The prospect of a state survey can feel like sailing in stormy waters for I/DD agencies. However, there are ways to get and stay prepared so that you and your staff aren’t scrambling to pull together information or fill gaps in documentation. Here are 6 steps to make state surveys feel like calm waters:
1. Make staff training an ongoing activity. Make sure everyone knows what information they need to document and how. Do regular ‘walk arounds’ to see what people are doing and provide feedback and suggestions in real time.
2. Use a checklist to capture all needed information in a consistent manner and to prevent gaps and missing pieces. Michelle Carpenter, State Director of Health Services, BrightSpring Health Services, said, “Pharmacy reviews need to happen every quarter, and nurse assessments, MARs, and physician orders need to be reviewed monthly. It’s also important to document activities of daily living and everything your clients are doing as well as goals of care and how they are being achieved.” All this information, she said, should paint a picture of how you are working to ensure people with I/DD are living their best lives.
3. Utilize experts and champions, such as quality assurance managers, to conduct regular mock surveys, train staff, and go through charts to look at ways to improve documentation. Carpenter said, “We have a quality team that takes data, looks at it and puts out information to every agency in the state. We have a call every Monday with the executive team, and they take information back and share it with their whole team. As a result, everyone is on the same page regarding quality and quality endeavors.” She added, “You will see the positive impact of these practices. We did this and now we are getting 100% on surveys.”
4. Involve everyone on your team. “Don’t make documentation a chore for staff. Instead, frame it as a way they can help demonstrate how they work to improve clients’ quality experience,” said Carpenter. “Seek their ideas and let them have a say. Give them feedback and let them know when you integrate their suggestions. Celebrate your wins with them,” she added.
5. Maintain open and honest communication with your team. “This is key to ensuring staff feel comfortable reporting a concern or mistake or suggesting a better way to do things,” said Carpenter. When you create this kind of culture, staff will help you catch things – such as when someone’s occupational therapy notes are missing – before the survey. “We also check each other’s work. We would rather find issues or errors ourselves and fix them than have the surveyor find it,” Carpenter observed.
6. During the state survey, don’t be rattled by a ‘gotcha moment.’ Sometimes information and data don’t match up or something is missing and you have to figure out why. It’s important to have your pharmacy team, physicians, and others available so they can get you answers in real time. Carpenter added, “If you can turn things around quickly, you may be able to avoid a citation.”
These steps require some effort, Carpenter admitted, but she stressed, “This investment makes us a better agency and helps with referrals. Do these things, and families and others will see all the extra steps you are taking for your clients. It demonstrates to surveyors that we are a caring, empathetic agency that is committed to quality.” She added that it also helps with staffing since people want to work at an organization that invests in its clients and its staff.