn't even mention the word 'survey', it's not entirely your fault. But if you haven't been taught it, you need to learn it for yourself. As anyone who has ever tried to read the watermelon book cover to cover can tell you (myself included), it's one hell of a boring book. Perhaps you could try this instead: Get the forms used in the quality indicator survey and do mock surveys through QAA committee with them. You will learn the rules as you go along because the contain the relevant F tags and the critical elements necessary for demonstrating compliance with them.
You can be paranoid about state if you want, but it's a waste of time and energy you probably don't have. If your facility is not survey ready when they walk in the door, there is only so much you can do to fix things while the surveyors aren't looking. Doing well on survey takes staff education and frequent mini mock surveys conducted over the course of the entire year. Waiting until you're already inside the window is uselsss.