Nursing and Boarding Care Home Inspections: Information for Residents, Families and Visitors
This page provides information about health department inspections of nursing and boarding care homes. "Survey" is the technical term for these inspections. Below are answers to the most often asked questions about surveys -- what they are, who performs them, and why it is important for you to be involved in the process
What is a survey, and why is it important?
A survey is the method used by states and the federal government to decide whether a home has permission to operate. A survey is performed to see whether a home "measures up" against state and federal rules.
Every nursing and boarding care home in Minnesota must have a state license to operate. Any home that gets payment through the Medicare or Medical Assistance program must obey federal certification rules as well.
These rules are basic standards for your care and comfort. Surveys help assure that you receive the kind of care you want and that money paid to homes was appropriately spent.
Who are the surveyors?
Staff, known as surveyors, from the Minnesota Department of Health check the home for compliance with state and federal rules.
Sometimes federal officials representing the Health Care Financing Administration (HCFA) will perform an additional inspection to assure quality nursing and boarding home care.
Typically, three or more surveyors inspect the home as a team. The team always includes a nurse and may include sanitarians, dietitians or other disciplines. The team members have been specifically trained in nursing home rules inspection methods, and teamwork.
Surveys for compliance with state rules must occur at least every two years. For federal rules, surveys are annual. Since most homes have to comply with both, many have an inspection about once a year.
The homes must not be notified beforehand of the starting date of the survey. The time is varied as much as possible, so that the surveyors will be able to observe how the home operates on any ordinary day.
Why do the surveyors inspect the home?
A sign, posted where people can easily see it, announces that the surveyors are in the home. They are there for only a few days, or a week at most.
While they are in the home, they spend most of their time reviewing the services that residents receive. They meet with the staff and administration and tour the whole facility, looking at how safe the building is for the residents.
Among other things, they observe the serving of a meal, how medications are given and examine the residents' medical records.
The surveyors depend a great deal on interviews with residents and families to tell them how the home is run and how care is delivered.
They will choose some residents who are able to participate in an interview and some of the families of other residents who cannot speak for themselves. These interviews usually last about 30 minutes.
Generally, the surveyors will ask to speak to the resident council members. An ombudsman may be invited to be present at the time of the interview.
What are the interviews like?
The surveyors often begin their interviews with general questions to encourage people to discuss whatever is most important to them.
Sometimes, people find it hard to talk about personal things to the strangers who are conducting the survey. But remember that the surveyors are truly interested in what you have to say and rely on your help to fully understand what everyday life in the home is like.
If the surveyors ask to interview you, you have every right to talk to them or to decline. You can ask to meet for short periods over the span of a few days, so that you can get to know them better before you talk to them.
How can you be involved?
Residents and family members, other than those selected by the surveyors, can ask for an interview. They can ask a surveyor personally, or they can tell their local ombudsman office 1(800) 657-3591 that they want one.
They can also call the Licensing and Certification office at the Health Department at (651) 201-4200 to ask to be notified when the home's survey begins.
If residents or family cannot arrange to meet with a surveyor personally, they can leave information that will be placed in the home's file and read by the surveyors later.
As a nursing or boarding care resident or as a family member of a resident, you have an important role in the survey. No one knows as well as you who live there or visit often -- what the home is like 24 hours a day?
What do the surveyors want to know?
The surveyors want to hear about the things you like about your home and the things you do not like. They want to know if the staff treats you with the dignity you deserve, if you are given choices about what you eat and when you go to bed.
They want to know whether the staff and other residents respect your rights and whether you have enough stimulating activities to do during the day and over the weekends.
Some of the ways you know if the staff is treating you properly are if they are always polite and say "hello" when they meet you in the hall and "thank you" when appropriate.
Do they help you without making you feel helpless and listen carefully when you talk about events and the people who are precious to you?
Do they respect your independence and privacy by knocking on the door before entering? Do they make you feel needed and ask you to share your abilities with the other residents and staff?
And do they, through the resident council, ask for your advice when important decisions need to be made at the home.
Isn't it risky to tell the surveyors negative things about the home?
Your name is kept confidential when you talk to a surveyor. It will not be written on the information you give.
Unfortunately, the fear of retaliation sometimes keeps both residents and their families from talking freely to the surveyors.
Remember that retaliation is a violation of federal and state laws and must not be tolerated.
If you feel that your speaking up has led to problems, report what happened to the Office of Health Facility Complaints (OHFC) at 1(800)369-7994 or in the Twin Cities metropolitan area at (651)201-4201.
You can also call the office of Ombudsman at 1(800) 657-3591 or in the Twin Cities at (651) 431-2555.
What happens at the end of the survey?
When the survey is completed, the team meets with the administrator and the home's staff directors. The surveyors report on what they have observed. This is called an "exit interview."
Notices are given if the surveyors believe that the home needs to change the way it is run to meet the standards set in nursing and boarding care regulations.
Failure to meet a state rule is called a "violation." Failure to meet a federal rule is called a "deficiency."
In about two weeks, your administrator will receive a written copy of the survey results. A copy should be placed in an easily accessible location for everyone who wishes to read it.
The Department of Health gives the home a period of time to develop a plan to correct deficiencies and approves the Home's time frame for making corrections. The more serious deficiencies must be corrected quickly. Federal rules set up remedies that will be imposed against a facility for failure to correct the deficiencies within the approved time frame. The type of remedy that would be imposed depends on both the severity and scope of the deficiencies. The severity of deficiencies is determined by evaluating whether the deficiencies caused actual harm, had the potential for causing more than minimal harm or did the deficiencies have the potential for only producing minimum harm to residents. The scope of the deficiencies is based on the number of residents impacted by the deficiencies. Examples of remedies include placement of a state monitor, directed inservice training, denial of payment for new admissions or civil money penalties.
Failure to correct violations or deficiencies can lead a home to financial penalties (fines), other legal actions by the state, and can ultimately lead to closure.
How can resident and family councils be involved?
Representatives of the resident and family councils can be present at the exit interview with the surveyors. They may observe and record information, but not participate directly.
Residents and their families should be familiar with the results of the home's past surveys. All surveys should be discussed in resident and family council meetings.
As much as possible the people who live in the home and the people who visit often should try to be familiar with nursing and boarding care regulations.
Regulations have been written to instruct everyone involved in long-term care-residents, families, and nursing home personnel - on the standards expected to be met.
Copies of the regulations should be available for you to read at the home. Check with the Administrator's office.
How can the surveyors inspect for "quality of life" issues?
Inspecting a home to observe residents' quality of life and respect for resident rights requires sensitive, well-trained surveyors.
These aspects of life in the home are, by their nature, more than meets the eye. They are feelings, and they are matters of individual taste or habit. The surveyors need your help to see below the surface.
Let them know if you are encouraged to continue living an interesting life despite your dependence on others for daily living needs.
Think about what you want to say before you meet with the surveyors, and then be as specific as possible. If you think something is not right, it is a good idea to write down the time, date, and place where the incident you observed occurred, describing it in detail, so you can recall the incident clearly and give a factual report.
Remember that while you live in the facility, you have a right to make it the home you want it to be. The same is true for families who have a resident in the home.
It is important to report everything you think the surveyors should know. Nothing is likely to change if you don't get involved or if you expect someone else to do something about it.
When something is going wrong, is it necessary to wait for a survey to report it?
Absolutely not. When something is bothering you, begin by trying to solve the problem on your own by bringing it to your resident council, family council, or an employee of the home. Your other avenues of help are an Ombudsman or the Office of Health Facility Complaints. Their toll-free phone numbers are listed at the end of this publication.
Glossary of Terms
Certification - A determination that a nursing facility meets the federal care standards for operating a home with medical assistance or Medicare funds.
Deficiency - A failure to meet a federal certification rule for care. The most serious deficiencies pose an immediate threat to resident health or safety.
Exit Conference - A meeting at the end of a survey where surveyors review their findings with the home's administrator and key staff. Resident and family council representatives and local ombudsman representatives may attend as well.
Family Council - A consumer group, composed of the nursing or boarding care home's relatives and friends, who meet regularly to improve the quality of life in their facility.
Centers for Medicare and Medicaid Services (CMS) - A federal agency that oversees the regulation of nursing facilities that are paid with medical assistance or Medicare funds.
Licensure - A determination that a nursing or boarding care home meets the state standards for operating a home in Minnesota.
Minnesota Department of Health (MDH) - A state agency whose staff perform licensure inspections, certification inspections, and complaint investigations, among other services.
Office of Health Facility Complaints (OHFC) - An office in the Health Department set up to receive and investigate complaints about the quality of services in nursing and boarding care homes, hospitals, and certain home care agencies. OHFC staff have authority to issue correction orders, deficiencies and fines. Toll-free 1(800) 369-7994 or in the Twin Cities (651) 201-4201.
Ombudsman - A federally-mandated program with offices throughout Minnesota. Ombudsman representatives are trained to receive questions\ complaints and to advocate for residents and families. The Ombudsman for Older Minnesotans has a toll-free line, 1(800) 657-3591. In the seven-county Twin Cities metro region the ombudsman program is at the Metropolitan Office of Ombudsman for older Minnesotans (651) 431-2555.
Resident Council - A group of residents in a nursing or boarding care home who meet regularly to improve the quality of life in their facility.
Survey - The periodic inspection of a nursing or boarding care home by staff of the MN Department of Health.
Licensing and Certification - The specific program where surveyors are employed in the MN Department of Health.
Violation - A failure to meet a state licensure rule for care. Violations are categorized by seriousness. Those that cause the greatest risk of harm must be corrected the soonest. Failure to correct them incurs the highest level of fines.
For more information please contact:
Minnesota Department of Health
Health Regulation Division
P.O. Box 64900
St. Paul, Minnesota 55164-0900
This information was originally prepared as a pamphlet by:
Advocacy Center for Long-Term Care
2626 82nd St.
Bloomington, MN 55425